Mayo Clinic Care Network: A Collaborative Health Care Model.

Science.gov (United States)

Wald, John T; Lowery-Schrandt, Sherri; Hayes, David L; Kotsenas, Amy L

2018-01-01

By leveraging its experience and expertise as a consultative clinical partner, the Mayo Clinic developed an innovative, scalable care model to accomplish several strategic goals: (1) create and sustain high-value relationships that benefit patients and providers, (2) foster relationships with like-minded partners to act as a strategy against the development of narrow health care networks, and (3) increase national and international brand awareness of Mayo Clinic. The result was the Mayo Clinic Care Network. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Low Cost Wireless Sensor Network for Continuous Bridge monitoring

DEFF Research Database (Denmark)

Han, Bo; Kalis, A; Tragas, P

2012-01-01

Continuous monitoring wireless sensor networks (WSN) are considered as one of the most promising means to harvest information from large structures in order to assist in structural health monitoring and management. At the same time, continuous monitoring WSNs suffer from limited network lifetimes...

Networked Learning and Network Science: Potential Applications to Health Professionals' Continuing Education and Development.

Science.gov (United States)

Margolis, Alvaro; Parboosingh, John

2015-01-01

Prior interpersonal relationships and interactivity among members of professional associations may impact the learning process in continuing medical education (CME). On the other hand, CME programs that encourage interactivity between participants may impact structures and behaviors in these professional associations. With the advent of information and communication technologies, new communication spaces have emerged that have the potential to enhance networked learning in national and international professional associations and increase the effectiveness of CME for health professionals. In this article, network science, based on the application of network theory and other theories, is proposed as an approach to better understand the contribution networking and interactivity between health professionals in professional communities make to their learning and adoption of new practices over time. © 2015 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

Exploring continuous organisational transformation as a form of network interdependence

OpenAIRE

Stebbings, H; Braganza, A

2008-01-01

In this paper we examine the problematic area of continuous transformation. We conduct our analysis from three theoretical perspectives: the resource based view, social network theory, and stakeholder theory. We found that the continuous transformation can be explained through the concept of Network Interdependence. This paper describes Network Interdependence and develops theoretical propositions from a synthesis of the three theories. Our contribution of Network Interdependence offers f...

Experienced continuity of care in patients at risk for depression in primary care.

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schene, A.H.; Schellevis, F.G.; Lucassen, P.; Bosch, W.J.H.M. van den

2014-01-01

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

Experienced continuity of care in patients at risk for depression in primary care

NARCIS (Netherlands)

Uijen, Annemarie A.; Schers, Henk J.; Schene, Aart H.; Schellevis, Francois G.; Lucassen, Peter; van den Bosch, Wil J. H. M.

2014-01-01

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

RFID Continuance Usage Intention in Health Care Industry.

Science.gov (United States)

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.

Continuity of care: betrayed values or misplaced nostalgia.

Science.gov (United States)

Roland, Martin

2012-10-01

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.

Continuity of care: betrayed values or misplaced nostalgia?

Directory of Open Access Journals (Sweden)

Martin Roland

2012-10-01

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.

How unique is continuity of care? A review of continuity and related concepts.

Science.gov (United States)

Uijen, Annemarie A; Schers, Henk J; Schellevis, François G; van den Bosch, Wil J H M

2012-06-01

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.

Function of local networks in palliative care: a Dutch view.

Science.gov (United States)

Nikbakht-Van de Sande, C V M Vahedi; van der Rijt, C C D; Visser, A Ph; ten Voorde, M A; Pruyn, J F A

2005-08-01

Although network formation is considered an effective method of stimulating the integrated delivery of palliative care, scientific evidence on the usefulness of network formation is scarce. In 1998 the Ministry of Health of The Netherlands started a 5-year stimulation program on palliative care by founding and funding six regional Centres for the Development of Palliative Care. These centers were structured around pivotal organizations such as university hospitals and comprehensive cancer centers. As part of the stimulation program a locoregional network model was introduced within each center for the Development of Palliative Care to integrate palliative care services in the Dutch health care system. We performed a study on network formation in the southwestern area of The Netherlands with 2.4 million inhabitants. The study aimed to answer the following questions: (1) how do networks in palliative care develop, which care providers participate and how do they function? (2) which are the achievements of the palliative care networks as perceived by their participants? (3) which are the success factors of the palliative care networks according to their participants and which factors predict the achievements? Between September 2000 and January 2004 eight local palliative care networks in the region of the Center for Development of Palliative Care-Rotterdam (southwestern area of The Netherlands) were closely followed to gain information on their characteristics and developmental course. At the start of the study semistructured interviews were held with the coordinators of the eight networks. The information from these interviews and from the network documents were used to constitute a questionnaire to assess the opinions and experiences of the network participants. According to the vast majority of responders, the most important reason to install the networks was the lack of integration between the existing local health care services. The networks were initiated to

Context-dependent retrieval of information by neural-network dynamics with continuous attractors.

Science.gov (United States)

Tsuboshita, Yukihiro; Okamoto, Hiroshi

2007-08-01

Memory retrieval in neural networks has traditionally been described by dynamic systems with discrete attractors. However, recent neurophysiological findings of graded persistent activity suggest that memory retrieval in the brain is more likely to be described by dynamic systems with continuous attractors. To explore what sort of information processing is achieved by continuous-attractor dynamics, keyword extraction from documents by a network of bistable neurons, which gives robust continuous attractors, is examined. Given an associative network of terms, a continuous attractor led by propagation of neuronal activation in this network appears to represent keywords that express underlying meaning of a document encoded in the initial state of the network-activation pattern. A dominant hypothesis in cognitive psychology is that long-term memory is archived in the network structure, which resembles associative networks of terms. Our results suggest that keyword extraction by the neural-network dynamics with continuous attractors might symbolically represent context-dependent retrieval of short-term memory from long-term memory in the brain.

CGBayesNets: conditional Gaussian Bayesian network learning and inference with mixed discrete and continuous data.

Science.gov (United States)

McGeachie, Michael J; Chang, Hsun-Hsien; Weiss, Scott T

2014-06-01

Bayesian Networks (BN) have been a popular predictive modeling formalism in bioinformatics, but their application in modern genomics has been slowed by an inability to cleanly handle domains with mixed discrete and continuous variables. Existing free BN software packages either discretize continuous variables, which can lead to information loss, or do not include inference routines, which makes prediction with the BN impossible. We present CGBayesNets, a BN package focused around prediction of a clinical phenotype from mixed discrete and continuous variables, which fills these gaps. CGBayesNets implements Bayesian likelihood and inference algorithms for the conditional Gaussian Bayesian network (CGBNs) formalism, one appropriate for predicting an outcome of interest from, e.g., multimodal genomic data. We provide four different network learning algorithms, each making a different tradeoff between computational cost and network likelihood. CGBayesNets provides a full suite of functions for model exploration and verification, including cross validation, bootstrapping, and AUC manipulation. We highlight several results obtained previously with CGBayesNets, including predictive models of wood properties from tree genomics, leukemia subtype classification from mixed genomic data, and robust prediction of intensive care unit mortality outcomes from metabolomic profiles. We also provide detailed example analysis on public metabolomic and gene expression datasets. CGBayesNets is implemented in MATLAB and available as MATLAB source code, under an Open Source license and anonymous download at http://www.cgbayesnets.com.

Training trajectories by continuous recurrent multilayer networks.

Science.gov (United States)

Leistritz, L; Galicki, M; Witte, H; Kochs, E

2002-01-01

This paper addresses the problem of training trajectories by means of continuous recurrent neural networks whose feedforward parts are multilayer perceptrons. Such networks can approximate a general nonlinear dynamic system with arbitrary accuracy. The learning process is transformed into an optimal control framework where the weights are the controls to be determined. A training algorithm based upon a variational formulation of Pontryagin's maximum principle is proposed for such networks. Computer examples demonstrating the efficiency of the given approach are also presented.

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

NARCIS (Netherlands)

Perdok, Hilde; Verhoeven, Corine J.; van Dillen, Jeroen; Schuitmaker, Tjerk Jan; Hoogendoorn, Karla; Colli, Jolanda; Schellevis, François G.; de Jonge, Ank

2018-01-01

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

Dynamics of neural networks with continuous attractors

Science.gov (United States)

Fung, C. C. Alan; Wong, K. Y. Michael; Wu, Si

2008-10-01

We investigate the dynamics of continuous attractor neural networks (CANNs). Due to the translational invariance of their neuronal interactions, CANNs can hold a continuous family of stationary states. We systematically explore how their neutral stability facilitates the tracking performance of a CANN, which is believed to have wide applications in brain functions. We develop a perturbative approach that utilizes the dominant movement of the network stationary states in the state space. We quantify the distortions of the bump shape during tracking, and study their effects on the tracking performance. Results are obtained on the maximum speed for a moving stimulus to be trackable, and the reaction time to catch up an abrupt change in stimulus.

How unique is continuity of care? A review of continuity and related concepts.

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Bosch, W.J.H.M. van den

2012-01-01

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

How unique is continuity of care? A review of continuity and related concepts

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; van den Bosch, W.J.H.M.

2012-01-01

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

A Highly Infectious Disease Care Network in the US Healthcare System.

Science.gov (United States)

Le, Aurora B; Biddinger, Paul D; Smith, Philip W; Herstein, Jocelyn J; Levy, Deborah A; Gibbs, Shawn G; Lowe, John J

During the 2014-15 Ebola outbreak in West Africa, the United States responded by stratifying hospitals into 1 of 3 Centers for Disease Control and Prevention (CDC)-designated categories-based on the hospital's ability to identify, isolate, assess, and provide care to patients with suspected or confirmed Ebola virus disease (EVD)-in an attempt to position the US healthcare system to safely isolate and care for potential patients. Now, with the Ebola epidemic quelled, it is crucial that we act on the lessons learned from the EVD response to broaden our national perspective on infectious disease mitigation and management, build on our newly enhanced healthcare capabilities to respond to infectious disease threats, develop a more cost-effective and sustainable model of infectious disease prevention, and continue to foster training so that the nation is not in a vulnerable position once more. We propose the formal creation of a US Highly Infectious Disease Care Network (HIDCN) modeled after 2 previous highly infectious disease consensus efforts in the United States and the European Union. A US Highly Infectious Disease Care Network can provide a common platform for the exchange of training, protocols, research, knowledge, and capability sharing among high-level isolation units. Furthermore, we envision the network will cultivate relationships among facilities and serve as a means of establishing national standards for infectious disease response, which will strengthen domestic preparedness and the nation's ability to respond to the next highly infectious disease threat.

Patients report better satisfaction with part-time primary care physicians, despite less continuity of care and access.

Science.gov (United States)

Panattoni, Laura; Stone, Ashley; Chung, Sukyung; Tai-Seale, Ming

2015-03-01

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.

[Regional geriatric care concept in the District of Lippe : Structural effects and network formation in the case management-based model project].

Science.gov (United States)

Şahin, Charlotte; Iseringhausen, Olaf; Hower, Kira; Liebe, Constanze; Rethmeier-Hanke, Anja; Wedmann, Bernd

2018-04-01

Regional planning of healthcare requires special consideration for the complex needs of elderly, multimorbid people living in a domestic environment. In the District of Lippe, a hospital (Klinikum Lippe) and network of ambulatory care physicians (Ärztenetz Lippe) developed and tested a geriatric care network based on case management for geriatric patients living in a domestic environment. The establishment of the geriatric care network (e.g. promoting networking acceptance and implementation) was formatively evaluated, e. g. with qualitative methods. Data were acquired by guideline-based interviews with experts and analyzed by qualitative content analysis according to Mayring. Structural effects included forming a cross-sectoral and interdisciplinary network for a functioning care network and a geriatric care pathway. The practical work of case managers (CM) is essential for communication with patients, family members and care providers as well as integrating providers into the network. A critical factor was working together with general practitioners and the close cooperation with the hospital's department of geriatric. The quality of care is improved because of exchange of information between sectors and continuity in the course of care. In the District of Lippe the quality of care was improved and structures of care were integrated by the network according to the needs of the target group. The integrative perspective was achieved in particular by the geriatric care pathway and integration of providers into the communication and care process; however, the scope of this care model could not be extended into routine care due to the rigid and subdivided health care system.

Networking to improve end of life care

Science.gov (United States)

2009-01-01

Network organisations are increasingly common in healthcare. This paper describes an example of clinically led networking, which improved end of life care (EOLC) in care homes, differentiating between a ‘network’ as a formal entity and the more informal process of ‘networking’. The paper begins with a brief discussion of networks and their development in healthcare, then an overview of EOLC policy, the case setting and methods. The paper describes four key features of this networking; (1) how it enabled discussions and implemented processes to help people address difficult taboos about dying; (2) how personal communication and ‘distributed leadership’ facilitated learning; (3) how EOLC occasionally lapsed during the handover of patient care, where personal relationship and communication were weaker; and (4) how successful learning and sharing of best practice was fragile and could be potentially undermined by wider financial pressures in the NHS. PMID:25949588

The Handover Project: Improving the continuity of patient care through identification and implementation of novel patient handoff processes in Europe

NARCIS (Netherlands)

Drachsler, Hendrik; Kicken, Wendy; Van der Klink, Marcel; Stoyanov, Slavi; Boshuizen, Els

2011-01-01

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,

NETWORKS OF HEALTH CARE: A CHALLENGE TO SUS MANAGEMENT

Directory of Open Access Journals (Sweden)

Camila Dubow

2013-09-01

Full Text Available The article proposes a critical reflection, based on national law, scholarly, scientific, on the current development of Networks of Health Care, as a strategy for strengthening the Single Health System (SUS. Are weighted inefficiency of traditional ways of organizing care and management, the challenge of Network Health Care for comprehensive care and management mechanisms used in this process. The work provides subsidies for the care practices and health management are reflected, pointing strategies that result in disruptions of paradigms through a refocusing of attention in existing models. For networks of health care can be consolidated, is fundamental to political sensitivity of health managers with a commitment to build a new model of care, through the struggle to consolidate the SUS and the realization of the principles of universality, comprehensiveness and equity.

Predictors of relational continuity in primary care: patient, provider and practice factors.

Science.gov (United States)

Kristjansson, Elizabeth; Hogg, William; Dahrouge, Simone; Tuna, Meltem; Mayo-Bruinsma, Liesha; Gebremichael, Goshu

2013-05-31

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

The Recovery-Oriented Care Collaborative: A Practice-Based Research Network to Improve Care for People With Serious Mental Illnesses.

Science.gov (United States)

Kelly, Erin L; Kiger, Holly; Gaba, Rebecca; Pancake, Laura; Pilon, David; Murch, Lezlie; Knox, Lyndee; Meyer, Mathew; Brekke, John S

2015-11-01

Practice-based research networks (PBRNs) create continuous collaborations among academic researchers and practitioners. Most PBRNs have operated in primary care, and less than 5% of federally registered PBRNs include mental health practitioners. In 2012 the first PBRN in the nation focused on individuals with serious mental illnesses-the Recovery-Oriented Care Collaborative-was established in Los Angeles. This column describes the development of this innovative PBRN through four phases: building an infrastructure, developing a research study, executing the study, and consolidating the PBRN. Key lessons learned are also described, such as the importance of actively engaging direct service providers and clients.

Continuous Learning of a Multilayered Network Topology in a Video Camera Network

Directory of Open Access Journals (Sweden)

Zou Xiaotao

2009-01-01

Full Text Available Abstract A multilayered camera network architecture with nodes as entry/exit points, cameras, and clusters of cameras at different layers is proposed. Unlike existing methods that used discrete events or appearance information to infer the network topology at a single level, this paper integrates face recognition that provides robustness to appearance changes and better models the time-varying traffic patterns in the network. The statistical dependence between the nodes, indicating the connectivity and traffic patterns of the camera network, is represented by a weighted directed graph and transition times that may have multimodal distributions. The traffic patterns and the network topology may be changing in the dynamic environment. We propose a Monte Carlo Expectation-Maximization algorithm-based continuous learning mechanism to capture the latent dynamically changing characteristics of the network topology. In the experiments, a nine-camera network with twenty-five nodes (at the lowest level is analyzed both in simulation and in real-life experiments and compared with previous approaches.

Continuous Learning of a Multilayered Network Topology in a Video Camera Network

Directory of Open Access Journals (Sweden)

Xiaotao Zou

2009-01-01

Full Text Available A multilayered camera network architecture with nodes as entry/exit points, cameras, and clusters of cameras at different layers is proposed. Unlike existing methods that used discrete events or appearance information to infer the network topology at a single level, this paper integrates face recognition that provides robustness to appearance changes and better models the time-varying traffic patterns in the network. The statistical dependence between the nodes, indicating the connectivity and traffic patterns of the camera network, is represented by a weighted directed graph and transition times that may have multimodal distributions. The traffic patterns and the network topology may be changing in the dynamic environment. We propose a Monte Carlo Expectation-Maximization algorithm-based continuous learning mechanism to capture the latent dynamically changing characteristics of the network topology. In the experiments, a nine-camera network with twenty-five nodes (at the lowest level is analyzed both in simulation and in real-life experiments and compared with previous approaches.

Social networks of professionals in health care organizations: a review.

Science.gov (United States)

Tasselli, Stefano

2014-12-01

In this article, we provide an overview of social network research in health care, with a focus on social interactions between professionals in organizations. We begin by introducing key concepts defining the social network approach, including network density, centrality, and brokerage. We then review past and current research on the antecedents of health care professionals' social networks-including demographic attributes, professional groups, and organizational arrangements-and their consequences-including satisfaction at work, leadership, behaviors, knowledge transfer, diffusion of innovation, and performance. Finally, we examine future directions for social network research in health care, focusing on micro-macro linkages and network dynamics. © The Author(s) 2014.

Simulation studies of a wide area health care network.

Science.gov (United States)

McDaniel, J. G.

1994-01-01

There is an increasing number of efforts to install wide area health care networks. Some of these networks are being built to support several applications over a wide user base consisting primarily of medical practices, hospitals, pharmacies, medical laboratories, payors, and suppliers. Although on-line, multi-media telecommunication is desirable for some purposes such as cardiac monitoring, store-and-forward messaging is adequate for many common, high-volume applications. Laboratory test results and payment claims, for example, can be distributed using electronic messaging networks. Several network prototypes have been constructed to determine the technical problems and to assess the effectiveness of electronic messaging in wide area health care networks. Our project, Health Link, developed prototype software that was able to use the public switched telephone network to exchange messages automatically, reliably and securely. The network could be configured to accommodate the many different traffic patterns and cost constraints of its users. Discrete event simulations were performed on several network models. Canonical star and mesh networks, that were composed of nodes operating at steady state under equal loads, were modeled. Both topologies were found to support the throughput of a generic wide area health care network. The mean message delivery time of the mesh network was found to be less than that of the star network. Further simulations were conducted for a realistic large-scale health care network consisting of 1,553 doctors, 26 hospitals, four medical labs, one provincial lab and one insurer. Two network topologies were investigated: one using predominantly peer-to-peer communication, the other using client-server communication.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7949966

How unique is continuity of care? A review of continuity and related concepts.

NARCIS (Netherlands)

Uijen, A.A.; Schers, H.J.; Schellevis, F.G.; Bosch, W.J.H.M. van den

2012-01-01

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

Continuous variable multipartite entanglement and optical implementations of quantum communication networks

International Nuclear Information System (INIS)

Lian Yimin; Xie Changde; Peng Kunchi

2007-01-01

A variety of optical quantum information networks based on the multipartite entanglement of amplitude and phase quadratures of an electromagnetic field have been proposed and experimentally realized in recent years. The multipartite entanglement of optical continuous variables provides flexible and reliable quantum resources for developing unconditional quantum information networks. In this paper, we review the generation schemes of the multipartite entangled states of optical continuous quantum variables and some applications in the quantum communication networks with emphasis on the experimental implementations

Accurate path integration in continuous attractor network models of grid cells.

Science.gov (United States)

Burak, Yoram; Fiete, Ila R

2009-02-01

Grid cells in the rat entorhinal cortex display strikingly regular firing responses to the animal's position in 2-D space and have been hypothesized to form the neural substrate for dead-reckoning. However, errors accumulate rapidly when velocity inputs are integrated in existing models of grid cell activity. To produce grid-cell-like responses, these models would require frequent resets triggered by external sensory cues. Such inadequacies, shared by various models, cast doubt on the dead-reckoning potential of the grid cell system. Here we focus on the question of accurate path integration, specifically in continuous attractor models of grid cell activity. We show, in contrast to previous models, that continuous attractor models can generate regular triangular grid responses, based on inputs that encode only the rat's velocity and heading direction. We consider the role of the network boundary in the integration performance of the network and show that both periodic and aperiodic networks are capable of accurate path integration, despite important differences in their attractor manifolds. We quantify the rate at which errors in the velocity integration accumulate as a function of network size and intrinsic noise within the network. With a plausible range of parameters and the inclusion of spike variability, our model networks can accurately integrate velocity inputs over a maximum of approximately 10-100 meters and approximately 1-10 minutes. These findings form a proof-of-concept that continuous attractor dynamics may underlie velocity integration in the dorsolateral medial entorhinal cortex. The simulations also generate pertinent upper bounds on the accuracy of integration that may be achieved by continuous attractor dynamics in the grid cell network. We suggest experiments to test the continuous attractor model and differentiate it from models in which single cells establish their responses independently of each other.

Wound Care Center of Excellence: A Process for Continuous Monitoring and Improvement of Wound Care Quality.

Science.gov (United States)

Howell, Raelina S; Kohan, Lauren S; Woods, Jon S; Criscitelli, Theresa; Gillette, Brian M; Donovan, Virginia; Gorenstein, Scott

2018-05-01

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.

Improved Clinical Efficacy with Wound Support Network Between Hospital and Home Care Service.

Science.gov (United States)

Bergersen, Tone Kristin; Storheim, Elisabeth; Gundersen, Stina; Kleven, Linn; Johnson, Maria; Sandvik, Leiv; Kvaerner, Kari Jorunn; Ørjasæter, Nils-Otto

2016-11-01

The aim of this study was to test the efficacy of a wound support network model between the primary home care service and the hospital. The impact on wound healing rate, cost benefit, and transfer of knowledge was investigated. The intervention group was exposed to a wound support network (n = 32), and the control group continued standard organization of treatment (n = 21). Nonrandomized controlled study; observations were made before (baseline) and after the implementation of the intervention (12 weeks). Patients with chronic wounds (lasting >6 weeks and with wound area >1 cm) in Oslo, Norway. Closure of the observation wound; wound size; total number of wounds; presence of eczema, edema, and pain; number of dressings per week; time spent per dressing; and number of control appointments at the hospital. The economic impact is calculated for the hospital and for the community of Oslo, Norway. The number of control appointments (t = 3.80, P home care service and the hospital is cost-effective, improves clinical efficacy of the home care services' work, and reduces the need for consultations at the hospital.

Accelerating a Network Model of Care: Taking a Social Innovation to Scale

Directory of Open Access Journals (Sweden)

Kerry Byrne

2012-07-01

Full Text Available Government-funded systems of health and social care are facing enormous fiscal and human-resource challenges. The space for innovation in care is wide open and new disruptive patterns are emerging. These include self-management and personal budgets, participatory and integrated care, supported decision making and a renewed focus on prevention. Taking these disruptive patterns to scale can be accelerated by a technologically enabled shift to a network model of care to co-create the best outcomes for individuals, family caregivers, and health and social care organizations. The connections, relationships, and activities within an individual’s personal network lay the foundation for care that health and social care systems/policy must simultaneously support and draw on for positive outcomes. Practical tools, adequate information, and tangible resources are required to coordinate and sustain care. Tyze Personal Networks is a social venture that uses technology to engage and inform the individual, their personal networks, and their care providers to co-create the best outcomes. In this article, we demonstrate how Tyze contributes to a shift to a network model of care by strengthening our networks and enhancing partnerships between care providers, individuals, and family and friends.

Service Users' and Caregivers' Perspectives on Continuity of Care in Out-of-Hours Primary Care.

LENUS (Irish Health Repository)

Gallagher, Niamh

2012-12-20

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.

A Health Care Project Management Office's Strategies for Continual Change and Continuous Improvement.

Science.gov (United States)

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.

42 CFR 438.208 - Coordination and continuity of care.

Science.gov (United States)

2010-10-01

... 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...

Critical Care Nurses' Reasons for Poor Attendance at a Continuous Professional Development Program.

Science.gov (United States)

Viljoen, Myra; Coetzee, Isabel; Heyns, Tanya

2016-12-01

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.

Do project management and network governance contribute to inter-organisational collaboration in primary care? A mixed methods study.

Science.gov (United States)

Schepman, Sanneke; Valentijn, Pim; Bruijnzeels, Marc; Maaijen, Marlies; de Bakker, Dinny; Batenburg, Ronald; de Bont, Antoinette

2018-06-07

The need for organisational development in primary care has increased as it is accepted as a means of curbing rising costs and responding to demographic transitions. It is only within such inter-organisational networks that small-scale practices can offer treatment to complex patients and continuity of care. The aim of this paper is to explore, through the experience of professionals and patients, whether, and how, project management and network governance can improve the outcomes of projects which promote inter-organisational collaboration in primary care. This paper describes a study of projects aimed at improving inter-organisational collaboration in Dutch primary care. The projects' success in project management and network governance was monitored by interviewing project leaders and board members on the one hand, and improvement in the collaboration by surveying professionals and patients on the other. Both qualitative and quantitative methods were applied to assess the projects. These were analysed, finally, using multi-level models in order to account for the variation in the projects, professionals and patients. Successful network governance was associated positively with the professionals' satisfaction with the collaboration; but not with improvements in the quality of care as experienced by patients. Neither patients nor professionals perceived successful project management as associated with the outcomes of the collaboration projects. This study shows that network governance in particular makes a difference to the outcomes of inter-organisational collaboration in primary care. However, project management is not a predictor for successful inter-organisational collaboration in primary care.

Continuity of care in mental health: understanding and measuring a complex phenomenon.

Science.gov (United States)

Burns, T; Catty, J; White, S; Clement, S; Ellis, G; Jones, I R; Lissouba, P; McLaren, S; Rose, D; Wykes, T

2009-02-01

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.

Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study.

Science.gov (United States)

Fairbrother, Peter; Pinnock, Hilary; Hanley, Janet; McCloughan, Lucy; Sheikh, Aziz; Pagliari, Claudia; McKinstry, Brian

2012-09-01

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.

Phase-synchronisation in continuous flow models of production networks

Science.gov (United States)

Scholz-Reiter, Bernd; Tervo, Jan Topi; Freitag, Michael

2006-04-01

To improve their position at the market, many companies concentrate on their core competences and hence cooperate with suppliers and distributors. Thus, between many independent companies strong linkages develop and production and logistics networks emerge. These networks are characterised by permanently increasing complexity, and are nowadays forced to adapt to dynamically changing markets. This factor complicates an enterprise-spreading production planning and control enormously. Therefore, a continuous flow model for production networks will be derived regarding these special logistic problems. Furthermore, phase-synchronisation effects will be presented and their dependencies to the set of network parameters will be investigated.

Finite time convergent learning law for continuous neural networks.

Science.gov (United States)

Chairez, Isaac

2014-02-01

This paper addresses the design of a discontinuous finite time convergent learning law for neural networks with continuous dynamics. The neural network was used here to obtain a non-parametric model for uncertain systems described by a set of ordinary differential equations. The source of uncertainties was the presence of some external perturbations and poor knowledge of the nonlinear function describing the system dynamics. A new adaptive algorithm based on discontinuous algorithms was used to adjust the weights of the neural network. The adaptive algorithm was derived by means of a non-standard Lyapunov function that is lower semi-continuous and differentiable in almost the whole space. A compensator term was included in the identifier to reject some specific perturbations using a nonlinear robust algorithm. Two numerical examples demonstrated the improvements achieved by the learning algorithm introduced in this paper compared to classical schemes with continuous learning methods. The first one dealt with a benchmark problem used in the paper to explain how the discontinuous learning law works. The second one used the methane production model to show the benefits in engineering applications of the learning law proposed in this paper. Copyright © 2013 Elsevier Ltd. All rights reserved.

Pulmonary Hypertension Care Center Network: Improving Care and Outcomes in Pulmonary Hypertension.

Science.gov (United States)

Sahay, Sandeep; Melendres-Groves, Lana; Pawar, Leena; Cajigas, Hector R

2017-04-01

Pulmonary hypertension (PH) is a chronic, progressive, life-threatening disease that requires expert multidisciplinary care. To facilitate this level of care, the Pulmonary Hypertension Association established across the United States a network of pulmonary hypertension care centers (PHCCs) with special expertise in PH, particularly pulmonary arterial hypertension, to raise the overall quality of care and outcomes for patients with this life-threatening disease. Since the inception of PHCCs in September 2014, to date 35 centers have been accredited in the United States. This model of care brings together physicians and specialists from other disciplines to provide care, facilitate basic and clinical research, and educate the next generation of providers. PHCCs also offer additional opportunities for improvements in PH care. The patient registry offered through the PHCCs is an organized system by which data are collected to evaluate the outcomes of patients with PH. This registry helps in detecting variations in outcomes across centers, thus identifying opportunities for improvement. Multiple tactics were undertaken to implement the strategic plan, training, and tools throughout the PHCC network. In addition, strategies to foster collaboration between care center staff and individuals with PH and their families are the cornerstone of the PHCCs. The Pulmonary Vascular Network of the American College of Chest Physicians believes this to be a positive step that will improve the quality of care delivered in the United States to patients with PH. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

A continuous-time control model on production planning network ...

African Journals Online (AJOL)

A continuous-time control model on production planning network. DEA Omorogbe, MIU Okunsebor. Abstract. In this paper, we give a slightly detailed review of Graves and Hollywood model on constant inventory tactical planning model for a job shop. The limitations of this model are pointed out and a continuous time ...

Patient Experienced Continuity of Care in the Psychiatric Healthcare System

DEFF Research Database (Denmark)

Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne

2014-01-01

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...

Building managed primary care practice networks to deliver better clinical care: a qualitative semi-structured interview study.

Science.gov (United States)

Pawa, Jasmine; Robson, John; Hull, Sally

2017-11-01

Primary care practices are increasingly working in larger groups. In 2009, all 36 primary care practices in the London borough of Tower Hamlets were grouped geographically into eight managed practice networks to improve the quality of care they delivered. Quantitative evaluation has shown improved clinical outcomes. To provide insight into the process of network implementation, including the aims, facilitating factors, and barriers, from both the clinical and managerial perspectives. A qualitative study of network implementation in the London borough of Tower Hamlets, which serves a socially disadvantaged and ethnically diverse population. Nineteen semi-structured interviews were carried out with doctors, nurses, and managers, and were informed by existing literature on integrated care and GP networks. Interviews were recorded and transcribed, and thematic analysis used to analyse emerging themes. Interviewees agreed that networks improved clinical care and reduced variation in practice performance. Network implementation was facilitated by the balance struck between 'a given structure' and network autonomy to adopt local solutions. Improved use of data, including patient recall and peer performance indicators, were viewed as critical key factors. Targeted investment provided the necessary resources to achieve this. Barriers to implementing networks included differences in practice culture, a reluctance to share data, and increased workload. Commissioners and providers were positive about the implementation of GP networks as a way to improve the quality of clinical care in Tower Hamlets. The issues that arose may be of relevance to other areas implementing similar quality improvement programmes at scale. © British Journal of General Practice 2017.

[General practice has to contribute to the continuous improvement of quality of care and integrate health promotion].

Science.gov (United States)

Vanmeerbeek, Marc

2009-09-01

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.

Personal Continuity of Care in a University-Based Primary Care Practice: Impact on Blood Pressure Control.

Directory of Open Access Journals (Sweden)

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.

Treating alcoholism as a chronic disease: approaches to long-term continuing care.

Science.gov (United States)

McKay, James R; Hiller-Sturmhofel, Susanne

2011-01-01

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.

Rural Health Networks: How Network Analysis Can Inform Patient Care and Organizational Collaboration in a Rural Breast Cancer Screening Network.

Science.gov (United States)

Prusaczyk, Beth; Maki, Julia; Luke, Douglas A; Lobb, Rebecca

2018-04-15

Rural health networks have the potential to improve health care quality and access. Despite this, the use of network analysis to study rural health networks is limited. The purpose of this study was to use network analysis to understand how a network of rural breast cancer care providers deliver services and to demonstrate the value of this methodology in this research area. Leaders at 47 Federally Qualified Health Centers and Rural Health Clinics across 10 adjacent rural counties were asked where they refer patients for mammograms or breast biopsies. These clinics and the 22 referral providers that respondents named comprised the network. The network was analyzed graphically and statistically with exponential random graph modeling. Most (96%, n = 45) of the clinics and referral sites (95%, n = 21) are connected to each other. Two clinics of the same type were 62% less likely to refer patients to the same providers as 2 clinics of different types (OR = 0.38, 95% CI = 0.29-0.50). Clinics in the same county have approximately 8 times higher odds of referring patients to the same providers compared to clinics in different counties (OR = 7.80, CI = 4.57-13.31). This study found that geographic location of resources is an important factor in rural health care providers' referral decisions and demonstrated the usefulness of network analysis for understanding rural health networks. These results can be used to guide delivery of patient care and strengthen the network by building resources that take location into account. © 2018 National Rural Health Association.

Conversion of Continuous-Valued Deep Networks to Efficient Event-Driven Networks for Image Classification.

Science.gov (United States)

Rueckauer, Bodo; Lungu, Iulia-Alexandra; Hu, Yuhuang; Pfeiffer, Michael; Liu, Shih-Chii

2017-01-01

Spiking neural networks (SNNs) can potentially offer an efficient way of doing inference because the neurons in the networks are sparsely activated and computations are event-driven. Previous work showed that simple continuous-valued deep Convolutional Neural Networks (CNNs) can be converted into accurate spiking equivalents. These networks did not include certain common operations such as max-pooling, softmax, batch-normalization and Inception-modules. This paper presents spiking equivalents of these operations therefore allowing conversion of nearly arbitrary CNN architectures. We show conversion of popular CNN architectures, including VGG-16 and Inception-v3, into SNNs that produce the best results reported to date on MNIST, CIFAR-10 and the challenging ImageNet dataset. SNNs can trade off classification error rate against the number of available operations whereas deep continuous-valued neural networks require a fixed number of operations to achieve their classification error rate. From the examples of LeNet for MNIST and BinaryNet for CIFAR-10, we show that with an increase in error rate of a few percentage points, the SNNs can achieve more than 2x reductions in operations compared to the original CNNs. This highlights the potential of SNNs in particular when deployed on power-efficient neuromorphic spiking neuron chips, for use in embedded applications.

Conversion of Continuous-Valued Deep Networks to Efficient Event-Driven Networks for Image Classification

Directory of Open Access Journals (Sweden)

Bodo Rueckauer

2017-12-01

Full Text Available Spiking neural networks (SNNs can potentially offer an efficient way of doing inference because the neurons in the networks are sparsely activated and computations are event-driven. Previous work showed that simple continuous-valued deep Convolutional Neural Networks (CNNs can be converted into accurate spiking equivalents. These networks did not include certain common operations such as max-pooling, softmax, batch-normalization and Inception-modules. This paper presents spiking equivalents of these operations therefore allowing conversion of nearly arbitrary CNN architectures. We show conversion of popular CNN architectures, including VGG-16 and Inception-v3, into SNNs that produce the best results reported to date on MNIST, CIFAR-10 and the challenging ImageNet dataset. SNNs can trade off classification error rate against the number of available operations whereas deep continuous-valued neural networks require a fixed number of operations to achieve their classification error rate. From the examples of LeNet for MNIST and BinaryNet for CIFAR-10, we show that with an increase in error rate of a few percentage points, the SNNs can achieve more than 2x reductions in operations compared to the original CNNs. This highlights the potential of SNNs in particular when deployed on power-efficient neuromorphic spiking neuron chips, for use in embedded applications.

Reliable dynamics in Boolean and continuous networks

International Nuclear Information System (INIS)

Ackermann, Eva; Drossel, Barbara; Peixoto, Tiago P

2012-01-01

We investigate the dynamical behavior of a model of robust gene regulatory networks which possess ‘entirely reliable’ trajectories. In a Boolean representation, these trajectories are characterized by being insensitive to the order in which the nodes are updated, i.e. they always go through the same sequence of states. The Boolean model for gene activity is compared with a continuous description in terms of differential equations for the concentrations of mRNA and proteins. We found that entirely reliable Boolean trajectories can be reproduced perfectly in the continuous model when realistic Hill coefficients are used. We investigate to what extent this high correspondence between Boolean and continuous trajectories depends on the extent of reliability of the Boolean trajectories, and we identify simple criteria that enable the faithful reproduction of the Boolean dynamics in the continuous description. (paper)

Impact of diabetes continuing education on health care ...

African Journals Online (AJOL)

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 ...

Continuity of care for patients on a waiting list for institutional long-term care.

NARCIS (Netherlands)

Caris-Verhallen, W.M.C.M.; Kerkstra, A.

2001-01-01

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

How is continuity of care experienced by people living with chronic kidney disease?

Science.gov (United States)

Brand, Sarah; Pollock, Kristian

2018-01-01

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

Continuing education for primary health care nurse practitioners in Ontario, Canada.

Science.gov (United States)

Baxter, Pamela; DiCenso, Alba; Donald, Faith; Martin-Misener, Ruth; Opsteen, Joanne; Chambers, Tracey

2013-04-01

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.

Global dissipativity of continuous-time recurrent neural networks with time delay

International Nuclear Information System (INIS)

Liao Xiaoxin; Wang Jun

2003-01-01

This paper addresses the global dissipativity of a general class of continuous-time recurrent neural networks. First, the concepts of global dissipation and global exponential dissipation are defined and elaborated. Next, the sets of global dissipativity and global exponentially dissipativity are characterized using the parameters of recurrent neural network models. In particular, it is shown that the Hopfield network and cellular neural networks with or without time delays are dissipative systems

Communication security in open health care networks.

Science.gov (United States)

Blobel, B; Pharow, P; Engel, K; Spiegel, V; Krohn, R

1999-01-01

Fulfilling the shared care paradigm, health care networks providing open systems' interoperability in health care are needed. Such communicating and co-operating health information systems, dealing with sensitive personal medical information across organisational, regional, national or even international boundaries, require appropriate security solutions. Based on the generic security model, within the European MEDSEC project an open approach for secure EDI like HL7, EDIFACT, XDT or XML has been developed. The consideration includes both securing the message in an unsecure network and the transport of the unprotected information via secure channels (SSL, TLS etc.). Regarding EDI, an open and widely usable security solution has been specified and practically implemented for the examples of secure mailing and secure file transfer (FTP) via wrapping the sensitive information expressed by the corresponding protocols. The results are currently prepared for standardisation.

Lapse in Institutional Animal Care and Use Committee Continuing Reviews.

Directory of Open Access Journals (Sweden)

Min-Fu Tsan

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.

Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes

Directory of Open Access Journals (Sweden)

Eva H. DuGoff

2016-06-01

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

Business continuity and pandemic preparedness: US health care versus non-health care agencies.

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Rebmann, Terri; Wang, Jing; Swick, Zachary; Reddick, David; delRosario, John Leon

2013-04-01

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.

Dynamics of continuous-time bidirectional associative memory neural networks with impulses and their discrete counterparts

International Nuclear Information System (INIS)

Huo Haifeng; Li Wantong

2009-01-01

This paper is concerned with the global stability characteristics of a system of equations modelling the dynamics of continuous-time bidirectional associative memory neural networks with impulses. Sufficient conditions which guarantee the existence of a unique equilibrium and its exponential stability of the networks are obtained. For the goal of computation, discrete-time analogues of the corresponding continuous-time bidirectional associative memory neural networks with impulses are also formulated and studied. Our results show that the above continuous-time and discrete-time systems with impulses preserve the dynamics of the networks without impulses when we make some modifications and impose some additional conditions on the systems, the convergence characteristics dynamics of the networks are preserved by both continuous-time and discrete-time systems with some restriction imposed on the impulse effect.

Primary care research conducted in networks: getting down to business.

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Mold, James W

2012-01-01

This seventh annual practice-based research theme issue of the Journal of the American Board of Family Medicine highlights primary care research conducted in practice-based research networks (PBRNs). The issue includes discussion of (1) theoretical and methodological research, (2) health care research (studies addressing primary care processes), (3) clinical research (studies addressing the impact of primary care on patients), and (4) health systems research (studies of health system issues impacting primary care including the quality improvement process). We had a noticeable increase in submissions from PBRN collaborations, that is, studies that involved multiple networks. As PBRNs cooperate to recruit larger and more diverse patient samples, greater generalizability and applicability of findings lead to improved primary care processes.

Disseminating Innovations in Teaching Value-Based Care Through an Online Learning Network.

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Gupta, Reshma; Shah, Neel T; Moriates, Christopher; Wallingford, September; Arora, Vineet M

2017-08-01

A national imperative to provide value-based care requires new strategies to teach clinicians about high-value care. We developed a virtual online learning network aimed at disseminating emerging strategies in teaching value-based care. The online Teaching Value in Health Care Learning Network includes monthly webinars that feature selected innovators, online discussion forums, and a repository for sharing tools. The learning network comprises clinician-educators and health system leaders across North America. We conducted a cross-sectional online survey of all webinar presenters and the active members of the network, and we assessed program feasibility. Six months after the program launched, there were 277 learning community members in 22 US states. Of the 74 active members, 50 (68%) completed the evaluation. Active members represented independently practicing physicians and trainees in 7 specialties, nurses, educators, and health system leaders. Nearly all speakers reported that the learning network provided them with a unique opportunity to connect with a different audience and achieve greater recognition for their work. Of the members who were active in the learning network, most reported that strategies gleaned from the network were helpful, and some adopted or adapted these innovations at their home institutions. One year after the program launched, the learning network had grown to 364 total members. The learning network helped participants share and implement innovations to promote high-value care. The model can help disseminate innovations in emerging areas of health care transformation, and is sustainable without ongoing support after a period of start-up funding.

The emotional and professional wellbeing of Australian midwives: A comparison between those providing continuity of midwifery care and those not providing continuity.

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Fenwick, Jennifer; Sidebotham, Mary; Gamble, Jenny; Creedy, Debra K

2018-02-01

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.

International Children's Palliative Care Network: A Global Action Network for Children With Life-Limiting Conditions.

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Marston, Joan; Boucher, Sue; Downing, Julia

2018-02-01

The International Children's Palliative Care Network (ICPCN) is a global network of individuals and organizations working together to reach the estimated 21 million children with life-limiting conditions and life-threatening illnesses. The drive to establish the ICPCN was born from the recognition of the gaps in service provision for children's palliative care and the need to collaborate, network, and share resources. Established in 2005 during a meeting in Seoul, South Korea, the ICPCN has developed over the years into an established network with a global membership. The history of the organization is described, including some of the key events since its inception. Working in collaboration with others, ICPCN has five key focus areas: Communication; Advocacy; Research; Education; and Strategic development, and is the only international charity working globally for the rights of children with palliative care needs. Activities in these areas are discussed, along with the inter-connection between the five areas. Without the ICPCN, palliative care for children would not have developed as far as it has over the years and the organization is committed to ongoing work in this area until all children requiring palliative care have access to quality services, wherever they live around the world. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Merging Bottom-Up with Top-Down: Continuous Lamellar Networks and Block Copolymer Lithography

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Campbell, Ian Patrick

Block copolymer lithography is an emerging nanopatterning technology with capabilities that may complement and eventually replace those provided by existing optical lithography techniques. This bottom-up process relies on the parallel self-assembly of macromolecules composed of covalently linked, chemically distinct blocks to generate periodic nanostructures. Among the myriad potential morphologies, lamellar structures formed by diblock copolymers with symmetric volume fractions have attracted the most interest as a patterning tool. When confined to thin films and directed to assemble with interfaces perpendicular to the substrate, two-dimensional domains are formed between the free surface and the substrate, and selective removal of a single block creates a nanostructured polymeric template. The substrate exposed between the polymeric features can subsequently be modified through standard top-down microfabrication processes to generate novel nanostructured materials. Despite tremendous progress in our understanding of block copolymer self-assembly, continuous two-dimensional materials have not yet been fabricated via this robust technique, which may enable nanostructured material combinations that cannot be fabricated through bottom-up methods. This thesis aims to study the effects of block copolymer composition and processing on the lamellar network morphology of polystyrene-block-poly(methyl methacrylate) (PS-b-PMMA) and utilize this knowledge to fabricate continuous two-dimensional materials through top-down methods. First, block copolymer composition was varied through homopolymer blending to explore the physical phenomena surrounding lamellar network continuity. After establishing a framework for tuning the continuity, the effects of various processing parameters were explored to engineer the network connectivity via defect annihilation processes. Precisely controlling the connectivity and continuity of lamellar networks through defect engineering and

Integration and Continuity of Primary Care: Polyclinics and Alternatives, a Patient-Centred Analysis of How Organisation Constrains Care Coordination

OpenAIRE

Sheaff, WR; Halliday, J; Øvretveit, J; Byng, R; Exworthy, M; Peckham, S; Asthana, S

2015-01-01

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...

Association between quality domains and health care spending across physician networks

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Rahman, Farah; Guan, Jun; Glazier, Richard H.; Brown, Adalsteinn; Bierman, Arlene S.; Croxford, Ruth; Stukel, Therese A.

2018-01-01

One of the more fundamental health policy questions is the relationship between health care quality and spending. A better understanding of these relationships is needed to inform health systems interventions aimed at increasing quality and efficiency of care. We measured 65 validated quality indicators (QI) across Ontario physician networks. QIs were aggregated into domains representing six dimensions of care: screening and prevention, evidence-based medications, hospital-community transitions (7-day post-discharge visit with a primary care physician; 30-day post-discharge visit with a primary care physician and specialist), potentially avoidable hospitalizations and emergency department (ED) visits, potentially avoidable readmissions and unplanned returns to the ED, and poor cancer end of life care. Each domain rate was computed as a weighted average of QI rates, weighting by network population at risk. We also measured overall and sector-specific per capita healthcare network spending. We evaluated the associations between domain rates, and between domain rates and spending using weighted correlations, weighting by network population at risk, using an ecological design. All indicators were measured using Ontario health administrative databases. Large variations were seen in timely hospital-community transitions and potentially avoidable hospitalizations. Networks with timely hospital-community transitions had lower rates of avoidable admissions and readmissions (r = -0.89, -0.58, respectively). Higher physician spending, especially outpatient primary care spending, was associated with lower rates of avoidable hospitalizations (r = -0.83) and higher rates of timely hospital-community transitions (r = 0.81) and moderately associated with lower readmission rates (r = -0.46). Investment in effective primary care services may help reduce burden on the acute care sector and associated expenditures. PMID:29614131

[Continuity, coordination and integration of care: from theory to practice].

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Schaller, Philippe; Gaspoz, Jean-Michel

2008-09-24

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.

Continuity of care for children with complex chronic health conditions: parents' perspectives

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Shaw Nicola

2009-12-01

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

Continuous environmental radiation monitoring network at Kalpakkam

International Nuclear Information System (INIS)

Somayaji, K.M.; Mathiyarasu, R.; Prakash, G.S.; Meenakshisundaram, V.; Rajagopal, V.

1997-01-01

The report highlights our experience in the design and installation of monitoring stations as part of continuous environmental radiation monitoring network around the periphery of the nuclear complex at Kalpakkam. Five monitoring stations, one each in south-west sector (Main Gate I) and south-south west (Main Gate II) and the others in North sector (HASL and ESG) and in north-west section (WIP) have been set up. Two independent detector systems, based on high pressure ionisation chamber (HPIC) and energy compensated GM have been installed at each of these locations and the data has been logged continuously using a data logger. The data so gathered at each monitoring station is retrieved every week by means of a hand held terminal (HHT) with a built-in non-volatile memory and transferred to an IBM PC-AT for data analysis and archival. The report discusses in depth the design and developmental efforts undertaken to set up the network, starting from the basic detectors. The work involved the design of suitable electrometer circuits for measuring the low levels of current from HPICs, and the subsequent study of the performance of the highly sensitive preamplifier under diurnal variations of ambient conditions. The report includes, in detail the design aspects and fabrication details of low current measuring electrometer circuits

Exponential stability of continuous-time and discrete-time bidirectional associative memory networks with delays

International Nuclear Information System (INIS)

Liang Jinling; Cao Jinde

2004-01-01

First, convergence of continuous-time Bidirectional Associative Memory (BAM) neural networks are studied. By using Lyapunov functionals and some analysis technique, the delay-independent sufficient conditions are obtained for the networks to converge exponentially toward the equilibrium associated with the constant input sources. Second, discrete-time analogues of the continuous-time BAM networks are formulated and studied. It is shown that the convergence characteristics of the continuous-time systems are preserved by the discrete-time analogues without any restriction imposed on the uniform discretionary step size. An illustrative example is given to demonstrate the effectiveness of the obtained results

Determinants of and opportunities for continuing education among health care professionals in public health care institutions in Jimma township, Southwest Ethiopia

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Fentahun N

2012-09-01

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

Reconstructing continuity of care in mental health services : a multilevel conceptual framework

NARCIS (Netherlands)

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

Continuous-time quantum walks on multilayer dendrimer networks

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Galiceanu, Mircea; Strunz, Walter T.

2016-08-01

We consider continuous-time quantum walks (CTQWs) on multilayer dendrimer networks (MDs) and their application to quantum transport. A detailed study of properties of CTQWs is presented and transport efficiency is determined in terms of the exact and average return probabilities. The latter depends only on the eigenvalues of the connectivity matrix, which even for very large structures allows a complete analytical solution for this particular choice of network. In the case of MDs we observe an interplay between strong localization effects, due to the dendrimer topology, and good efficiency from the linear segments. We show that quantum transport is enhanced by interconnecting more layers of dendrimers.

Continuous Online Sequence Learning with an Unsupervised Neural Network Model.

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Cui, Yuwei; Ahmad, Subutar; Hawkins, Jeff

2016-09-14

The ability to recognize and predict temporal sequences of sensory inputs is vital for survival in natural environments. Based on many known properties of cortical neurons, hierarchical temporal memory (HTM) sequence memory recently has been proposed as a theoretical framework for sequence learning in the cortex. In this letter, we analyze properties of HTM sequence memory and apply it to sequence learning and prediction problems with streaming data. We show the model is able to continuously learn a large number of variableorder temporal sequences using an unsupervised Hebbian-like learning rule. The sparse temporal codes formed by the model can robustly handle branching temporal sequences by maintaining multiple predictions until there is sufficient disambiguating evidence. We compare the HTM sequence memory with other sequence learning algorithms, including statistical methods: autoregressive integrated moving average; feedforward neural networks-time delay neural network and online sequential extreme learning machine; and recurrent neural networks-long short-term memory and echo-state networks on sequence prediction problems with both artificial and real-world data. The HTM model achieves comparable accuracy to other state-of-the-art algorithms. The model also exhibits properties that are critical for sequence learning, including continuous online learning, the ability to handle multiple predictions and branching sequences with high-order statistics, robustness to sensor noise and fault tolerance, and good performance without task-specific hyperparameter tuning. Therefore, the HTM sequence memory not only advances our understanding of how the brain may solve the sequence learning problem but is also applicable to real-world sequence learning problems from continuous data streams.

[Innovations in continuing/permanent education methods for the intensive care nurses].

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Vázquez Guillamet, B; Guillamet Lloveras, A; Martínez Estalella, G; Pérez Ramírez, F

2014-01-01

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.

Assessment of energy supply and continuity of service in distribution network with renewable distributed generation

International Nuclear Information System (INIS)

Abdullah, M.A.; Agalgaonkar, A.P.; Muttaqi, K.M.

2014-01-01

Highlights: • Difficulties in assessing distribution network adequacy with DG are addressed. • Indices are proposed to assess adequacy of energy supply and service continuity. • Analytical methodology is developed to assess the proposed indices. • Concept of joint probability distribution of demand and generation is applied. - Abstract: Continuity of electricity supply with renewable distributed generation (DG) is a topical issue for distribution system planning and operation, especially due to the stochastic nature of power generation and time varying load demand. The conventional adequacy and reliability analysis methods related to bulk generation systems cannot be applied directly for the evaluation of adequacy criteria such as ‘energy supply’ and ‘continuity of service’ for distribution networks embedded with renewable DG. In this paper, new indices highlighting ‘available supply capacity’ and ‘continuity of service’ are proposed for ‘energy supply’ and ‘continuation of service’ evaluation of generation-rich distribution networks, and analytical techniques are developed for their quantification. A probability based analytical method has been developed using the joint probability of the demand and generation, and probability distributions of the proposed indices have been used to evaluate the network adequacy in energy supply and service continuation. A data clustering technique has been used to evaluate the joint probability between coincidental demand and renewable generation. Time sequential Monte Carlo simulation has been used to compare the results obtained using the proposed analytical method. A standard distribution network derived from Roy Billinton test system and a practical radial distribution network have been used to test the proposed method and demonstrate the estimation of the well-being of a system for hosting renewable DG units. It is found that renewable DG systems improve the ‘energy supply’ and ‘continuity

Policy choices in dementia care-An exploratory analysis of the Alberta continuing care system (ACCS) using system dynamics.

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Cepoiu-Martin, Monica; Bischak, Diane P

2018-02-01

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.

Continuity of care by a midwife team versus routine care during pregnancy and birth: a randomised trial.

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Rowley, M J; Hensley, M J; Brinsmead, M W; Wlodarczyk, J H

1995-09-18

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.

Establishment and preliminary outcomes of a palliative care research network.

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Hudson, Peter; Street, Annette; Graham, Suzanne; Aranda, Sanchia; O'Connor, Margaret; Thomas, Kristina; Jackson, Kate; Spruyt, Odette; Ugalde, Anna; Philip, Jennifer

2016-02-01

The difficulties in conducting palliative care research have been widely acknowledged. In order to generate the evidence needed to underpin palliative care provision, collaborative research is considered essential. Prior to formalizing the development of a research network for the state of Victoria, Australia, a preliminary study was undertaken to ascertain interest and recommendations for the design of such a collaboration. Three data-collection strategies were used: a cross-sectional questionnaire, interviews, and workshops. The questionnaire was completed by multidisciplinary palliative care specialists from across the state (n = 61); interviews were conducted with senior clinicians and academics (n = 21) followed by two stakeholder workshops (n = 29). The questionnaire was constructed specifically for this study, measuring involvement of and perceptions of palliative care research. Both the interview and the questionnaire data demonstrated strong support for a palliative care research network and aided in establishing a research agenda. The stakeholder workshops assisted with strategies for the formation of the Palliative Care Research Network Victoria (PCRNV) and guided the development of the mission and strategic plan. The research and efforts to date to establish the PCRNV are encouraging and provide optimism for the evolution of palliative care research in Australia. The international implications are highlighted.

Nursing care for patients carrying indwelling catheter in target vessel for continuous chemotherapy

International Nuclear Information System (INIS)

Wen Lihong

2009-01-01

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)

Social networks of patients with chronic skin lesions: nursing care.

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Bandeira, Luciana Alves; Santos, Maxuel Cruz Dos; Duarte, Êrica Rosalba Mallmann; Bandeira, Andrea Gonçalves; Riquinho, Deise Lisboa; Vieira, Letícia Becker

2018-01-01

To describe the social networks of patients with chronic skin damages. A qualitative study conducted through semi-structured interviews with nine subjects with chronic skin lesions from June 2016 to March 2017; we used the theoretical-methodological framework of Lia Sanicola's Social Network. The analysis of the relational maps revealed that the primary network was formed mainly by relatives and neighbors; its characteristics, such as: reduced size, low density and few exchanges/relationships, configures fragility in these links. The secondary network was essentially described by health services, and the nurse was cited as a linker in the therapeutic process. Faced with the fragility of the links and social isolation, the primary health care professionals are fundamental foundations for the construction of networks of social support and care for patients with chronic skin lesions.

Network Analysis Approach to Stroke Care and Assistance Provision: An Empirical Study

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Szczygiel Nina

2017-06-01

Full Text Available To model and analyse stroke care and assistance provision in the Portuguese context from the network perspective. We used the network theory as a theoretical foundation for the study. The model proposed by Frey et al. (2006 was used to elicit and comprehend possible interactions and relations between organisations expected to be involved in the provision of care and assistance to stroke patients in their pathway to rehabilitation. Providers were identified and contacted to evaluate the nature and intensity of relationships. Network analysis was performed with the NodeXL software package. Analysis of 509 entities based on about 260 000 entries indicates that stroke care provision in the evaluated context is best captured in the coalition-collaboration setting, which appears to best demonstrate the character of the network. Information from analysis of the collaboration stage was not sufficient to determine the network dynamics. Application of the network theory to understand interorganisational dynamics of the complex health care context. Empirical validation of the model proposed by Frey et al. (2006 in terms of its operationalisation and the way it actually reflects the practical context. Examination and analysis of interorganisational relationships and its contribution to management of compound health care context involving actors from various sectors.

Collaborative Chronic Care Networks (C3Ns) to transform chronic illness care.

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Margolis, Peter A; Peterson, Laura E; Seid, Michael

2013-06-01

Despite significant gains by pediatric collaborative improvement networks, the overall US system of chronic illness care does not work well. A new paradigm is needed: a Collaborative Chronic Care Network (C3N). A C3N is a network-based production system that harnesses the collective intelligence of patients, clinicians, and researchers and distributes the production of knowledge, information, and know-how over large groups of people, dramatically accelerating the discovery process. A C3N is a platform of "operating systems" on which interconnected processes and interventions are designed, tested, and implemented. The social operating system is facilitated by community building, engaging all stakeholders and their expertise, and providing multiple ways to participate. Standard progress measures and a robust information technology infrastructure enable the technical operating system to reduce unwanted variation and adopt advances more rapidly. A structured approach to innovation design provides a scientific operating system or "laboratory" for what works and how to make it work. Data support testing and research on multiple levels: comparative effectiveness research for populations, evaluating care delivery processes at the care center level, and N-of-1 trials and other methods to select the best treatment of individual patient circumstances. Methods to reduce transactional costs to participate include a Federated IRB Model in which centers rely on a protocol approved at 1 central institutional review board and a "commons framework" for organizational copyright and intellectual property concerns. A fully realized C3N represents a discontinuous leap to a self-developing learning health system capable of producing a qualitatively different approach to improving health.

Effects of primary care team social networks on quality of care and costs for patients with cardiovascular disease.

Science.gov (United States)

Mundt, Marlon P; Gilchrist, Valerie J; Fleming, Michael F; Zakletskaia, Larissa I; Tuan, Wen-Jan; Beasley, John W

2015-03-01

Cardiovascular disease is the leading cause of mortality and morbidity in the United States. Primary care teams can be best suited to improve quality of care and lower costs for patients with cardiovascular disease. This study evaluates the associations between primary care team communication, interaction, and coordination (ie, social networks); quality of care; and costs for patients with cardiovascular disease. Using a sociometric survey, 155 health professionals from 31 teams at 6 primary care clinics identified with whom they interact daily about patient care. Social network analysis calculated variables of density and centralization representing team interaction structures. Three-level hierarchical modeling evaluated the link between team network density, centralization, and number of patients with a diagnosis of cardiovascular disease for controlled blood pressure and cholesterol, counts of urgent care visits, emergency department visits, hospital days, and medical care costs in the previous 12 months. Teams with dense interactions among all team members were associated with fewer hospital days (rate ratio [RR] = 0.62; 95% CI, 0.50-0.77) and lower medical care costs (-$556; 95% CI, -$781 to -$331) for patients with cardiovascular disease. Conversely, teams with interactions revolving around a few central individuals were associated with increased hospital days (RR = 1.45; 95% CI, 1.09-1.94) and greater costs ($506; 95% CI, $202-$810). Team-shared vision about goals and expectations mediated the relationship between social network structures and patient quality of care outcomes. Primary care teams that are more interconnected and less centralized and that have a shared team vision are better positioned to deliver high-quality cardiovascular disease care at a lower cost. © 2015 Annals of Family Medicine, Inc.

C-RNN-GAN: Continuous recurrent neural networks with adversarial training

OpenAIRE

Mogren, Olof

2016-01-01

Generative adversarial networks have been proposed as a way of efficiently training deep generative neural networks. We propose a generative adversarial model that works on continuous sequential data, and apply it by training it on a collection of classical music. We conclude that it generates music that sounds better and better as the model is trained, report statistics on generated music, and let the reader judge the quality by downloading the generated songs.

Outcome of alcohol dependence: The role of continued care

Directory of Open Access Journals (Sweden)

Murthy Pratima

2009-01-01

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.

Social networks of patients with chronic skin lesions: nursing care

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Luciana Alves Bandeira

Full Text Available ABSTRACT Objective: To describe the social networks of patients with chronic skin damages. Method: A qualitative study conducted through semi-structured interviews with nine subjects with chronic skin lesions from June 2016 to March 2017; we used the theoretical-methodological framework of Lia Sanicola’s Social Network. Results: The analysis of the relational maps revealed that the primary network was formed mainly by relatives and neighbors; its characteristics, such as: reduced size, low density and few exchanges/relationships, configures fragility in these links. The secondary network was essentially described by health services, and the nurse was cited as a linker in the therapeutic process. Final considerations: Faced with the fragility of the links and social isolation, the primary health care professionals are fundamental foundations for the construction of networks of social support and care for patients with chronic skin lesions.

Continuity of care of emergency surgical admissions: impact on SpR training.

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Ledwidge, S F C; Bryden, E; Halestrap, P; Galland, R B

2008-06-01

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.

Primary health care teams and the patient perspective: a social network analysis.

Science.gov (United States)

Cheong, Lynn H M; Armour, Carol L; Bosnic-Anticevich, Sinthia Z

2013-01-01

Multidisciplinary care (MDC) has been proposed as a potential strategy to address the rising challenges of modern health issues. However, it remains unclear as to how patients' health connections may impact on multidisciplinary processes and outcomes. This research aims to gain a deeper understanding of patients' potential role in MDC: i) describe patients' health networks, ii) compare different care groups, iii) gain an understanding of the nature and extent of their interactions, and iv) identify the role of pharmacists within patient networks. In-depth, semi-structured interviews were conducted with asthma patients from Sydney, Australia. Participants were recruited from a range of standard asthma health care access points (community group) and a specialized multidisciplinary asthma clinic (clinic group). Quantitative social network analysis provided structural insight into asthma networks while qualitative social network analysis assisted in interpretation of network data. A total of 47 interviews were conducted (26 community group participants and 21 clinic group participants). Although participants' asthma networks consisted of a range of health care professionals (HCPs), these did not reflect or encourage MDC. Not only did participants favor minimal interaction with any HCP, they preferred sole-charge care and were found to strongly rely on lay individuals such as family and friends. While general practitioners and respiratory specialists were participants' principal choice of HCP, community pharmacists were less regarded. Limited opportunities were presented for HCPs to collaborate, particularly pharmacists. As patients' choices of HCPs may strongly influence collaborative processes and outcomes, this research highlights the need to consider patient perspectives in the development of MDC models in primary care. Copyright © 2013 Elsevier Inc. All rights reserved.

Vertical integration and organizational networks in health care.

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Robinson, J C; Casalino, L P

1996-01-01

This paper documents the growing linkages between primary care-centered medical groups and specialists and between physicians and hospitals under managed care. We evaluate the two alternative forms of organizational coordination: "vertical integration," based on unified ownership, and "virtual integration," based on contractual networks. Excess capacity and the need for investment capital are major short-term determinants of these vertical versus virtual integration decisions in health care. In the longer term, the principal determinants are economies of scale, risk-bearing ability, transaction costs, and the capacity for innovation in methods of managing care.

Using Social Network Analysis to Examine the Effect of Care Management Structure on Chronic Disease Management Communication Within Primary Care.

Science.gov (United States)

Holtrop, Jodi Summers; Ruland, Sandra; Diaz, Stephanie; Morrato, Elaine H; Jones, Eric

2018-05-01

Care management and care managers are becoming increasingly prevalent in primary care medical practice as a means of improving population health and reducing unnecessary care. Care managers are often involved in chronic disease management and associated transitional care. In this study, we examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. We sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? Individual written surveys were given to all practice members in the participating practices. Survey questions assessed demographics as well as practice culture, quality improvement, care management activities, and communication regarding chronic disease care. Using social network analysis and other statistical methods, we analyzed the communication dynamics related to chronic disease care for each practice. The structure of chronic disease communication varies greatly from practice to practice. Care managers who were embedded in the practice or co-located were more likely to be in the core of the communication network than were off-site care managers. These care managers also had higher in-degree centrality, indicating that they acted as a hub for communication with team members in many other roles. Social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. Structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.

The association between continuity of care in the community and health outcomes: a population-based study

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Dreiher Jacob

2012-05-01

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.

Continuing Professional Development: Pedagogical Practices of Interprofessional Simulation in Health Care

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Nyström, Sofia; Dahlberg, Johanna; Edelbring, Samuel; Hult, Håkan; Abrandt Dahlgren, Madeleine

2017-01-01

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…

Do social networks affect the use of residential aged care among older Australians?

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Glonek Gary FV

2007-10-01

Full Text Available Abstract Background Older people's social networks with family and friends can affect residential aged care use. It remains unclear if there are differences in the effects of specific (with children, other relatives, friends and confidants and total social networks upon use of low-level residential care and nursing homes. Methods Data were drawn from the Australian Longitudinal Study of Ageing. Six waves of data from 1477 people aged ≥ 70 collected over nine years of follow-up were used. Multinomial logistic regressions of the effects of specific and total social networks on residential care use were carried out. Propensity scores were used in the analyses to adjust for differences in participant's health, demographic and lifestyle characteristics with respect to social networks. Results Higher scores for confidant networks were protective against nursing home use (odds ratio [OR] upper versus lower tertile of confidant networks = 0.50; 95%CI 0.33–0.75. Similarly, a significant effect of upper versus lower total network tertile on nursing home use was observed (OR = 0.62; 95%CI 0.43–0.90. Evidence of an effect of children networks on nursing home use was equivocal. Nursing home use was not predicted by other relatives or friends social networks. Use of lower-level residential care was unrelated to social networks of any type. Social networks of any type did not have a significant effect upon low-level residential care use. Discussion Better confidant and total social networks predict nursing home use in a large cohort of older Australians. Policy needs to reflect the importance of these particular relationships in considering where older people want to live in the later years of life.

Continuity of care as experienced by mental health service users - a qualitative study

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Eva Biringer

2017-11-01

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

Adaptive-impulsive synchronization in drive-response networks of continuous systems and its application

International Nuclear Information System (INIS)

Sun Mei; Zeng Changyan; Tao Yangwei; Tian Lixin

2009-01-01

Based on the comparison theorem for the stability of impulsive control system, adaptive-impulsive synchronization in drive-response networks of continuous systems with time-delay and non-time-delay is investigated. And the continuous control input, the simple updated laws and a linear impulsive controller are proposed. Moreover, two numerical examples are presented to verify the effectiveness and correctness of the theorem, using the energy resource system and Lue's system as the nodes of the networks.

Social network approaches to recruitment, HIV prevention, medical care, and medication adherence.

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Latkin, Carl A; Davey-Rothwell, Melissa A; Knowlton, Amy R; Alexander, Kamila A; Williams, Chyvette T; Boodram, Basmattee

2013-06-01

This article reviews the current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates, treatment access, and outcomes. Social network analysis is a valuable tool to link social structural factors to individual behaviors. Social networks provide an avenue for low-cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social networks can be utilized as a viable approach to recruitment for HIV testing and counseling, HIV prevention interventions, optimizing HIV medical care, and medication adherence. Social network interventions may be face-to-face or through social media. Key issues in designing social network interventions are contamination due to social diffusion, network stability, density, and the choice and training of network members. There are also ethical issues involved in the development and implementation of social network interventions. Social network analyses can also be used to understand HIV transmission dynamics.

Innovation or rebranding, acute care surgery diffusion will continue.

Science.gov (United States)

Collins, Courtney E; Pringle, Patricia L; Santry, Heena P

2015-08-01

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.

The continuous glucose monitoring sensor in neonatal intensive care

OpenAIRE

Beardsall, K; Ogilvy-Stuart, A; Ahluwalia, J; Thompson, M; Dunger, D

2005-01-01

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.

Scotland's Knowledge Network: translating knowledge into action to improve quality of care.

Science.gov (United States)

Wales, A; Graham, S; Rooney, K; Crawford, A

2012-11-01

The Knowledge Network (www.knowledge.scot.nhs.uk) is Scotland's online knowledge service for health and social care. It is designed to support practitioners to apply knowledge in frontline delivery of care, helping to translate knowledge into better health-care outcomes through safe, effective, person-centred care. The Knowledge Network helps to combine the worlds of evidence-based practice and quality improvement by providing access to knowledge about the effectiveness of clinical interventions ('know-what') and knowledge about how to implement this knowledge to support individual patients in working health-care environments ('know-how'). An 'evidence and guidance' search enables clinicians to quickly access quality-assured evidence and best practice, while point of care and mobile solutions provide knowledge in actionable formats to embed in clinical workflow. This research-based knowledge is complemented by social networking services and improvement tools which support the capture and exchange of knowledge from experience, facilitating practice change and systems improvement. In these cases, the Knowledge Network supports key components of the knowledge-to-action cycle--acquiring, creating, sharing and disseminating knowledge to improve performance and innovate. It provides a vehicle for implementing the recommendations of the national Knowledge into Action review, which outlines a new national approach to embedding knowledge in frontline practice and systems improvement.

Care networking: a study of technical mediations in a home telecare service.

Science.gov (United States)

Correa, Gonzalo; Domènech, Miquel

2013-07-22

This article examines the processes of technical mediation within familial care networks based on a study of home telecare targeted at older people. Supported by contributions from the actor-network theory as part of the social psychology of science and technology, these processes of technical mediation are analyzed using a qualitative approach. The data were gathered through six focus groups and four in-depth interviews; the participants in the study included users, relatives and formal carers. Thematic analysis techniques encompassing the information were used, revealing the effects on the patterns of caring relationships. The results show the interplay between presence-absence made possible by the devices; the two-way direction of care between the older people and the artifacts; and the process of sustaining care using the technology. We conclude that care should be seen as a socio-technical network where technology plays an active role in sustaining family relationships.

Network and social support in family care of children with diabetes.

Science.gov (United States)

Pennafort, Viviane Peixoto Dos Santos; Queiroz, Maria Veraci Oliveira; Nascimento, Lucila Castanheira; Guedes, Maria Vilani Cavalcante

2016-01-01

to understand the influence of network and social support in the care of a child with type 1 diabetes. qualitative study, with assumptions of ethnonursing, conducted in a reference service specialized in the treatment of diabetes, in 2014, in the city of Fortaleza, state of Ceará, Brazil. Twenty-six members of the family and their respective school children participated in the study. The process of collection and analysis followed the observation-participation-reflection model. the analytical categories showed that the social network in the care of children with diabetes helped sharing of information and experiences, moments of relaxation and aid in the acquisition of supplies for treatment, with positive repercussions in the family context, generating well-being and confidence in the care of children with diabetes. the cultural care provided by nurses strengthens the network and social support because it encourages autonomy in the promotion of the quality of life of children with type 1 diabetes and their families.

Designing a Pregnancy Care Network for Pregnant Women

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Sabiha Khanum

2017-12-01

Full Text Available All pregnant women need easy access to pregnancy-related personalized information, on-time quality healthcare services and effective communication links with healthcare providers. Smartphone-based devices, communication systems and eHealth applications can play an important role in facilitating some of these services to pregnant women in a fast and efficient way and can thus prevent most of the pregnancy-related complications. The objective of this work is to propose and design a pregnancy care network for pregnant women and healthcare providers. The network model, an eHealth application based on smartphone-based devices and communication systems, is designed to strengthen communication links between health professionals and pregnant women and increase education, awareness and quality of care during pregnancy and childbirth.

Social-Professional Networks in Long-Term Care Settings With People With Dementia: An Approach to Better Care? A Systematic Review.

Science.gov (United States)

Mitchell, Janet I; Long, Janet C; Braithwaite, Jeffrey; Brodaty, Henry

2016-02-01

Dementia is a syndrome associated with stigma and social isolation. Forty-two percent of people with dementia in the United States and almost 40% in the United Kingdom live in assisted living and residential care facilities. Up to 90% of residents with dementia experience behavioral and psychological symptoms of dementia (BPSD). Currently psychotropic drugs are often used to manage BPSD, despite the drugs' limited efficacy and adverse effects. Even though psychosocial approaches are as effective as medical ones without side effects, their uptake has been slow. Social networks that investigate the structure of relationships among residents and staff may represent an important resource to increase the uptake of psychosocial approaches and facilitate improvements in care. To conduct a systematic review of social network studies set in long-term care (LTC), including residents with dementia, and identify network factors influencing the care available to residents. Peer-reviewed articles across CINAHL, EMBASE, IBSS, Medline, PsychInfo, Scopus, and Web of Science were searched from January 1994 to December 2014 inclusive, using PRISMA guidelines. Studies included those examining social networks of residents or staff in LTC. Nine articles from studies in the United States, Europe, Asia, and Australia met search criteria. Resident networks had few social connections. One study proposed that residents with high centrality be encouraged to welcome new residents and disseminate information. The high density in 2 staff network studies was associated with the cooperation needed to provide care to residents with dementia. Staff's boundary-spanning led to higher-status nurses becoming more involved in decision-making and problem-solving in one study. In another, the outcome was staff treating residents with more respect and actively caring for them. These studies suggest interventions using a network approach may improve care services in LTC. Copyright © 2016 AMDA – The

Reconciling disparate information in continuity of care documents: Piloting a system to consolidate structured clinical documents.

Science.gov (United States)

Hosseini, Masoud; Jones, Josette; Faiola, Anthony; Vreeman, Daniel J; Wu, Huanmei; Dixon, Brian E

2017-10-01

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.

Care Networking: A Study of Technical Mediations in a Home Telecare Service

Science.gov (United States)

Correa, Gonzalo; Domènech, Miquel

2013-01-01

This article examines the processes of technical mediation within familial care networks based on a study of home telecare targeted at older people. Supported by contributions from the actor—network theory as part of the social psychology of science and technology, these processes of technical mediation are analyzed using a qualitative approach. The data were gathered through six focus groups and four in-depth interviews; the participants in the study included users, relatives and formal carers. Thematic analysis techniques encompassing the information were used, revealing the effects on the patterns of caring relationships. The results show the interplay between presence-absence made possible by the devices; the two-way direction of care between the older people and the artifacts; and the process of sustaining care using the technology. We conclude that care should be seen as a socio-technical network where technology plays an active role in sustaining family relationships. PMID:23880730

Health care for women in situations of violence: discoordination of network professionals

Directory of Open Access Journals (Sweden)

Jaqueline Arboit

Full Text Available Abstract OBJECTIVE To learn the conceptions and actions of health professionals on the care network for women in situations of violence. METHOD A qualitative, descriptive, exploratory study was conducted between April and July 2015 with the participation of 21 health professionals from four primary health care teams in a city of the central region of the state of Rio Grande do Sul. Data were collected by means of individual semi-structured interviews. Content analysis was used for data systematization. RESULTS Health professionals recognized the importance of the health care network for coping with the problem of violence against women. However, their conceptions and actions were limited by the discoordination or absence of integration among professionals and services of the care network. CONCLUSION The conceptions and actions of health professionals contribute to the discoordination among the services. It is necessary to reflect on the daily practices of care for women in situations of violence.

Breakout Prediction Based on BP Neural Network in Continuous Casting Process

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Zhang Ben-guo

2016-01-01

Full Text Available An improved BP neural network model was presented by modifying the learning algorithm of the traditional BP neural network, based on the Levenberg-Marquardt algorithm, and was applied to the breakout prediction system in the continuous casting process. The results showed that the accuracy rate of the model for the temperature pattern of sticking breakout was 96.43%, and the quote rate was 100%, that verified the feasibility of the model.

Marketing for health-care organizations: an introduction to network management.

Science.gov (United States)

Boonekamp, L C

1994-01-01

The introduction of regulated competition in health care in several Western countries confronts health care providing organizations with changing relationships, with their environment and a need for knowledge and skills to analyse and improve their market position. Marketing receives more and more attention, as recent developments in this field of study provide a specific perspective on the relationships between an organization and external and internal parties. In doing so, a basis is offered for network management. A problem is that the existing marketing literature is not entirely appropriate for the specific characteristics of health care. After a description of the developments in marketing and its most recent key concepts, the applicability of these concepts in health-care organizations is discussed. States that for the health-care sector, dominated by complex networks of interorganizational relationships, the strategic marketing vision on relationships can be very useful. At the same time however, the operationalization of these concepts requires special attention and a distinct role of the management of health-care organizations, because of the characteristics of such organizations and the specific type of their service delivery.

Ambient-aware continuous care through semantic context dissemination.

Science.gov (United States)

Ongenae, Femke; Famaey, Jeroen; Verstichel, Stijn; De Zutter, Saar; Latré, Steven; Ackaert, Ann; Verhoeve, Piet; De Turck, Filip

2014-12-04

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

The effect of narrow provider networks on health care use.

Science.gov (United States)

Atwood, Alicia; Lo Sasso, Anthony T

2016-12-01

Network design is an often overlooked aspect of health insurance contracts. Recent policy factors have resulted in narrower provider networks. We provide plausibly causal evidence on the effect of narrow network plans offered by a large national health insurance carrier in a major metropolitan market. Our econometric design exploits the fact that some firms offer a narrow network plan to their employees and some do not. Our results show that narrow network health plans lead to reductions in health care utilization and spending. We find evidence that narrow networks save money by selecting lower cost providers into the network. Copyright © 2016 Elsevier B.V. All rights reserved.

Achieving continuity of care: facilitators and barriers in community mental health teams.

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Belling, Ruth; Whittock, Margaret; McLaren, Susan; Burns, Tom; Catty, Jocelyn; Jones, Ian Rees; Rose, Diana; Wykes, Til

2011-03-18

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

Boundary Region Detection for Continuous Objects in Wireless Sensor Networks

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Yaqiang Zhang

2018-01-01

Full Text Available Industrial Internet of Things has been widely used to facilitate disaster monitoring applications, such as liquid leakage and toxic gas detection. Since disasters are usually harmful to the environment, detecting accurate boundary regions for continuous objects in an energy-efficient and timely fashion is a long-standing research challenge. This article proposes a novel mechanism for continuous object boundary region detection in a fog computing environment, where sensing holes may exist in the deployed network region. Leveraging sensory data that have been gathered, interpolation algorithms have been applied to estimate sensory data at certain geographical locations, in order to estimate a more accurate boundary line. To examine whether estimated sensory data reflect that fact, mobile sensors are adopted to traverse these locations for gathering their sensory data, and the boundary region is calibrated accordingly. Experimental evaluation shows that this technique can generate a precise object boundary region with certain time constraints, and the network lifetime can be prolonged significantly.

Implementation and integration of regional health care data networks in the Hellenic National Health Service.

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Lampsas, Petros; Vidalis, Ioannis; Papanikolaou, Christos; Vagelatos, Aristides

2002-12-01

Modern health care is provided with close cooperation among many different institutions and professionals, using their specialized expertise in a common effort to deliver best-quality and, at the same time, cost-effective services. Within this context of the growing need for information exchange, the demand for realization of data networks interconnecting various health care institutions at a regional level, as well as a national level, has become a practical necessity. To present the technical solution that is under consideration for implementing and interconnecting regional health care data networks in the Hellenic National Health System. The most critical requirements for deploying such a regional health care data network were identified as: fast implementation, security, quality of service, availability, performance, and technical support. The solution proposed is the use of proper virtual private network technologies for implementing functionally-interconnected regional health care data networks. The regional health care data network is considered to be a critical infrastructure for further development and penetration of information and communication technologies in the Hellenic National Health System. Therefore, a technical approach was planned, in order to have a fast cost-effective implementation, conforming to certain specifications.

Association of Continuity of Primary Care and Statin Adherence.

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James R Warren

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

Association of Continuity of Primary Care and Statin Adherence.

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Warren, James R; Falster, Michael O; Tran, Bich; Jorm, Louisa

2015-01-01

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.

[The importance of longitudinality, comprehensiveness, coordination and continuity of nursing home care].

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Corrales-Nevado, Dolores; Palomo-Cobos, Luis

2014-01-01

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.

Patients' assessments of the continuity of primary care in Finland: a 15-year follow-up questionnaire survey.

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Raivio, Risto; Holmberg-Marttila, Doris; Mattila, Kari J

2014-10-01

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.

[Network Analyses in Regional Health Care Research: Example of Dermatological Care in the Metropolitan Region of Hamburg].

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Augustin, J; Austermann, J; Erasmi, S

2016-10-18

Background: One of the overall objectives of the legislator is to ensure an overall "homogeneous", and easily accessible medical care for the population. The physician-patient ratio can be used to describe the regional health care situation. But this method does not provide information concerning the availability of, for instance, the nearest doctor. Therefore, further parameters such as accessibility must be taken into consideration. For this purpose, network analyses are an appropriate method. The objective of this study is to present methodological tools to evaluate the healthcare situation in the metropolitan region of Hamburg, primarily focusing on accessibility using dermatologists as an example. Methods: Analyzing data of 20 counties, the geographical distribution of N=357 dermatologists and the physician-patient ratio were calculated. In a second step, a network analysis regarding accessibility was performed. In order to calculate accessibility, address data (physicians) were transformed into coordinates, consisting of defined places (N=303) and restrictions (e. g. speed, turn restrictions) of the network. The calculation of population-based accessibility is based on grid cells for the population density. Results: Despite adequacy of the overall medical situation, differences in the availability of the nearest dermatologists in the metropolitan region are remarkable, particularly when use of public transport is taken into consideration. In some counties, over 60% of the population require at least one hour to get to the nearest dermatologist using public transportation. In rural regions within the metropolitan area are particularly affected. Conclusion: The network analysis has shown that the choice and availability of transportation in combination with the location (rural/urban) is essential for health care access. Especially elderly people in rural areas with restricted mobility are at a disadvantage. Therefore, modern health care approaches (e

Patient perspectives on continuity of care: adaption and preliminary psychometric assessment of a Norwegian version of the Nijmegen Continuity Questionnaire (NCQ-N

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Øystein Hetlevik

2017-11-01

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

Exploring family physicians' reasons to continue or discontinue providing intrapartum care: Qualitative descriptive study.

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Dove, Marion; Dogba, Maman Joyce; Rodríguez, Charo

2017-08-01

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.

Lifelong Learning for Clinical Practice: How to Leverage Technology for Telebehavioral Health Care and Digital Continuing Medical Education.

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Hilty, Donald M; Turvey, Carolyn; Hwang, Tiffany

2018-03-12

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.

Challenges on network care considering the perceptions of preceptors of a Pet-Network regarding people with disabilities and at-risk infants: access, comprehensiveness and communication

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Marta Aoki

2017-09-01

Full Text Available Introduction: Health Care Networks (HCN are seen as a possibility for articulating and coordinating actions, health services and is a priority in the health system. One strategy to assure their improvement is the Tutorial Education Program (PET-Redes in the health area. Within this context, it is important to understand the challenges and strengths for the effectiveness of HCN to the network care. Objective: To identify and analyze the perceptions of professionals who are preceptors of PET-Networks (Stork/at-risk infants Network and Disabled People Network about the configuration of the network care and the challenges of professional actions related to it. Method: Qualitative study conducted through two focus groups with professionals that are preceptors of the PET-Networks. Thematic analysis was used for data analysis. Results: Both networks presented the following categories related to the network care configuration: access, comprehensive health care and communication. For this care network configuration, some challenges mentioned include geographical and architectural barriers, lack of social support, lack of transportation, failure on care flow and discontinuities in the communicative process. To deal with these challenges, the following strategies were mentioned: implementation of electronic medical records and formulation of specific forums for debate and articulation of actions, among others. It is important to notice that these categories are intertwined and that more challenges than strategies to overcome them were pointed out by the participants. Conclusion: There are several challenges for effective HCN from different levels and the construction of strategies needs to be convened among all persons involved in the HCN

A tool for assessing continuity of care across care levels: an extended psychometric validation of the CCAENA questionnaire

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Marta Beatriz Aller

2013-12-01

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.

78 FR 69018 - Improving the Resiliency of Mobile Wireless Communications Networks; Reliability and Continuity...

Science.gov (United States)

2013-11-18

... consumers value overall network reliability and quality in selecting mobile wireless service providers, they...-125] Improving the Resiliency of Mobile Wireless Communications Networks; Reliability and Continuity... (Reliability NOI) in 2011 to ``initiate a comprehensive examination of issues regarding the reliability...

Experiences of security and continuity of care: Patients' and families' narratives about the work of specialized palliative home care teams.

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Klarare, Anna; Rasmussen, Birgit H; Fossum, Bjöörn; Fürst, Carl Johan; Hansson, Johan; Hagelin, Carina Lundh

2017-04-01

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.

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

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Stc Hamilton, Karen E; Sullivan, Frank M; Donnan, Peter T; Taylor, Rex; Ikenwilo, Divine; Scott, Anthony; Baker, Chris; Wyke, Sally

2005-01-01

To investigate the set up and operation of a Managed Clinical Network for cardiac services and assess its impact on patient care. This single case study used process evaluation with observational before and after comparison of indicators of quality of care and costs. The study was conducted in Dumfries and Galloway, Scotland and used a three-level framework. Process evaluation of the network set-up and operation through a documentary review of minutes; guidelines and protocols; transcripts of fourteen semi-structured interviews with health service personnel including senior managers, general practitioners, nurses, cardiologists and members of the public. Outcome evaluation of the impact of the network through interrupted time series analysis of clinical data of 202 patients aged less than 76 years admitted to hospital with a confirmed myocardial infarction one-year pre and one-year post, the establishment of the network. The main outcome measures were differences between indicators of quality of care targeted by network protocols. Economic evaluation of the transaction costs of the set-up and operation of the network and the resource costs of the clinical care of the 202 myocardial infarction patients from the time of hospital admission to 6 months post discharge through interrupted time series analysis. The outcome measure was different in National Health Service resource use. Despite early difficulties, the network was successful in bringing together clinicians, patients and managers to redesign services, exhibiting most features of good network management. The role of the energetic lead clinician was crucial, but the network took time to develop and 'bed down'. Its primary "modus operand" was the development of a myocardial infarction pathway and associated protocols. Of sixteen clinical care indicators, two improved significantly following the launch of the network and nine showed improvements, which were not statistically significant. There was no difference

Achieving Continuity of Care: Facilitators and Barriers in Community Mental Health Teams

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Jones Ian Rees

2011-03-01

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

Reform, change, and continuity in Finnish health care.

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Häkkinen, Unto; Lehto, Juhani

2005-01-01

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.

Analyzing Networked Learning Practices in HigherEducation and Continuing Professional Development

DEFF Research Database (Denmark)

Dirckinck-Holmfeld, Lone

Deliverable 28.5.4 reports on the preparation of the book "Analysing Networked Learning Practices in Higher Education and Continuing Professional Development", which consists of an Introduction, case studies and a concluding section, which presents the theoretical work and empirical work conducte...

The Importance of and the Complexities Associated With Measuring Continuity of Care During Resident Training: Possible Solutions Do Exist.

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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

2016-04-01

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.

Phenomenological perspectives of self-care in healthcare professionals' continuing education

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Daniele Bruzzone

2014-12-01

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.

EurOOHnet-the European research network for out-of-hours primary health care.

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Huibers, Linda; Philips, Hilde; Giesen, Paul; Remmen, Roy; Christensen, Morten Bondo; Bondevik, Gunnar Tschudi

2014-09-01

European countries face similar challenges in the provision of health care. Demographic factors like ageing, population growth, changing patient behaviour, and lack of work force lead to increasing demands, costs, and overcrowding of out-of-hours (OOH) care (i.e. primary care services, emergency departments (EDs), and ambulance services). These developments strain services and imply safety risks. In the last few decades, countries have been re-organizing their OOH primary health care services. AIM AND SCOPE OF THE NETWORK: We established a European research network for out-of-hours primary health care (EurOOHnet), which aims to transfer knowledge, share experiences, and conduct research. Combining research competencies and integrating results can generate a profound information flow to European researchers and decision makers in health policy, contributing towards feasible and high-quality OOH care. It also contributes to a more comparable performance level within European regions. CONDUCTED RESEARCH PROJECTS: The European research network aims to conduct mutual research projects. At present, three projects have been accomplished, among others concerning the diagnostic scope in OOH primary care services and guideline adherence for diagnosis and treatment of cystitis in OOH primary care. Future areas of research will be organizational models for OOH care; appropriate use of the OOH services; quality of telephone triage; quality of medical care; patient safety issues; use of auxiliary personnel; collaboration with EDs and ambulance care; and the role of GPs in OOH care.

Cumulative Risk and Continuity in Nonparental Care from Infancy to Early Adolescence.

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Colwell, Malinda J; Pettit, Gregory S; Meece, Darrell; Bates, John E; Dodge, Kenneth A

2001-04-01

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.

Opioid use in palliative care | Hosking | Continuing Medical Education

African Journals Online (AJOL)

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.

Gender Differences in the Continuance of Online Social Networks

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Shi, Na; Cheung, Christy M. K.; Lee, Matthew K. O.; Chen, Huaping

Social network sites (SNS) have become increasingly popular in the past few years benefiting from the rapid growth of Web 2.0 applications. However, research on the adoption and usage of SNS is limited. In this study, we attempt to understand users' continuance intention to use SNS and investigate the role of gender. A research model was developed and tested with 213 respondents from an online survey. The results confirm that users' continuance intention to use SNS is strongly determined by satisfaction. The effect of disconfirmation of maintaining offline contacts on satisfaction is more important for women, while the effect of disconfirmation of entertainment is more salient for men. Implications of this study for both researchers and practitioners are discussed.

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

Directory of Open Access Journals (Sweden)

Karen E. Hamilton

2005-09-01

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

OA20 The positioning of family, friends, community, and service providers in support networks for caring at end-of-life: a social network analysis.

Science.gov (United States)

Leonard, Rosemary; Horsfall, Debbie; Rosenberg, John; Noonan, Kerrie

2015-04-01

Although there is ample evidence of the risk to carers from the burden of caring, there is also evidence that a caring network can relieve the burden on the principal carer, strengthen community relationships, and increase 'Death Literacy' in the community. There is often an assumption that, in caring networks, family and service providers are central and friends and community are marginal. We examined whether this is the case in practice using SNA. To identify the relative positioning of family, friends, community, and service providers in caring networks. In interviews with carers (N = 23) and focus groups with caring networks (N = 13) participants were asked to list the people in the caring network and rate the strength of their relationships to them (0 no relationship to 3 strong relationship). SNA in UCInet was used to map the networks, examine density (number and strength of relationships) across time (when caring began to the present) and across relationship types (family, friends, community, and service providers) supplemented by qualitative data. The analysis revealed significant increases in the density of the networks over time. The density of relationships with friends was similar to that other family. Community and service providers had significantly lower density. Qualitative analysis revealed that often service providers were not seen as part of the networks. To avoid carer burnout, it is important not to make assumptions about where carers obtain support but work with each carer to mobilise any support that is available. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Equivalent continuous noise level in neonatal intensive care unit associated to burnout syndrome].

Science.gov (United States)

Garrido Galindo, A P; Camargo Caicedo, Y; Vélez-Pereira, A M

2015-01-01

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.

Continuity of midwifery care and gestational weight gain in obese women: a randomised controlled trial

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Patterson Denise

2011-03-01

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

The ClaudicatioNet concept: design of a national integrated care network providing active and healthy aging for patients with intermittent claudication.

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Lauret, Gert-Jan; Gijsbers, Harm J H; Hendriks, Erik J M; Bartelink, Marie-Louise; de Bie, Rob A; Teijink, Joep A W

2012-01-01

Intermittent claudication (IC) is a manifestation of peripheral arterial occlusive disease (PAOD). Besides cardiovascular risk management, supervised exercise therapy (SET) should be offered to all patients with IC. Outdated guidelines, an insufficient number of specialized physiotherapists (PTs), lack of awareness of the importance of SET by referring physicians, and misguided financial incentives all seriously impede the availability of a structured SET program in The Netherlands. By initiating regional care networks, ClaudicatioNet aims to improve the quality of care for patients with IC. Based on the chronic care model as a conceptual framework, these networks should enhance the access, continuity, and (cost) efficiency of the health care system. With the aid of a national database, health care professionals will be able to benchmark patient results while ClaudicatioNet will be able to monitor quality of care by way of functional and patient reported outcome measures. The success of ClaudicatioNet is dependent on several factors. Vascular surgeons, general practitioners and coordinating central caregivers will need to team up and work in close collaboration with specialized PTs. A substantial task in the upcoming years will be to monitor the quality, volume, and distribution of ClaudicatioNet PTs. Finally, misguided financial incentives within the Dutch health care system need to be tackled. With ClaudicatioNet, integrated care pathways are likely to improve in the upcoming years. This should result in the achievement of optimal quality of care for all patients with IC.

[Primary Health Care in Austria - Tu Felix Austria nube - Concept for networking in the primary care of Upper Austria].

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Kriegel, Johannes; Rebhandl, Erwin; Hockl, Wolfgang; Stöbich, Anna-Maria

2017-10-01

The primary health care in rural areas in Austria is currently determined by challenges such as ageing of the population, the shift towards chronic and age-related illnesses, the specialist medical and hospital-related education and training of physicians' as well growing widespread difficulty of staffing doctor's office. The objective is to realize a general practitioner centered and team-oriented primary health care (PHC) approach by establishing networked primary health care in rural areas of Austria. Using literature research, online survey, expert interviews and expert workshops, we identified different challenges in terms of primary health care in rural areas. Further, current resources and capacities of primary health care in rural areas were identified using the example of the district of Rohrbach. Twelve design dimensions and 51 relevant measurement indicators of a PHC network were delineated and described. Based on this, 12 design approaches of PHC concept for the GP-centered and team-oriented primary health care in rural areas have been developed.

The effect of provider affiliation with a primary care network on emergency department visits and hospital admissions

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Bakal, Jeffrey A.; Green, Lee; Bahler, Brad; Lewanczuk, Richard

2018-01-01

BACKGROUND: Primary care networks are designed to facilitate access to inter-professional, team-based care. We compared health outcomes associated with primary care networks versus conventional primary care. METHODS: We obtained data on all adult residents of Alberta who visited a primary care physician during fiscal years 2008 and 2009 and classified them as affiliated with a primary care network or not, based on the physician most involved in their care. The primary outcome was an emergency department visit or nonelective hospital admission for a Patient Medical Home indicator condition (asthma, chronic obstructive pulmonary disease, heart failure, coronary disease, hypertension and diabetes) within 12 months. RESULTS: Adults receiving care within a primary care network (n = 1 502 916) were older and had higher comorbidity burdens than those receiving conventional primary care (n = 1 109 941). Patients in a primary care network were less likely to visit the emergency department for an indicator condition (1.4% v. 1.7%, mean 0.031 v. 0.035 per patient, adjusted risk ratio [RR] 0.98, 95% confidence interval [CI] 0.96–0.99) or for any cause (25.5% v. 30.5%, mean 0.55 v. 0.72 per patient, adjusted RR 0.93, 95% CI 0.93–0.94), but were more likely to be admitted to hospital for an indicator condition (0.6% v. 0.6%, mean 0.018 v. 0.017 per patient, adjusted RR 1.07, 95% CI 1.03–1.11) or all-cause (9.3% v. 9.1%, mean 0.25 v. 0.23 per patient, adjusted RR 1.08, 95% CI 1.07–1.09). Patients in a primary care network had 169 fewer all-cause emergency department visits and 86 fewer days in hospital (owing to shorter lengths of stay) per 1000 patient-years. INTERPRETATION: Care within a primary care network was associated with fewer emergency department visits and fewer hospital days. PMID:29530868

Continuing Care

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... 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 ...

Adopting new models for continuity of care: what are the needs?

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May, P R

1975-09-01

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.

An Approach to measuring Integrated Care within a Maternity Care System: Experiences from the Maternity Care Network Study and the Dutch Birth Centre Study

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Valentijn, Pim P.; Hitzert, Marit; Hermus, Marieke A.A.; Franx, Arie; de Vries, Raymond G.; Wiegers, Therese A.; Bruijnzeels, Marc A.

2017-01-01

Introduction: Integrated care is considered to be a means to reduce costs, improve the quality of care and generate better patient outcomes. At present, little is known about integrated care in maternity care systems. We developed questionnaires to examine integrated care in two different settings, using the taxonomy of the Rainbow Model of Integrated Care. The aim of this study was to explore the validity of these questionnaires. Methods: We used data collected between 2013 and 2015 from two studies: the Maternity Care Network Study (634 respondents) and the Dutch Birth Centre Study (56 respondents). We assessed the feasibility, discriminative validity, and reliability of the questionnaires. Results: Both questionnaires showed good feasibility (overall missing rate 0.70). Between-subgroups post-hoc comparisons showed statistically significant differences on integration profiles between regional networks (on all items, dimensions of integration and total integration score) and birth centres (on 50% of the items and dimensions of integration). Discussion: Both questionnaires are feasible and can discriminate between sites with different integration profiles in The Netherlands. They offer an opportunity to better understand integrated care as one step in understanding the complexity of the concept. PMID:28970747

Social network approaches to recruitment, HIV prevention, medical care, and medication adherence

OpenAIRE

Latkin, Carl A.; Davey-Rothwell, Melissa A.; Knowlton, Amy R.; Alexander, Kamila A.; Williams, Chyvette T.; Boodram, Basmattee

2013-01-01

This article reviews current issues and advancements in social network approaches to HIV prevention and care. Social network analysis can provide a method to understand health disparities in HIV rates and treatment access and outcomes. Social network analysis is a value tool to link social structural factors to individual behaviors. Social networks provide an avenue for low cost and sustainable HIV prevention interventions that can be adapted and translated into diverse populations. Social ne...

Continual and One-Shot Learning Through Neural Networks with Dynamic External Memory

DEFF Research Database (Denmark)

Lüders, Benno; Schläger, Mikkel; Korach, Aleksandra

2017-01-01

it easier to find unused memory location and therefor facilitates the evolution of continual learning networks. Our results suggest that augmenting evolving networks with an external memory component is not only a viable mechanism for adaptive behaviors in neuroevolution but also allows these networks...... a new task is learned. This paper takes a step in overcoming this limitation by building on the recently proposed Evolving Neural Turing Machine (ENTM) approach. In the ENTM, neural networks are augmented with an external memory component that they can write to and read from, which allows them to store...... associations quickly and over long periods of time. The results in this paper demonstrate that the ENTM is able to perform one-shot learning in reinforcement learning tasks without catastrophic forgetting of previously stored associations. Additionally, we introduce a new ENTM default jump mechanism that makes...

Spina Bifida Care In Kenya Through A Network Of Mobile Clinics ...

African Journals Online (AJOL)

Background: Children with spina bifida require ongoing multidisciplinary care in order to prevent complications and improve quality of life. Bethany Crippled Children's Centre of Kenya and BethanyKids at Kijabe Hospital have been providing such care for spina bifida patients through a network of mobile clinics throughout ...

Clinic Network Collaboration and Patient Tracing to Maximize Retention in HIV Care.

Directory of Open Access Journals (Sweden)

James H McMahon

Full Text Available Understanding retention and loss to follow up in HIV care, in particular the number of people with unknown outcomes, is critical to maximise the benefits of antiretroviral therapy. Individual-level data are not available for these outcomes in Australia, which has an HIV epidemic predominantly focused amongst men who have sex with men.A network of the 6 main HIV clinical care sites was established in the state of Victoria, Australia. Individuals who had accessed care at these sites between February 2011 and June 2013 as assessed by HIV viral load testing but not accessed care between June 2013 and February 2014 were considered individuals with potentially unknown outcomes. For this group an intervention combining cross-referencing of clinical data between sites and phone tracing individuals with unknown outcomes was performed. 4966 people were in care in the network and before the intervention estimates of retention ranged from 85.9%-95.8% and the proportion with unknown outcomes ranged from 1.3-5.5%. After the intervention retention increased to 91.4-98.8% and unknown outcomes decreased to 0.1-2.4% (p<.01 for all sites for both outcomes. Most common reasons for disengagement from care were being too busy to attend or feeling well. For those with unknown outcomes prior to the intervention documented active psychiatric illness at last visit was associated with not re-entering care (p = 0.04.The network demonstrated low numbers of people with unknown outcomes and high levels of retention in care. Increased levels of retention in care and reductions in unknown outcomes identified after the intervention largely reflected confirmation of clinic transfers while a smaller number were successfully re-engaged in care. Factors associated with disengagement from care were identified. Systems to monitor patient retention, care transfer and minimize disengagement will maximise individual and population-level outcomes for populations with HIV.

Information management for aged care provision in Australia: development of an aged care minimum dataset and strategies to improve quality and continuity of care.

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Davis, Jenny; Morgans, Amee; Burgess, Stephen

2016-04-01

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.

Self-organizing path integration using a linked continuous attractor and competitive network: path integration of head direction.

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Stringer, Simon M; Rolls, Edmund T

2006-12-01

A key issue is how networks in the brain learn to perform path integration, that is update a represented position using a velocity signal. Using head direction cells as an example, we show that a competitive network could self-organize to learn to respond to combinations of head direction and angular head rotation velocity. These combination cells can then be used to drive a continuous attractor network to the next head direction based on the incoming rotation signal. An associative synaptic modification rule with a short term memory trace enables preceding combination cell activity during training to be associated with the next position in the continuous attractor network. The network accounts for the presence of neurons found in the brain that respond to combinations of head direction and angular head rotation velocity. Analogous networks in the hippocampal system could self-organize to perform path integration of place and spatial view representations.

An estimation of the domain of attraction and convergence rate for Hopfield continuous feedback neural networks

International Nuclear Information System (INIS)

Cao Jinde

2004-01-01

In this Letter, the domain of attraction of memory patterns and exponential convergence rate of the network trajectories to memory patterns for Hopfield continuous associative memory are estimated by means of matrix measure and comparison principle. A new estimation is given for the domain of attraction of memory patterns and exponential convergence rate. These results can be used for the evaluation of fault-tolerance capability and the synthesis procedures for Hopfield continuous feedback associative memory neural networks

Improving collaboration between primary care research networks using Access Grid technology

Directory of Open Access Journals (Sweden)

Zsolt Nagykaldi

2008-05-01

Full Text Available Access Grid (AG is an Internet2-driven, high performance audio_visual conferencing technology used worldwide by academic and government organisations to enhance communication, human interaction and group collaboration. AG technology is particularly promising for improving academic multi-centre research collaborations. This manuscript describes how the AG technology was utilised by the electronic Primary Care Research Network (ePCRN that is part of the National Institutes of Health (NIH Roadmap initiative to improve primary care research and collaboration among practice- based research networks (PBRNs in the USA. It discusses the design, installation and use of AG implementations, potential future applications, barriers to adoption, and suggested solutions.

The influence of care interventions on the continuity of sleep of intensive care unit patients.

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Hamze, Fernanda Luiza; de Souza, Cristiane Chaves; Chianca, Tânia Couto Machado

2015-01-01

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.

Analysis of the social network development of a virtual community for Australian intensive care professionals.

Science.gov (United States)

Rolls, Kaye Denise; Hansen, Margaret; Jackson, Debra; Elliott, Doug

2014-11-01

Social media platforms can create virtual communities, enabling healthcare professionals to network with a broad range of colleagues and facilitate knowledge exchange. In 2003, an Australian state health department established an intensive care mailing list to address the professional isolation experienced by senior intensive care nurses. This article describes the social network created within this virtual community by examining how the membership profile evolved from 2003 to 2009. A retrospective descriptive design was used. The data source was a deidentified member database. Since 2003, 1340 healthcare professionals subscribed to the virtual community with 78% of these (n = 1042) still members at the end of 2009. The membership profile has evolved from a single-state nurse-specific network to an Australia-wide multidisciplinary and multiorganizational intensive care network. The uptake and retention of membership by intensive care clinicians indicated that they appeared to value involvement in this virtual community. For healthcare organizations, a virtual community may be a communications option for minimizing professional and organizational barriers and promoting knowledge flow. Further research is, however, required to demonstrate a link between these broader social networks, enabling the exchange of knowledge and improved patient outcomes.

Integration of Continuous-Time Dynamics in a Spiking Neural Network Simulator

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Jan Hahne

2017-05-01

Full Text Available Contemporary modeling approaches to the dynamics of neural networks include two important classes of models: biologically grounded spiking neuron models and functionally inspired rate-based units. We present a unified simulation framework that supports the combination of the two for multi-scale modeling, enables the quantitative validation of mean-field approaches by spiking network simulations, and provides an increase in reliability by usage of the same simulation code and the same network model specifications for both model classes. While most spiking simulations rely on the communication of discrete events, rate models require time-continuous interactions between neurons. Exploiting the conceptual similarity to the inclusion of gap junctions in spiking network simulations, we arrive at a reference implementation of instantaneous and delayed interactions between rate-based models in a spiking network simulator. The separation of rate dynamics from the general connection and communication infrastructure ensures flexibility of the framework. In addition to the standard implementation we present an iterative approach based on waveform-relaxation techniques to reduce communication and increase performance for large-scale simulations of rate-based models with instantaneous interactions. Finally we demonstrate the broad applicability of the framework by considering various examples from the literature, ranging from random networks to neural-field models. The study provides the prerequisite for interactions between rate-based and spiking models in a joint simulation.

Integration of Continuous-Time Dynamics in a Spiking Neural Network Simulator.

Science.gov (United States)

Hahne, Jan; Dahmen, David; Schuecker, Jannis; Frommer, Andreas; Bolten, Matthias; Helias, Moritz; Diesmann, Markus

2017-01-01

Contemporary modeling approaches to the dynamics of neural networks include two important classes of models: biologically grounded spiking neuron models and functionally inspired rate-based units. We present a unified simulation framework that supports the combination of the two for multi-scale modeling, enables the quantitative validation of mean-field approaches by spiking network simulations, and provides an increase in reliability by usage of the same simulation code and the same network model specifications for both model classes. While most spiking simulations rely on the communication of discrete events, rate models require time-continuous interactions between neurons. Exploiting the conceptual similarity to the inclusion of gap junctions in spiking network simulations, we arrive at a reference implementation of instantaneous and delayed interactions between rate-based models in a spiking network simulator. The separation of rate dynamics from the general connection and communication infrastructure ensures flexibility of the framework. In addition to the standard implementation we present an iterative approach based on waveform-relaxation techniques to reduce communication and increase performance for large-scale simulations of rate-based models with instantaneous interactions. Finally we demonstrate the broad applicability of the framework by considering various examples from the literature, ranging from random networks to neural-field models. The study provides the prerequisite for interactions between rate-based and spiking models in a joint simulation.

Relationship Between Attention-Deficit/Hyperactivity Disorder Care and Medication Continuity.

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Brinkman, William B; Baum, Rebecca; Kelleher, Kelly J; Peugh, James; Gardner, William; Lichtenstein, Phil; Langberg, Joshua; Epstein, Jeffery N

2016-04-01

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.

The KIzSS network, a sentinel surveillance system for infectious diseases in day care centers: study protocol

Directory of Open Access Journals (Sweden)

Enserink Remko

2012-10-01

Full Text Available Abstract Background Day care-associated infectious diseases are widely recognized as a public health problem but rarely studied. Insights into their dynamics and their association with the day care setting are important for effective decision making in management of infectious disease control. This paper describes the purpose, design and potential of our national multi-center, day care-based sentinel surveillance network for infectious diseases (the KIzSS network. The aim of the KIzSS network is to acquire a long-term insight into the syndromic and microbiological aspects of day care-related infectious diseases and associated disease burden and to model these aspects with day care setting characteristics. Methods/design The KIzSS network applies a prospective cohort design, following day care centers rather than individual children or staff members over time. Data on infectious disease symptoms and related morbidity (children and staff, medical consumption, absenteeism and circulating enteric pathogens (children are collected on a daily, weekly or monthly basis. Every two years, a survey is performed to assess the characteristics of participating day care centers. Discussion The KIzSS network offers a unique potential to study infectious disease dynamics in the day care setting over a sustained period of time. The created (biodatabases will help us to assess day care-related disease burden of infectious diseases among attending children and staff and their relation with the day care setting. This will support the much needed development of evidence-based and pragmatic guidelines for infectious disease control in day care centers.

Continuous-variable Measurement-device-independent Quantum Relay Network with Phase-sensitive Amplifiers

Science.gov (United States)

Li, Fei; Zhao, Wei; Guo, Ying

2018-01-01

Continuous-variable (CV) measurement-device-independent (MDI) quantum cryptography is now heading towards solving the practical problem of implementing scalable quantum networks. In this paper, we show that a solution can come from deploying an optical amplifier in the CV-MDI system, aiming to establish a high-rate quantum network. We suggest an improved CV-MDI protocol using the EPR states coupled with optical amplifiers. It can implement a practical quantum network scheme, where the legal participants create the secret correlations by using EPR states connecting to an untrusted relay via insecure links and applying the multi-entangled Greenberger-Horne-Zeilinger (GHZ) state analysis at relay station. Despite the possibility that the relay could be completely tampered with and imperfect links are subject to the powerful attacks, the legal participants are still able to extract a secret key from network communication. The numerical simulation indicates that the quantum network communication can be achieved in an asymmetric scenario, fulfilling the demands of a practical quantum network. Furthermore, we show that the use of optical amplifiers can compensate the inherent imperfections and improve the secret key rate of the CV-MDI system.

Business and continuity of operations: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

Science.gov (United States)

Tosh, Pritish K; Feldman, Henry; Christian, Michael D; Devereaux, Asha V; Kissoon, Niranjan; Dichter, Jeffrey R

2014-10-01

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

The Pediatric Emergency Care Applied Research Network Registry: A Multicenter Electronic Health Record Registry of Pediatric Emergency Care.

Science.gov (United States)

Deakyne Davies, Sara J; Grundmeier, Robert W; Campos, Diego A; Hayes, Katie L; Bell, Jamie; Alessandrini, Evaline A; Bajaj, Lalit; Chamberlain, James M; Gorelick, Marc H; Enriquez, Rene; Casper, T Charles; Scheid, Beth; Kittick, Marlena; Dean, J Michael; Alpern, Elizabeth R

2018-04-01

 Electronic health record (EHR)-based registries allow for robust data to be derived directly from the patient clinical record and can provide important information about processes of care delivery and patient health outcomes.  A data dictionary, and subsequent data model, were developed describing EHR data sources to include all processes of care within the emergency department (ED). ED visit data were deidentified and XML files were created and submitted to a central data coordinating center for inclusion in the registry. Automated data quality control occurred prior to submission through an application created for this project. Data quality reports were created for manual data quality review.  The Pediatric Emergency Care Applied Research Network (PECARN) Registry, representing four hospital systems and seven EDs, demonstrates that ED data from disparate health systems and EHR vendors can be harmonized for use in a single registry with a common data model. The current PECARN Registry represents data from 2,019,461 pediatric ED visits, 894,503 distinct patients, more than 12.5 million narrative reports, and 12,469,754 laboratory tests and continues to accrue data monthly.  The Registry is a robust harmonized clinical registry that includes data from diverse patients, sites, and EHR vendors derived via data extraction, deidentification, and secure submission to a central data coordinating center. The data provided may be used for benchmarking, clinical quality improvement, and comparative effectiveness research. Schattauer.

PollyNET - an emerging network of automated raman-polarizarion lidars for continuous aerosolprofiling

Science.gov (United States)

Baars, Holger; Althausen, Dietrich; Engelmann, Ronny; Heese, Birgit; Ansmann, Albert; Wandinger, Ulla; Hofer, Julian; Skupin, Annett; Komppula, Mika; Giannakaki, Eleni; Filioglou, Maria; Bortoli, Daniele; Silva, Ana Maria; Pereira, Sergio; Stachlewska, Iwona S.; Kumala, Wojciech; Szczepanik, Dominika; Amiridis, Vassilis; Marinou, Eleni; Kottas, Michail; Mattis, Ina; Müller, Gerhard

2018-04-01

PollyNET is a network of portable, automated, and continuously measuring Ramanpolarization lidars of type Polly operated by several institutes worldwide. The data from permanent and temporary measurements sites are automatically processed in terms of optical aerosol profiles and displayed in near-real time at polly.tropos.de. According to current schedules, the network will grow by 3-4 systems during the upcoming 2-3 years and will then comprise 11 permanent stations and 2 mobile platforms.

The ClaudicatioNet concept: design of a national integrated care network providing active and healthy aging for patients with intermittent claudication

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Lauret GJ

2012-08-01

Full Text Available Gert-Jan Lauret,1,2 Harm JH Gijsbers,3 Erik JM Hendriks,2 Marie-Louise Bartelink,4 Rob A de Bie,2 Joep AW Teijink1,2 On behalf of the ClaudicatioNet Study Group members1Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; 2Caphri Research Institute, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands; 3Dutch Society for Heart, Vascular and Lung Physiotherapy, Meijerslaan PG Heemstede, The Netherlands; 4Julius Center Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The NetherlandsIntroduction: Intermittent claudication (IC is a manifestation of peripheral arterial occlusive disease (PAOD. Besides cardiovascular risk management, supervised exercise therapy (SET should be offered to all patients with IC. Outdated guidelines, an insufficient number of specialized physiotherapists (PTs, lack of awareness of the importance of SET by referring physicians, and misguided financial incentives all seriously impede the availability of a structured SET program in The Netherlands.Description of care practice: By initiating regional care networks, ClaudicatioNet aims to improve the quality of care for patients with IC. Based on the chronic care model as a conceptual framework, these networks should enhance the access, continuity, and (cost efficiency of the health care system. With the aid of a national database, health care professionals will be able to benchmark patient results while ClaudicatioNet will be able to monitor quality of care by way of functional and patient reported outcome measures.Discussion: The success of ClaudicatioNet is dependent on several factors. Vascular surgeons, general practitioners and coordinating central caregivers will need to team up and work in close collaboration with specialized PTs. A substantial task in the upcoming years will be to monitor the quality, volume, and distribution of ClaudicatioNet PTs. Finally, misguided financial incentives

Effect of direct reciprocity and network structure on continuing prosperity of social networking services.

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Osaka, Kengo; Toriumi, Fujio; Sugawara, Toshihauru

2017-01-01

Social networking services (SNSs) are widely used as communicative tools for a variety of purposes. SNSs rely on the users' individual activities associated with some cost and effort, and thus it is not known why users voluntarily continue to participate in SNSs. Because the structures of SNSs are similar to that of the public goods (PG) game, some studies have focused on why voluntary activities emerge as an optimal strategy by modifying the PG game. However, their models do not include direct reciprocity between users, even though reciprocity is a key mechanism that evolves and sustains cooperation in human society. We developed an abstract SNS model called the reciprocity rewards and meta-rewards games that include direct reciprocity by extending the existing models. Then, we investigated how direct reciprocity in an SNS facilitates cooperation that corresponds to participation in SNS by posting articles and comments and how the structure of the networks of users exerts an influence on the strategies of users using the reciprocity rewards game. We run reciprocity rewards games on various complex networks and an instance network of Facebook and found that two types of stable cooperation emerged. First, reciprocity slightly improves the rate of cooperation in complete graphs but the improvement is insignificant because of the instability of cooperation. However, this instability can be avoided by making two assumptions: high degree of fun, i.e. articles are read with high probability, and different attitudes to reciprocal and non-reciprocal agents. We then propose the concept of half free riders to explain what strategy sustains cooperation-dominant situations. Second, we indicate that a certain WS network structure affects users' optimal strategy and facilitates stable cooperation without any extra assumptions. We give a detailed analysis of the different characteristics of the two types of cooperation-dominant situations and the effect of the memory of

Feasibility of Construction of the Continuously Operating Geodetic GPS Network of Sinaloa, Mexico

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Vazquez, G. E.; Jacobo, C.

2011-12-01

This research is based on the study and analysis of feasibility for the construction of the geodetic network for GPS continuous operation for Sinaloa, hereafter called (RGOCSIN). A GPS network of continuous operation is defined as that materialized structure physically through permanent monuments where measurements to the systems of Global Positioning (GPS) is performed continuously throughout a region. The GPS measurements in this network are measurements of accuracy according to international standards to define its coordinates, thus constituting the basic structure of geodetic referencing for a country. In this context is that in the near future the RGOCSIN constitutes a system state only accurate and reliable georeferencing in real-time (continuous and permanent operation) and will be used for different purposes; i.e., in addition to being fundamental basis for any lifting topographic or geodetic survey, and other areas such as: (1) Different construction processes (control and monitoring of engineering works); (2) Studies of deformation of the Earth's crust (before and after a seismic event); (3) GPS meteorology (weather forecasting); (4) Demarcation projects (natural and political); (5) Establishment of bases to generate mapping (necessary for the economic and social development of the state); (6) Precision agriculture (optimization of economic resources to the various crops); (7) Geographic information systems (Organization and planning activities associated with the design and construction of public services); (8) Urban growth (possible settlements in the appropriate form and taking care of the environmental aspect), among others. However there are criteria and regulations according to the INEGI (Instituto Nacional de Estadística y Geografía, http://www.inegi.org.mx/) that must be met; even for this stage of feasibility of construction that sees this project as a first phase. The fundamental criterion to be taken into account according to INEGI is a

Effect of continuous versus intermittent turning on nursing and non-nursing care time for acute spinal cord injuries.

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Bugaresti, J M; Tator, C H; Szalai, J P

1991-06-01

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.

Midwifery students׳ experiences of an innovative clinical placement model embedded within midwifery continuity of care in Australia.

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Carter, Amanda G; Wilkes, Elizabeth; Gamble, Jenny; Sidebotham, Mary; Creedy, Debra K

2015-08-01

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.

The influence of care interventions on the continuity of sleep of intensive care unit patients

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Fernanda Luiza Hamze

2015-10-01

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.

A survey of primary care resident attitudes toward continuity clinic patient handover

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Victor O. Kolade

2014-11-01

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.

Integrated palliative care in the Spanish context: a systematic review of the literature

NARCIS (Netherlands)

Garralda, E.; Hasselaar, J.G.; Carrasco, J.M.; Beek, K.; Siouta, N.; Csikos, A.; Menten, J.; Centeno, C.

2016-01-01

BACKGROUND: Integrated palliative care (IPC) involves bringing together administrative, organisational, clinical and service aspects in order to achieve continuity of care between all actors involved in the care network of patients receiving palliative care (PC) services. The purpose of this study

What are the roles involved in establishing and maintaining informational continuity of care within family practice? A systematic review

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Agarwal Gina

2008-12-01

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

Continued care of uranium mill sites: some economic considerations

International Nuclear Information System (INIS)

Harrington, W.; Sawyer, J.W. Jr.

1978-01-01

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

Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support

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Kapadia Dharmi

2011-05-01

Full Text Available Abstract Background Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support. Methods Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT, and the whole systems informing self-management engagement (WISE approach to self-care support. Discussion The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.

Professional social networking.

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Rowley, Robert D

2014-12-01

We review the current state of social communication between healthcare professionals, the role of consumer social networking, and some emerging technologies to address the gaps. In particular, the review covers (1) the current state of loose social networking for continuing medical education (CME) and other broadcast information dissemination; (2) social networking for business promotion; (3) social networking for peer collaboration, including simple communication as well as more robust data-centered collaboration around patient care; and (4) engaging patients on social platforms, including integrating consumer-originated data into the mix of healthcare data. We will see how, as the nature of healthcare delivery moves from the institution-centric way of tradition to a more social and networked ambulatory pattern that we see emerging today, the nature of health IT has also moved from enterprise-centric systems to more socially networked, cloud-based options.

Primary health care service delivery networks for the prevention and management of type 2 diabetes: using social network methods to describe interorganisational collaboration in a rural setting.

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McDonald, Julie; Jayasuriya, Rohan; Harris, Mark Fort

2011-01-01

Adults with type 2 diabetes or with behavioural risk factors require comprehensive and well coordinated responses from a range of health care providers who often work in different organisational settings. This study examines three types of collaborative links between organisations involved in a rural setting. Social network methods were employed using survey data on three types of links, and data was collected from a purposive sample of 17 organisations representing the major provider types. The analysis included a mix of unconfirmed and confirmed links, and network measures. General practices were the most influential provider group in initiating referrals, and they referred to the broadest range of organisations in the network. Team care arrangements formed a small part of the general practice referral network. They were used more for access to private sector allied health care providers and less for sharing care with public sector health services. Involvement in joint programs/activities was limited to public and non-government sector services, with no participation from the private sector. The patterns of interactions suggest that informal referral networks provide access to services and coordination of care for individual patients with diabetes. Two population subgroups would benefit from more proactive approaches to ensure equitable access to services and coordination of care across organisational boundaries: people with more complex health care needs and people at risk of developing diabetes.

Predictors of change and continuity in home care for dementia patients

NARCIS (Netherlands)

Vernooy-Dassen, M.J.F.J.; Felling, A.J.A.; Persoon, J.M.G.

1997-01-01

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

Continuous glucose and exhaled breath analysis in the Intensive Care Unit

NARCIS (Netherlands)

Leopold, J.H.

2017-01-01

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

Continuity in care of older people chronically ill patients in a battlefield of competing rationales

DEFF Research Database (Denmark)

Kjerholt, Mette; Wagner, Lis; Delmar, Charlotte

2014-01-01

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...

A scalable and continuous-upgradable optical wireless and wired convergent access network.

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Sung, J Y; Cheng, K T; Chow, C W; Yeh, C H; Pan, C-L

2014-06-02

In this work, a scalable and continuous upgradable convergent optical access network is proposed. By using a multi-wavelength coherent comb source and a programmable waveshaper at the central office (CO), optical millimeter-wave (mm-wave) signals of different frequencies (from baseband to > 100 GHz) can be generated. Hence, it provides a scalable and continuous upgradable solution for end-user who needs 60 GHz wireless services now and > 100 GHz wireless services in the future. During the upgrade, user only needs to upgrade their optical networking unit (ONU). A programmable waveshaper is used to select the suitable optical tones with wavelength separation equals to the desired mm-wave frequency; while the CO remains intact. The centralized characteristics of the proposed system can easily add any new service and end-user. The centralized control of the wavelength makes the system more stable. Wired data rate of 17.45 Gb/s and w-band wireless data rate up to 3.36 Gb/s were demonstrated after transmission over 40 km of single-mode fiber (SMF).

Continuing professional development for volunteers working in palliative care in a tertiary care cancer institute in India: A cross-sectional observational study of educational needs

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Jayita Kedar Deodhar

2015-01-01

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.

Technology-dependent children and the demand for pharmaceutical care.

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Okido, Aline Cristiane Cavicchioli; Cunha, Suelen Teles da; Neves, Eliane Tatsch; Dupas, Giselle; Lima, Regina Aparecida Garcia de

2016-01-01

to understand the experience of mothers of technology-dependent children as regards pharmaceutical care. this was a qualitative, descriptive-exploratory study developed based on open interviews using a structured characterization tool, and applied during home visits to 12 mothers caring for technology-dependent children. The data was submitted to inductive content analysis. this study is split into two themes: (i) maternal overload during pharmaceutical care, demonstrating the need to administer drugs continuously and the repercussions of this exhaustive care on the caregivers; (ii) the ease or difficulty of access to the medicines required, showing informal strategies and support networks. pharmaceutical care is a daily challenge expressed in maternal overload and difficulty accessing the drugs, made worse by failures in the care network and coordinated care.

Continuity of care: what matters to women when they are referred from primary to secondary care during labour? a qualitative interview study in the Netherlands.

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de Jonge, Ank; Stuijt, Rosan; Eijke, Iva; Westerman, Marjan J

2014-03-17

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

Evaluating program integration and the rise in collaboration: case study of a palliative care network.

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Bainbridge, Daryl; Brazil, Kevin; Krueger, Paul; Ploeg, Jenny; Taniguchi, Alan; Darnay, Julie

2011-01-01

There is increasing global interest in using regional palliative care networks (PCNs) to integrate care and create systems that are more cost-effective and responsive. We examined a PCN that used a community development approach to build capacity for palliative care in each distinct community in a region of southern Ontario, Canada, with the goal of achieving a competent integrated system. Using a case study methodology, we examined a PCN at the structural level through a document review, a survey of 20 organizational administrators, and an interview with the network director. The PCN identified 14 distinct communities at different stages of development within the region. Despite the lack of some key features that would facilitate efficient palliative care delivery across these communities, administrators largely viewed the network partnership as beneficial and collaborative. The PCN has attempted to recognize specific needs in each local area. Change is gradual but participatory. There remain structural issues that may negatively affect the functioning of the PCN.

Global asymptotic stability of Cohen-Grossberg neural network with continuously distributed delays

International Nuclear Information System (INIS)

Wan Li; Sun Jianhua

2005-01-01

The convergence dynamical behaviors of Cohen-Grossberg neural network with continuously distributed delays are discussed. By using Brouwer's fixed point theorem, matrix theory and analysis techniques such as Gronwall inequality, some new sufficient conditions guaranteeing the existence, uniqueness of an equilibrium point and its global asymptotic stability are obtained. An example is given to illustrate the theoretical results

The mentoring experiences of new graduate midwives working in midwifery continuity of care models in Australia.

Science.gov (United States)

Cummins, Allison M; Denney-Wilson, E; Homer, C S E

2017-05-01

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.

The US Network of Pediatric Multiple Sclerosis Centers: Development, Progress, and Next Steps

Science.gov (United States)

Casper, T. Charles; Rose, John W.; Roalstad, Shelly; Waubant, Emmanuelle; Aaen, Gregory; Belman, Anita; Chitnis, Tanuja; Gorman, Mark; Krupp, Lauren; Lotze, Timothy E.; Ness, Jayne; Patterson, Marc; Rodriguez, Moses; Weinstock-Guttman, Bianca; Browning, Brittan; Graves, Jennifer; Tillema, Jan-Mendelt; Benson, Leslie; Harris, Yolanda

2014-01-01

Multiple sclerosis and other demyelinating diseases in the pediatric population have received an increasing level of attention by clinicians and researchers. The low incidence of these diseases in children creates a need for the involvement of multiple clinical centers in research efforts. The Network of Pediatric Multiple Sclerosis Centers was created initially in 2006 to improve the diagnosis and care of children with demyelinating diseases. In 2010, the Network shifted its focus to multicenter research while continuing to advance the care of patients. The Network has obtained support from the National Multiple Sclerosis Society, the Guthy-Jackson Charitable Foundation, and the National Institutes of Health. The Network will continue to serve as a platform for conducting impactful research in pediatric demyelinating diseases of the central nervous system. This article provides a description of the history and development, organization, mission, research priorities, current studies, and future plans of the Network. PMID:25270659

Interest in Collaborative, Practice-Based Research Networks in Pediatric Refugee Health Care.

Science.gov (United States)

Shah, Sural; Yun, Katherine

2018-02-01

Over the last decade, approximately 200,000 refugee children have resettled across the United States. This population is dispersed, resulting in limited data. Collaborative research networks, where clinicians across distinct practice sites work together to answer research questions, can improve the evidence base regarding clinical care. We distributed a web-based survey to pediatric refugee providers around North America to assess priorities, perceived barriers and benefits to collaborative research. We recruited 57 participants. Of respondents, 89 % were interested in collaborative research, prioritizing: (1) access to health care (33 %), (2) mental health (24 %) and (3) nutrition/growth (24 %). Perceived benefits were "improving clinical practice" (98 %) and "raising awareness about the needs of pediatric refugees" (94 %). Perceived barriers were "too many other priorities" (89 %) and "lack of funding for data entry" (78 %). There is widespread interest in collaborative networks around pediatric refugee healthcare. A successful network will address barriers and emphasize priorities.

Needs assessment for home-based care and the strengthening of social support networks: the role of community care workers in rural South Africa

Directory of Open Access Journals (Sweden)

Mosa Moshabela

2015-12-01

Full Text Available Background: Community care workers (CCWs in rural South Africa provide medical, personal, household, educational, and social care services to their clients. However, little understanding exists on how provision of services is approached within a household, taking into account available social support networks. Objective: The aim of this study was to generate an understanding of the processes that underpin the provision of care by CCWs in rural households and their engagement with clients, primary caregivers (PCGs, and other members of the social support network. Design: We analysed in-depth interviews conducted in a triad of participants involved in a home-based care (HBC encounter – 32 clients, 32 PCGs, and 17 CCWs. For each triad, a purposefully selected CCW was linked with a purposefully selected client and the corresponding PCG using maximum variation sampling. Three coders used an inductive content analysis method to describe participants’ references to the nuances of processes followed by CCWs in servicing HBC clients. Written informed consent was obtained from all participants. Findings: The results suggest that, by intuition and prior knowledge, CCWs treated each household uniquely, depending on the clients’ care needs, cooperation, availability of a social network, and the reliability and resilience of the social support system for the client. Four distinct processes took place in rural households: needs assessment for care, rationing of care, appraisal of care, and reinforcement of a social support system. However, there was no particular order or sequence established for these processes, and caregivers followed no prescribed or shared standards. Conclusions: CCWs bring a basket of services to a household, but engage in a constant, dynamic, and cyclical process of weighing needs against services provided. The service package is uniquely crafted and tailored for each household, depending on the absorptive capacity of the social

Patient experienced continuity of care in the psychiatric healthcare system-a study including immigrants, refugees and ethnic danes.

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Jensen, Natasja Koitzsch; Johansen, Katrine Schepelern; Kastrup, Marianne; Krasnik, Allan; Norredam, Marie

2014-09-17

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.

The perspectives of clinical staff and bereaved informal care-givers on the use of continuous sedation until death for cancer patients: The study protocol of the UNBIASED study

Science.gov (United States)

2011-01-01

Background A significant minority of dying people experience refractory symptoms or extreme distress unresponsive to conventional therapies. In such circumstances, sedation may be used to decrease or remove consciousness until death occurs. This practice is described in a variety of ways, including: 'palliative sedation', 'terminal sedation', 'continuous deep sedation until death', 'proportionate sedation' or 'palliative sedation to unconsciousness'. Surveys show large unexplained variation in incidence of sedation at the end of life across countries and care settings and there are ethical concerns about the use, intentions, risks and significance of the practice in palliative care. There are also questions about how to explain international variation in the use of the practice. This protocol relates to the UNBIASED study (UK Netherlands Belgium International Sedation Study), which comprises three linked studies with separate funding sources in the UK, Belgium and the Netherlands. The aims of the study are to explore decision-making surrounding the application of continuous sedation until death in contemporary clinical practice, and to understand the experiences of clinical staff and decedents' informal care-givers of the use of continuous sedation until death and their perceptions of its contribution to the dying process. The UNBIASED study is part of the European Association for Palliative Care Research Network. Methods/Design To realize the study aims, a two-phase study has been designed. The study settings include: the domestic home, hospital and expert palliative care sites. Phase 1 consists of: a) focus groups with health care staff and bereaved informal care-givers; and b) a preliminary case notes review to study the range of sedation therapy provided at the end of life to cancer patients who died within a 12 week period. Phase 2 employs qualitative methods to develop 30 patient-centred case studies in each country. These involve interviews with staff and

[Continuous subcutaneous infusion in palliative care, an undervalued method].

Science.gov (United States)

van Marum, R J; de Vogel, E M; Zylicz, Z

2002-11-23

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.

The new health-care quality: value, outcomes, and continuous improvement.

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O'Connor, S J; Lanning, J A

1991-01-01

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.

Addressing the Concerns Surrounding Continuous Deep Sedation in Singapore and Southeast Asia: A Palliative Care Approach.

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Krishna, Lalit Kumar Radha

2015-09-01

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.

Taiwan Automated Telescope Network

Directory of Open Access Journals (Sweden)

Dean-Yi Chou

2010-01-01

can be operated either interactively or fully automatically. In the interactive mode, it can be controlled through the Internet. In the fully automatic mode, the telescope operates with preset parameters without any human care, including taking dark frames and flat frames. The network can also be used for studies that require continuous observations for selected objects.

Continuity and Change : Comparative Case Study of Hospital and Home Care Governance in The Netherlands

NARCIS (Netherlands)

Oomkens, Rosanne|info:eu-repo/dai/nl/314569286; Hoogenboom, Marcel|info:eu-repo/dai/nl/14667863X; Knijn, Trudie|info:eu-repo/dai/nl/072101032

2015-01-01

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

Global exponential stability of cellular neural networks with continuously distributed delays and impulses

International Nuclear Information System (INIS)

Wang Yixuan; Xiong Wanmin; Zhou Qiyuan; Xiao Bing; Yu Yuehua

2006-01-01

In this Letter cellular neural networks with continuously distributed delays and impulses are considered. Sufficient conditions for the existence and global exponential stability of a unique equilibrium point are established by using the fixed point theorem and differential inequality techniques. The results of this Letter are new and they complement previously known results

Social capital in a lower socioeconomic palliative care population: a qualitative investigation of individual, community and civic networks and relations.

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Lewis, Joanne M; DiGiacomo, Michelle; Currow, David C; Davidson, Patricia M

2014-01-01

Lower socioeconomic populations live and die in contexts that render them vulnerable to poorer health and wellbeing. Contexts of care at the end of life are overwhelmingly determined by the capacity and nature of formal and informal networks and relations to support care. To date, studies exploring the nature of networks and relations of support in lower socioeconomic populations at the end of life are absent. This qualitative study sought to identify the nature of individual, community and civic networks and relations that defined the contexts of care for this group. Semi-structured qualitative interviews were conducted with 16 patients and 6 informal carers who identified that they had social and economic needs and were from a lower socioeconomic area. A social capital questionnaire identifying individual, community and civic networks and relations formed the interview guide. Interviews were audio-taped, transcribed and analysed using framework analysis. Participants identified that individual and community networks and relations of support were mainly inadequate to meet care needs. Specifically, data revealed: (1) individual (informal caregivers) networks and relations were small and fragile due to the nature of conflict and crisis; (2) community trust and engagement was limited and shifted by illness and caregiving; (3) and formal care services were inconsistent and provided limited practical support. Some transitions in community relations for support were noted. Levels of civic and government engagement and support were overall positive and enabled access to welfare resources. Networks and relations of support are essential for ensuring quality end of life care is achieved. Lower socioeconomic groups are at a distinct disadvantage where these networks and relations are limited, as they lack the resources necessary to augment these gaps. Understanding of the nature of assets and limitations, in networks and relations of support, is necessary to inform

Integrated care organizations in Switzerland.

Science.gov (United States)

Berchtold, Peter; Peytremann-Bridevaux, Isabelle

2011-01-01

The Swiss health care system is characterized by its decentralized structure and high degree of local autonomy. Ambulatory care is provided by physicians working mainly independently in individual private practices. However, a growing part of primary care is provided by networks of physicians and health maintenance organizations (HMOs) acting on the principles of gatekeeping. The share of insured choosing an alternative (managed care) type of basic health insurance and therefore restrict their choice of doctors in return for lower premiums increased continuously since 1990. To date, an average of one out of eight insured person in Switzerland, and one out of three in the regions in north-eastern Switzerland, opted for the provision of care by general practitioners in one of the 86 physician networks or HMOs. About 50% of all general practitioners and more than 400 other specialists have joined a physician networks. Seventy-three of the 86 networks (84%) have contracts with the healthcare insurance companies in which they agree to assume budgetary co-responsibility, i.e., to adhere to set cost targets for particular groups of patients. Within and outside the physician networks, at regional and/or cantonal levels, several initiatives targeting chronic diseases have been developed, such as clinical pathways for heart failure and breast cancer patients or chronic disease management programs for patients with diabetes. Swiss physician networks and HMOs were all established solely by initiatives of physicians and health insurance companies on the sole basis of a healthcare legislation (Swiss Health Insurance Law, KVG) which allows for such initiatives and developments. The relevance of these developments towards more integration of healthcare as well as their implications for the future are discussed.

Net one, net two: the primary care network income statement.

Science.gov (United States)

Halley, M D; Little, A W

1999-10-01

Although hospital-owned primary care practices have been unprofitable for most hospitals, some hospitals are achieving competitive advantage and sustainable practice operations. A key to the success of some has been a net income reporting tool that separates practice operating expenses from the costs of creating and operating a network of practices to help healthcare organization managers, physicians, and staff to identify opportunities to improve the network's financial performance. This "Net One, Net Two" reporting allows operations leadership to be held accountable for Net One expenses and strategic leadership to be held accountable for Net Two expenses.

The continuing care retirement community executive: a manager for all seasons.

Science.gov (United States)

Hurley, R E; Brewer, K P

1991-01-01

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.

An “All Teach, All Learn” Approach to Research Capacity Strengthening in Indigenous Primary Health Care Continuous Quality Improvement

Science.gov (United States)

McPhail-Bell, Karen; Matthews, Veronica; Bainbridge, Roxanne; Redman-MacLaren, Michelle Louise; Askew, Deborah; Ramanathan, Shanthi; Bailie, Jodie; Bailie, Ross; Matthews, Veronica

2018-01-01

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

[Using eHealth in the Continuity Care of Chronic Kidney Disease: Opportunities and Considerations].

Science.gov (United States)

Chen, Yu-Chi; Chang, Polun

2016-04-01

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.

Practice Innovation, Health Care Utilization and Costs in a Network of Federally Qualified Health Centers and Hospitals for Medicaid Enrollees.

Science.gov (United States)

Johnson, Tricia J; Jones, Art; Lulias, Cheryl; Perry, Anthony

2018-06-01

State Medicaid programs need cost-effective strategies to provide high-quality care that is accessible to individuals with low incomes and limited resources. Integrated delivery systems have been formed to provide care across the continuum, but creating a shared vision for improving community health can be challenging. Medical Home Network was created as a network of primary care providers and hospital systems providing care to Medicaid enrollees, guided by the principles of egalitarian governance, practice-level care coordination, real-time electronic alerts, and pay-for-performance incentives. This analysis of health care utilization and costs included 1,189,195 Medicaid enrollees. After implementation of Medical Home Network, a risk-adjusted increase of $9.07 or 4.3% per member per month was found over the 2 years of implementation compared with an increase of $17.25 or 9.3% per member per month, before accounting for the cost of care management fees and other financial incentives, for Medicaid enrollees within the same geographic area with a primary care provider outside of Medical Home Network. After accounting for care coordination fees paid to providers, the net risk-adjusted cost reduction was $11.0 million.

Support network and social support for children with special health care need

Directory of Open Access Journals (Sweden)

Thaís Araújo Barbosa

2016-02-01

Full Text Available Objective: to understand and identify the support network and social support from the perspective of families of children with chronic conditions. Methods: a qualitative study, with content analysis of 134 records, followed by ten semi-structured interviews. Results: the analysis has revealed that the primary caregiver, the mother, participates in a network of limited support, only with the help of her husband, children, grandparents and the child´s godparents. They also have a social network through a multidisciplinary team, which in some cases is not effective. Conclusion: families have a deficient and limited support network and the demand for care rely only on the support of the husband, grandparents, children, and godparents. Social networking refers to the philanthropic institutions, while the aid of public service, basic health unit is basic.

Mobile Health to Maintain Continuity of Patient-Centered Care for Chronic Kidney Disease: Content Analysis of Apps.

Science.gov (United States)

Lee, Ying-Li; Cui, Yan-Yan; Tu, Ming-Hsiang; Chen, Yu-Chi; Chang, Polun

2018-04-20

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

Study of relation of continuing medical education to quality of family physicians' care.

Science.gov (United States)

Dunn, E V; Bass, M J; Williams, J I; Borgiel, A E; MacDonald, P; Spasoff, R A

1988-10-01

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.

The Benefits of Continuous Leisure Participation in Relocation Adjustment Among Residents of Long-Term Care Facilities.

Science.gov (United States)

Lin, Li-Jung; Yen, Hsin-Yen

2018-03-19

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

Local health care system utilizing the LPG (liquid propane gas) network.

Science.gov (United States)

Umemoto, T; Hoshi, H; Tsuda, M; Horio, S; Itou, N; Neriki, T

1998-07-01

JAC's LPG monitoring network system is mainly provided in mountain villages. However, by using this system, it will be possible to start a Digital Network Program for the Elderly while maintaining superior economic feasibility and public benefit using existing information infrastructures. This project also has the capabilities for the creation of a fire/disaster monitoring system, as well as a health care system by using conventional LPG monitoring systems. Telemedicine is an option for the future, as well, by connecting medical equipment and a tele-conferencing system.

Networked remote area dental services: a viable, sustainable approach to oral health care in challenging environments.

Science.gov (United States)

Dyson, Kate; Kruger, Estie; Tennant, Marc

2012-12-01

This study examines the cost effectiveness of a model of remote area oral health service. Retrospective financial analysis. Rural and remote primary health services. Clinical activity data and associated cost data relating to the provision of a networked visiting oral health service by the Centre for Rural and Remote Oral Health formed the basis of the study data frameset. The cost-effectiveness of the Centre's model of service provision at five rural and remote sites in Western Australia during the calendar years 2006, 2008 and 2010 was examined in the study. Calculations of the service provision costs and value of care provided were made using data records and the Fee Schedule of Dental Services for Dentists. The ratio of service provision costs to the value of care provided was determined for each site and was benchmarked against the equivalent ratios applicable to large scale government sector models of service provision. The use of networked models have been effective in other disciplines but this study is the first to show a networked hub and spoke approach of five spokes to one hub is cost efficient in remote oral health care. By excluding special cost-saving initiatives introduced by the Centre, the study examines easily translatable direct service provision costs against direct clinical care outcomes in some of Australia's most challenging locations. This study finds that networked hub and spoke models of care can be financially efficient arrangements in remote oral health care. © 2012 The Authors. Australian Journal of Rural Health © National Rural Health Alliance Inc.

Connecting research discovery with care delivery in dementia: the development of the Indianapolis Discovery Network for Dementia

Directory of Open Access Journals (Sweden)

Boustani MA

2012-11-01

Full Text Available Malaz A Boustani,1–3 Amie Frame,1,2 Stephanie Munger,1,2 Patrick Healey,4 Jessie Westlund,5 Martin Farlow,6,7 Ann Hake,8 Mary Guerriero Austrom,6,9 Polly Shepard,10 Corby Bubp,10 Jose Azar,3 Arif Nazir,3 Nadia Adams,11 Noll L Campbell,1,2,12,13 Azita Chehresa,5 Paul Dexter2,31Indiana University Center for Aging Research, 2Regenstrief Institute, Inc, 3Department of Medicine, Indiana University School of Medicine (IUSM, 4St Vincent Health Network, 5Community Health Network, 6Indiana Alzheimer Disease Center, IUSM, 7Department of Neurology, IUSM, 8Eli Lilly and Company, 9Department of Psychiatry, IUSM, 10The Memory Clinic of Indianapolis, 11Indiana University Health, Indianapolis, IN, USA; 12Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN, USA; 13Department of Pharmacy, Wishard Health Services, Indianapolis, IN, USABackground: The US Institute of Medicine has recommended an integrated, locally sensitive collaboration among the various members of the community, health care systems, and research organizations to improve dementia care and dementia research.Methods: Using complex adaptive system theory and reflective adaptive process, we developed a professional network called the “Indianapolis Discovery Network for Dementia” (IDND. The IDND facilitates effective and sustainable interactions among a local and diverse group of dementia researchers, clinical providers, and community advocates interested in improving care for dementia patients in Indianapolis, Indiana.Results: The IDND was established in February 2006 and now includes more than 250 members from more than 30 local (central Indiana organizations representing 20 disciplines. The network uses two types of communication to connect its members. The first is a 2-hour face-to-face bimonthly meeting open to all members. The second is a web-based resource center (http://www.indydiscoverynetwork.org. To date, the network has: (1 accomplished the

Characterizing steady states of genome-scale metabolic networks in continuous cell cultures.

Directory of Open Access Journals (Sweden)

Jorge Fernandez-de-Cossio-Diaz

2017-11-01

Full Text Available In the continuous mode of cell culture, a constant flow carrying fresh media replaces culture fluid, cells, nutrients and secreted metabolites. Here we present a model for continuous cell culture coupling intra-cellular metabolism to extracellular variables describing the state of the bioreactor, taking into account the growth capacity of the cell and the impact of toxic byproduct accumulation. We provide a method to determine the steady states of this system that is tractable for metabolic networks of arbitrary complexity. We demonstrate our approach in a toy model first, and then in a genome-scale metabolic network of the Chinese hamster ovary cell line, obtaining results that are in qualitative agreement with experimental observations. We derive a number of consequences from the model that are independent of parameter values. The ratio between cell density and dilution rate is an ideal control parameter to fix a steady state with desired metabolic properties. This conclusion is robust even in the presence of multi-stability, which is explained in our model by a negative feedback loop due to toxic byproduct accumulation. A complex landscape of steady states emerges from our simulations, including multiple metabolic switches, which also explain why cell-line and media benchmarks carried out in batch culture cannot be extrapolated to perfusion. On the other hand, we predict invariance laws between continuous cell cultures with different parameters. A practical consequence is that the chemostat is an ideal experimental model for large-scale high-density perfusion cultures, where the complex landscape of metabolic transitions is faithfully reproduced.

Social networks of nursing staff and organizational performance. A study in long-term care facilities

NARCIS (Netherlands)

Beek, A.P.A van

2013-01-01

Over the years, there has been increasing attention for the role of social networks in explaining performance differences between organizations. Yet, research on social networks within healthcare organizations in general and long-term care facilities specifically has been rare, despite growing

An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia

OpenAIRE

Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

2016-01-01

The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various healthcare service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The current work is a quality monitoring report of a novel care setting, called Integrated Care Initiative Schizophrenia. It has implemented a networked care con...

Connecting primary care clinics and community pharmacies through a nationwide electronic prescribing network: A qualitative study

Directory of Open Access Journals (Sweden)

Marie-Pierre Gagnon

2015-10-01

Full Text Available Background The use of medication is at the heart of primary care, but is also the cause for major health concerns. It is therefore important to examine the prescription of medication process.Objective This study identifies the barriers and facilitators perceived by community pharmacists and primary care physicians concerning the adoption of a nationwide electronic prescribing (e-prescribing network in the province of Quebec, Canada.Methods We used purposive sampling to identify the most intensive users of the e-prescribing network. We conducted phone and in-person interviews. Interviews were transcribed, and we analysed their content with NVivo, using the clinical adoption framework (CAF for the codification of the data.Results We interviewed 33 pharmacists, 2 pharmacy technicians, 11 physicians and 3 clinic managers. Adoption of the e-prescribing network was fairly low. The respondents underlined adaptation of their work environment, openness to change and perception of benefits as facilitators to the adoption of the network. However, important barriers were perceived, including system quality issues and paper prescriptions being the only legal document in the prescribing process. Even if respondents recognised that the e-prescribing network can offer substantial benefits to the prescribing process, issues still persisted and raised barriers to the full use of such a network, especially in a context where different local information systems are connected within a nationwide e-prescribing network.Conclusion This study, based on the CAF, provides a better understanding of the factors related to the adoption of a nationwide e-prescribing network connecting primary care clinics and community pharmacies. 

Sustaining Transfers through Affordable Research Translation (START): study protocol to assess knowledge translation interventions in continuing care settings.

Science.gov (United States)

Slaughter, Susan E; Estabrooks, Carole A; Jones, C Allyson; Wagg, Adrian S; Eliasziw, Misha

2013-10-26

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

The facilitators’ point of view regarding the primary health care planning as a continuing education program

Directory of Open Access Journals (Sweden)

Kênia Lara Silva

2012-09-01

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.

Evidence, Engagement, and Technology: Themes of and the State of Primary Care Practice-based Network Research.

Science.gov (United States)

Nease, Donald E

2016-01-01

Practice-based research supported by practice-based research network (PBRN) infrastructure has historically provided an important method for challenging guidelines and evidence arising from secondary and tertiary care settings. This sample of current practice-based research in this issue of the JABFM provides an opportunity to ask whether practice-based research continues to address questions relevant to primary care practices and clinicians and whether a PBRN infrastructure is instrumental to maintaining the relevance and feasibility of practice-based research. Based on this issue's articles, the current state of practice-based research seems to be good, at face value addressing relevant issues for primary care practices. Less clear is the degree to which PBRN infrastructures and relationships informed the questions asked and facilitated the implementation of the studies presented. Practice-based research-related articles that routinely report about how study questions arose-from practices and their clinicians, staff and communities, or elsewhere-could help directly answer questions of relevance. In addition, reporting how practices are recruited to practice-based research studies could inform the degree to which ongoing relationships central to PBRNs facilitate the recruitment and conduct of practice-based research. © Copyright 2016 by the American Board of Family Medicine.

Audit Trail Management System in Community Health Care Information Network.

Science.gov (United States)

Nakamura, Naoki; Nakayama, Masaharu; Nakaya, Jun; Tominaga, Teiji; Suganuma, Takuo; Shiratori, Norio

2015-01-01

After the Great East Japan Earthquake we constructed a community health care information network system. Focusing on the authentication server and portal server capable of SAML&ID-WSF, we proposed an audit trail management system to look over audit events in a comprehensive manner. Through implementation and experimentation, we verified the effectiveness of our proposed audit trail management system.

An initiative to improve the management of clinically significant test results in a large health care network.

Science.gov (United States)

Roy, Christopher L; Rothschild, Jeffrey M; Dighe, Anand S; Schiff, Gordon D; Graydon-Baker, Erin; Lenoci-Edwards, Jennifer; Dwyer, Cheryl; Khorasani, Ramin; Gandhi, Tejal K

2013-11-01

The failure of providers to communicate and follow up clinically significant test results (CSTR) is an important threat to patient safety. The Massachusetts Coalition for the Prevention of Medical Errors has endorsed the creation of systems to ensure that results can be received and acknowledged. In 2008 a task force was convened that represented clinicians, laboratories, radiology, patient safety, risk management, and information systems in a large health care network with the goals of providing recommendations and a road map for improvement in the management of CSTR and of implementing this improvement plan during the sub-force sequent five years. In drafting its charter, the task broadened the scope from "critical" results to "clinically significant" ones; clinically significant was defined as any result that requires further clinical action to avoid morbidity or mortality, regardless of the urgency of that action. The task force recommended four key areas for improvement--(1) standardization of policies and definitions, (2) robust identification of the patient's care team, (3) enhanced results management/tracking systems, and (4) centralized quality reporting and metrics. The task force faced many challenges in implementing these recommendations, including disagreements on definitions of CSTR and on who should have responsibility for CSTR, changes to established work flows, limitations of resources and of existing information systems, and definition of metrics. This large-scale effort to improve the communication and follow-up of CSTR in a health care network continues with ongoing work to address implementation challenges, refine policies, prepare for a new clinical information system platform, and identify new ways to measure the extent of this important safety problem.

[Continuous medical education of general practitioners/family doctors in chronic wound care].

Science.gov (United States)

Sinozić, Tamara; Kovacević, Jadranka

2014-10-01

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

[Continuity of nutritional care at discharge in the era of ICT].

Science.gov (United States)

Martínez Olmos, Miguel Ángel

2015-05-07

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.

The perspectives of clinical staff and bereaved informal care-givers on the use of continuous sedation until death for cancer patients: The study protocol of the UNBIASED study

Directory of Open Access Journals (Sweden)

van der Heide Agnes

2011-03-01

Full Text Available Abstract Background A significant minority of dying people experience refractory symptoms or extreme distress unresponsive to conventional therapies. In such circumstances, sedation may be used to decrease or remove consciousness until death occurs. This practice is described in a variety of ways, including: 'palliative sedation', 'terminal sedation', 'continuous deep sedation until death', 'proportionate sedation' or 'palliative sedation to unconsciousness'. Surveys show large unexplained variation in incidence of sedation at the end of life across countries and care settings and there are ethical concerns about the use, intentions, risks and significance of the practice in palliative care. There are also questions about how to explain international variation in the use of the practice. This protocol relates to the UNBIASED study (UK Netherlands Belgium International Sedation Study, which comprises three linked studies with separate funding sources in the UK, Belgium and the Netherlands. The aims of the study are to explore decision-making surrounding the application of continuous sedation until death in contemporary clinical practice, and to understand the experiences of clinical staff and decedents' informal care-givers of the use of continuous sedation until death and their perceptions of its contribution to the dying process. The UNBIASED study is part of the European Association for Palliative Care Research Network. Methods/Design To realize the study aims, a two-phase study has been designed. The study settings include: the domestic home, hospital and expert palliative care sites. Phase 1 consists of: a focus groups with health care staff and bereaved informal care-givers; and b a preliminary case notes review to study the range of sedation therapy provided at the end of life to cancer patients who died within a 12 week period. Phase 2 employs qualitative methods to develop 30 patient-centred case studies in each country. These involve

Mental health care delivery system reform in Belgium: the challenge of achieving deinstitutionalisation whilst addressing fragmentation of care at the same time.

Science.gov (United States)

Nicaise, Pablo; Dubois, Vincent; Lorant, Vincent

2014-04-01

Most mental health care delivery systems in welfare states currently face two major issues: deinstitutionalisation and fragmentation of care. Belgium is in the process of reforming its mental health care delivery system with the aim of simultaneously strengthening community care and improving integration of care. The new policy model attempts to strike a balance between hospitals and community services, and is based on networks of services. We carried out a content analysis of the policy blueprint for the reform and performed an ex-ante evaluation of its plan of operation, based on the current knowledge of mental health service networks. When we examined the policy's multiple aims, intermediate goals, suggested tools, and their articulation, we found that it was unclear how the new policy could achieve its goals. Indeed, deinstitutionalisation and integration of care require different network structures, and different modes of governance. Furthermore, most of the mechanisms contained within the new policy were not sufficiently detailed. Consequently, three major threats to the effectiveness of the reform were identified. These were: issues concerning the relationship between network structure and purpose, the continued influence of hospitals despite the goal of deinstitutionalisation, and the heterogeneity in the actual implementation of the new policy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Prediction of hot-ductility of steels during continuous casting using artificial neural networks

International Nuclear Information System (INIS)

Liu, W.J.; Emadi, D.; Essadiqi, E.

2000-01-01

During continuous casting, transversal cracks can be developed due to tensile stress in temperature regions where the steel exhibits a low ductility. The cracking tendency during continuous casting depends on the steel chemistry and the casting parameters such as lubrication, mold type, secondary cooling and bending/unbending temperatures. To prevent cracking one needs to predict the hot-ductility of a material under continuous-casting conditions. However, hot-ductility is one of the poorly understood material behaviors and cannot be readily modeled using conventional techniques. In the present study, we used an alternative method, namely Artificial Neural Networks (ANN), to model the ductility of a steel under continuous casting conditions. A hot-ductility database was established based on published literature. Several standard three-layer ANN models were then trained using data randomly selected from the database. The outputs of the ANN models were subsequently compared with the remaining data in the database. The results indicate that ANN is a suitable modelling technique for hot-ductility prediction. (author)

[The effectiveness of continuing care models in patients with chronic diseases: a systematic review].

Science.gov (United States)

Chen, Hsiao-Mei; Han, Tung-Chen; Chen, Ching-Min

2014-04-01

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.

Evaluation of intersectoral resources in the composition of care networks for crack users

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Leandro Barbosa de Pinho

2017-10-01

Full Text Available Abstract Objective: To evaluate the intersectoral resources in the composition of care networks for crack users. Method: Evaluative, qualitative study based on the Fourth Generation Evaluation. The participants were 10 users, 11 family members, eight workers, and seven managers from a municipality in the metropolitan region of Porto Alegre/Rio Grande do Sul, Brazil. Data were collected in 2014 through observation and semi-structured interviews. The analysis occurred by the constant comparative method. Results: Stakeholders have discussed how the Public Prosecutor's Office and the Military Brigade are inserted in the network, since they carry out actions that often are not compatible with the psychosocial care proposal. The need for expansion and maintenance of liaisons with community resources was identified. Conclusion: It is noted the need for sector integration and participation of all social agents from different spheres in order to promote and evaluate the practices and policies of care for crack users.

Continuity of care: what matters to women when they are referred from primary to secondary care during labour? a qualitative interview study in the Netherlands

NARCIS (Netherlands)

de Jonge, J.; Stuijt, R.; Eijke, I.; Westerman, M.J.

2014-01-01

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

Older patients' experiences during care transition

Directory of Open Access Journals (Sweden)

Rustad EC

2016-05-01

Full Text Available Else Cathrine Rustad,1–4 Bodil Furnes,1 Berit Seiger Cronfalk,2,5,6 Elin Dysvik1 1Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway; 2Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway; 3Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Haugesund, Norway; 4Department of Clinical Medicine, Helse Fonna Local Health Authority, Haugesund, Norway; 5Palliative Research Center, Ersta Sköndal University College, Stockholm, Sweden; 6Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden Background: A fragmented health care system leads to an increased demand for continuity of care across health care levels. Research indicates age-related differences during care transition, with the oldest patients having experiences and needs that differ from those of other patients. To meet the older patients’ needs and preferences during care transition, professionals must understand their experiences.Objective: The purpose of the study was to explore how patients ≥80 years of age experienced the care transition from hospital to municipal health care services.Methods: The study has a descriptive, explorative design, using semistructured interviews. Fourteen patients aged ≥80 participated in the study. Qualitative content analysis was used to describe the individuals’ experiences during care transition.Results: Two complementary themes emerged during the analysis: “Participation depends on being invited to plan the care transition” and “Managing continuity of care represents a complex and challenging process”.Discussion: Lack of participation, insufficient information, and vague responsibilities among staff during care transition seemed to limit the continuity of care. The patients are the vulnerable part of the care transition process, although they possess important

Networks of Learning : Professional Association and the Continuing Education of Teachers of Mathematics in Pakistan

DEFF Research Database (Denmark)

Baber, Sikunder Ali

" and shows how a number of professional associations have become as networks of learning to encourage the continuing professional education of both pre-service and in-service teachers in the context of Pakistan. A case of the Mathematics Association of Pakistan (MAP) as a Network of Learning is presented....... The formation and growth of this network can be viewed as developing insights into the improvement of mathematics education in the developing world. The contributions of the association may also add value to the learning of teacher colleagues in other parts of the world. This sharing of the experience may......Importance of the professional development of teachers has been recognized and research has contributed greatly in terms of proposing variety of approaches for the development of teachers,both pre-service and in-service. Among them, networking among teachers, teacher educators,curriculum developers...

Partnership effectiveness in primary community care networks: A national empirical analysis of partners' coordination infrastructure designs.

Science.gov (United States)

Lin, Blossom Yen-Ju; Lin, Yung-Kai; Lin, Cheng-Chieh

2010-01-01

Previous empirical and managerial studies have ignored the effectiveness of integrated health networks. It has been argued that the varying definitions and strategic imperatives of integrated organizations may have complicated the assessment of the outcomes/performance of varying models, particularly when their market structures and contexts differed. This study aimed to empirically verify a theoretical perspective on the coordination infrastructure designs and the effectiveness of the primary community care networks (PCCNs) formed and funded by the Bureau of National Health Insurance since March 2003. The PCCNs present a model to replace the traditional fragmented providers in Taiwan's health care. The study used a cross-sectional mailed survey designed to ascertain partnership coordination infrastructure and integration of governance, clinical care, bonding, finances, and information. The outcome indicators were PCCNs' perceived performance and willingness to remain within the network. Structural equation modeling examined the causal relationships, controlling for organizational and environmental factors. Primary data collection occurred from February through December 2005, via structured questionnaires sent to 172 PCCNs. Using the individual PCCN as the unit of analysis, the results found that a network's efforts regarding coordination infrastructures were positively related to the PCCN's perceived performance and willingness to remain within the network. In addition, PCCNs practicing in rural areas and in areas with higher density of medical resources had better perceived effectiveness and willingness to cooperate in the network.Practical Implication: The lack of both an operational definition and an information about system-wide integration may have obstructed understanding of integrated health networks' organizational dynamics. This study empirically examined individual PCCNs and offers new insights on how to improve networks' organizational design and

Optimizing Diamond Structured Automobile Supply Chain Network Towards a Robust Business Continuity Management

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Abednico Montshiwa

2016-02-01

Full Text Available This paper presents an optimized diamond structured automobile supply chain network towards a robust Business Continuity Management model. The model is necessitated by the nature of the automobile supply chain. Companies in tier two are centralized and numerically limited and have to supply multiple tier one companies with goods and services. The challenge with this supply chain structure is the inherent risks in the supply chain. Once supply chain disruption takes place at tier 2 level, the whole supply chain network suffers huge loses. To address this challenge, the paper replaces Risk Analysis with Risk Ranking and it introduces Supply Chain Cooperation (SCC to the traditional Business Continuity Plan (BCP concept. The paper employed three statistical analysis techniques (correlation analysis, regression analysis and Smart PLS 3.0 calculations. In this study, correlation and regression analysis results on risk rankings, SCC and Business Impact Analysis were significant, ascertaining the value of the model. The multivariate data analysis calculations demonstrated that SCC has a positive total significant effect on risk rankings and BCM while BIA has strongest positive effects on all BCP factors. Finally, sensitivity analysis demonstrated that company size plays a role in BCM.

Patient referral patterns and the spread of hospital-acquired infections through national health care networks.

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Tjibbe Donker

2010-03-01

Full Text Available Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA, are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the Dutch medical registration of 2004 to measure the connectedness between hospitals. This allowed us to reconstruct the network of hospitals in the Netherlands. We used mathematical models to assess the effect of different patient referral patterns on the potential spread of hospital-acquired infections between hospitals, and between categories of hospitals (University medical centers, top clinical hospitals and general hospitals. University hospitals have a higher number of shared patients than teaching or general hospitals, and are therefore more likely to be among the first to receive colonized patients. Moreover, as the network is directional towards university hospitals, they have a higher prevalence, even when infection control measures are equally effective in all hospitals. Patient referral patterns have a profound effect on the spread of health care-associated infections like hospital-acquired MRSA. The MRSA prevalence therefore differs between hospitals with the position of each hospital within the health care network. Any comparison of MRSA rates between hospitals, as a benchmark for hospital hygiene, should therefore take the position of a hospital within the network into account.

3D position estimation using an artificial neural network for a continuous scintillator PET detector

International Nuclear Information System (INIS)

Wang, Y; Zhu, W; Cheng, X; Li, D

2013-01-01

Continuous crystal based PET detectors have features of simple design, low cost, good energy resolution and high detection efficiency. Through single-end readout of scintillation light, direct three-dimensional (3D) position estimation could be another advantage that the continuous crystal detector would have. In this paper, we propose to use artificial neural networks to simultaneously estimate the plane coordinate and DOI coordinate of incident γ photons with detected scintillation light. Using our experimental setup with an ‘8 + 8’ simplified signal readout scheme, the training data of perpendicular irradiation on the front surface and one side surface are obtained, and the plane (x, y) networks and DOI networks are trained and evaluated. The test results show that the artificial neural network for DOI estimation is as effective as for plane estimation. The performance of both estimators is presented by resolution and bias. Without bias correction, the resolution of the plane estimator is on average better than 2 mm and that of the DOI estimator is about 2 mm over the whole area of the detector. With bias correction, the resolution at the edge area for plane estimation or at the end of the block away from the readout PMT for DOI estimation becomes worse, as we expect. The comprehensive performance of the 3D positioning by a neural network is accessed by the experimental test data of oblique irradiations. To show the combined effect of the 3D positioning over the whole area of the detector, the 2D flood images of oblique irradiation are presented with and without bias correction. (paper)

[Semantic Network Analysis of Online News and Social Media Text Related to Comprehensive Nursing Care Service].

Science.gov (United States)

Kim, Minji; Choi, Mona; Youm, Yoosik

2017-12-01

As comprehensive nursing care service has gradually expanded, it has become necessary to explore the various opinions about it. The purpose of this study is to explore the large amount of text data regarding comprehensive nursing care service extracted from online news and social media by applying a semantic network analysis. The web pages of the Korean Nurses Association (KNA) News, major daily newspapers, and Twitter were crawled by searching the keyword 'comprehensive nursing care service' using Python. A morphological analysis was performed using KoNLPy. Nodes on a 'comprehensive nursing care service' cluster were selected, and frequency, edge weight, and degree centrality were calculated and visualized with Gephi for the semantic network. A total of 536 news pages and 464 tweets were analyzed. In the KNA News and major daily newspapers, 'nursing workforce' and 'nursing service' were highly rated in frequency, edge weight, and degree centrality. On Twitter, the most frequent nodes were 'National Health Insurance Service' and 'comprehensive nursing care service hospital.' The nodes with the highest edge weight were 'national health insurance,' 'wards without caregiver presence,' and 'caregiving costs.' 'National Health Insurance Service' was highest in degree centrality. This study provides an example of how to use atypical big data for a nursing issue through semantic network analysis to explore diverse perspectives surrounding the nursing community through various media sources. Applying semantic network analysis to online big data to gather information regarding various nursing issues would help to explore opinions for formulating and implementing nursing policies. © 2017 Korean Society of Nursing Science

Telephone survey of private patients' views on continuity of care and registration with general practice in Ireland.

LENUS (Irish Health Repository)

Carmody, Patricia

2007-01-01

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

Continuity of care in dermatology residency programs in the United States.

Science.gov (United States)

Loh, Tiffany; Vazirnia, Aria; Afshar, Maryam; Dorschner, Robert; Paravar, Taraneh

2017-05-15

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).

Home hospitalization in the spectrum of community geriatric care.

Science.gov (United States)

Stessman, J; Hammerman-Rozenberg, R; Cohen, A

1997-04-01

The Home Hospitalization Programme was initiated in Jerusalem in 1991 to provide intensive medical care at home in order to prevent or shorten hospitalizations. The programme was based upon regular home visits by physicians, and nursing assessment to determine the need for regular nursing care. Primary-care physicians and nurses were renumerated by a global monthly fee, and were on 24-h call in addition to their periodic visits. Patients were recruited by senior geriatric physicians from acute hospital wards, as well as from the community, at the family doctor's request. Ancillary services available to the home hospitalization team included laboratory and electrocardiographic testing, specialty consultations, physical occupational or speech therapy, social work and home help up to 3 h daily. Monthly visits by a senior physician provided oversight and further consultation. Home hospitalization grew out of the continuing care division of the Clalit Sick Fund, a health maintenance organization providing umbrella medical insurance and ambulatory care. The programme grew synergistically with the other facilities of continuing care to encompass a network of comprehensive services to acute, subacute and chronic patients both at home and in institutional settings. In 4 years this network succeeded in establishing the focus of subacute intensive care in the community, achieving high levels of patient and family satisfaction, as well as striking economic advantages. In its first 2 years of operation home hospitalization saved S4 million due to reduced hospital utilization, and preliminary data for the subsequent 2 years indicated that this trend continued. Home hospitalization became the hub of a far-reaching system of supportive, intensive and humane care in the community.

Continuous Timescale Long-Short Term Memory Neural Network for Human Intent Understanding

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Zhibin Yu

2017-08-01

Full Text Available Understanding of human intention by observing a series of human actions has been a challenging task. In order to do so, we need to analyze longer sequences of human actions related with intentions and extract the context from the dynamic features. The multiple timescales recurrent neural network (MTRNN model, which is believed to be a kind of solution, is a useful tool for recording and regenerating a continuous signal for dynamic tasks. However, the conventional MTRNN suffers from the vanishing gradient problem which renders it impossible to be used for longer sequence understanding. To address this problem, we propose a new model named Continuous Timescale Long-Short Term Memory (CTLSTM in which we inherit the multiple timescales concept into the Long-Short Term Memory (LSTM recurrent neural network (RNN that addresses the vanishing gradient problem. We design an additional recurrent connection in the LSTM cell outputs to produce a time-delay in order to capture the slow context. Our experiments show that the proposed model exhibits better context modeling ability and captures the dynamic features on multiple large dataset classification tasks. The results illustrate that the multiple timescales concept enhances the ability of our model to handle longer sequences related with human intentions and hence proving to be more suitable for complex tasks, such as intention recognition.

Research on continuous environmental radiation monitoring system for NPP based on wireless sensor network

International Nuclear Information System (INIS)

Fu Hailong; Jia Mingchun; Peng Guichu

2010-01-01

According to the characteristics of environmental gamma radiation monitoring and the requirement of nuclear power plant (NPP) developing, a new continuous environmental radiation monitoring system based on wireless sensor network (WSN) was presented. The basic concepts and application of WSN were introduced firstly. And then the characteristics of the new system were analyzed. At the same time the configuration of the WSN and the whole structure of the system were built. Finally, the crucial techniques used in system designing, such as the design of sensor node, the choice of communication mode and protocol, the time synchronization and space location, the security of the network and the faults tolerance were introduced. (authors)

Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

Directory of Open Access Journals (Sweden)

Lars Henrik Myklebust

2011-12-01

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

Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

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Lars Henrik Myklebust

2011-12-01

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

Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway

Science.gov (United States)

Myklebust, Lars Henrik; Olstad, Reidun; Bjorbekkmo, Svein; Eisemann, Martin; Wynn, Rolf; Sørgaard, Knut

2011-01-01

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

Performance Analysis of Dual-Polarized Massive MIMO System with Human-Care IoT Devices for Cellular Networks

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Jun-Ki Hong

2018-01-01

Full Text Available The performance analysis of the dual-polarized massive multiple-input multiple-output (MIMO system with Internet of things (IoT devices is studied when outdoor human-care IoT devices are connected to a cellular network via a dual-polarized massive MIMO system. The research background of the performance analysis of dual-polarized massive MIMO system with IoT devices is that recently the data usage of outdoor human-care IoT devices has increased. Therefore, the outdoor human-care IoT devices are necessary to connect with 5G cellular networks which can expect 1000 times higher performance compared with 4G cellular networks. Moreover, in order to guarantee the safety of the patient for emergency cases, a human-care Iot device must be connected to cellular networks which offer more stable communication for outdoors compared to short-range communication technologies such as Wi-Fi, Zigbee, and Bluetooth. To analyze the performance of the dual-polarized massive MIMO system for human-care IoT devices, a dual-polarized MIMO spatial channel model (SCM is proposed which considers depolarization effect between the dual-polarized transmit-antennas and the receive-antennas. The simulation results show that the performance of the dual-polarized massive MIMO system is improved about 16% to 92% for 20 to 150 IoT devices compared to conventional single-polarized massive MIMO system for identical size of the transmit array.

Networked learning in children's transition from day-care to school: Connections between contexts

DEFF Research Database (Denmark)

Odgaard, Ane Bjerre

This paper reports on a socioculturally informed design-based study concerning young children's use of tablets within the educational contexts constituting their transition from day-care to school. The study explores tablet-mediated and dialogical activities as potential means for negotiating...... connections between the different contexts which the children traverse during this transition. At several occasions, the participating 5- to 7-year-old children are invited to use tablets for producing photos, photo-collages and e-books about their everyday institutional environments, thus aiming at mediating...... these contexts are pivots of dialogue. Networked learning is thus conceptualized as a matter of networked situations and contexts for young children during their transition from day-care to primary school, and technological artefacts are viewed as potential means for mediating children's meaning making about...

Internal Medicine Residents' Perceptions of Team-Based Care and its Educational Value in the Continuity Clinic: A Qualitative Study.

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Soones, Tacara N; O'Brien, Bridget C; Julian, Katherine A

2015-09-01

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

Therapeutic itineraries for patients with cerebrovascular accident: fragmentation of care in a regionalized health network

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Márcia Cristina Rodrigues Fausto

Full Text Available Abstract Objectives: to analyze the itineraries of patients with cerebrovascular accident (CVA in the Interstate health region in San Francisco Valley. Methods: this study uses the qualitative approach through the construction of Therapeutic Itineraries (IT. In the IT mapping the observation was prioritized on the different points and forms to access health service in search of care. Results: sixteen semi-structured interviews with healthcare users were conducted. There were diverse forms to access and provide services at the Rede Interestadual de Atenção à Saúde do Vale do Médio São Francisco-PEBA (Interstate Healthcare Network Region in the San Francisco Valley, which could be characterized by disorganized and uncoordinated care in the analyzed cases, despite the guarantee of hospital care. The Primary Health Care (APS teams are present at a care point with most of the patients' itineraries, however, little integration to the regionalized network and they were unable to perform their functions and coordinate the care. It is observed pilgrimage assistance, fragmented care and difficulties in receiving care after post hospitalization which is essential for the patients’ rehabilitation. Conclusions: traces of fragments of the regional health system are important warning signs that points out fragility in PEBA and demonstrate persistent gaps in the public health system to fulfil the responsibility and guarantee individuals’ right for health.

CONTINUING EDUCATION TEACHER OF INDIGENOUS AND NON-INDIGENOUS MEDIATED SOCIAL NETWORK ON THE INTERNET: A PERSPECTIVE INTERCULTURAL

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Maria Cristina Lima Paniago Lopes

2013-04-01

Full Text Available This research aims to analyze continuous training of teachers indigenous and non-indigenous, mediated by a social network on Ning called Internet under an intercultural perspective. This social network has come up as a virtual community as they have been established emotional ties, webs of connections and relationships between its participants. This is a qualitative research and collaborative in the sense that the experiences of researchers and teachers are valued and shared within a social context. The results show that participants in the group continuing of education, despite their difficulties using the technology itself and with little technological infrastructure, they see these virtual spaces as a possibility for new discoveries, creations and knowledge production, not forsaking the customs, traditions and their own culture.

Storytelling: a care technology in continuing education for active ageing.

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Costa, Nadia Pinheiro da; Polaro, Sandra Helena Isse; Vahl, Eloá Aparecida Caliari; Gonçalves, Lucia Hisako Takase

2016-01-01

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.

Continuous flow left ventricular assist devices: shared care goals of monitoring and treating patients.

Science.gov (United States)

Estep, Jerry D; Trachtenberg, Barry H; Loza, Laurie P; Bruckner, Brian A

2015-01-01

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.

E-I balance emerges naturally from continuous Hebbian learning in autonomous neural networks.

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Trapp, Philip; Echeveste, Rodrigo; Gros, Claudius

2018-06-12

Spontaneous brain activity is characterized in part by a balanced asynchronous chaotic state. Cortical recordings show that excitatory (E) and inhibitory (I) drivings in the E-I balanced state are substantially larger than the overall input. We show that such a state arises naturally in fully adapting networks which are deterministic, autonomously active and not subject to stochastic external or internal drivings. Temporary imbalances between excitatory and inhibitory inputs lead to large but short-lived activity bursts that stabilize irregular dynamics. We simulate autonomous networks of rate-encoding neurons for which all synaptic weights are plastic and subject to a Hebbian plasticity rule, the flux rule, that can be derived from the stationarity principle of statistical learning. Moreover, the average firing rate is regulated individually via a standard homeostatic adaption of the bias of each neuron's input-output non-linear function. Additionally, networks with and without short-term plasticity are considered. E-I balance may arise only when the mean excitatory and inhibitory weights are themselves balanced, modulo the overall activity level. We show that synaptic weight balance, which has been considered hitherto as given, naturally arises in autonomous neural networks when the here considered self-limiting Hebbian synaptic plasticity rule is continuously active.

The feasibility of measuring social networks among older adults in assisted living and dementia special care units.

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Abbott, Katherine M; Bettger, Janet Prvu; Hampton, Keith N; Kohler, Hans-Peter

2015-03-01

Studies indicate that social integration has a significant influence on physical and mental health. Older adults experience an increased risk of social isolation as their social networks decline with fewer traditional opportunities to add new social relationships. Deaths of similar aged friends, cognitive and functional impairments, and relocating to a nursing home (NH) or assisted-living (AL) facility contribute to difficulties in maintaining one's social network. Due to the paucity of research examining the social networks of people residing in AL and NH, this study was designed to develop and test the feasibility of using a combination of methodological approaches to capture social network data among older adults living in AL and a dementia special care unit NH. Social network analysis of both egocentric and sociocentric networks was conducted to visualize the social networks of 15 residents of an AL neighborhood and 12 residents of a dementia special care unit NH and to calculate measures network size, centrality, and reciprocity. The combined egocentric and sociocentric method was feasible and provided a robust indicator of resident social networks highlighting individuals who were socially integrated as well as isolated. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The Continuing Growth of Global Cooperation Networks in Research: A Conundrum for National Governments.

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Caroline S Wagner

Full Text Available Global collaboration continues to grow as a share of all scientific cooperation, measured as coauthorships of peer-reviewed, published papers. The percent of all scientific papers that are internationally coauthored has more than doubled in 20 years, and they account for all the growth in output among the scientifically advanced countries. Emerging countries, particularly China, have increased their participation in global science, in part by doubling their spending on R&D; they are increasingly likely to appear as partners on internationally coauthored scientific papers. Given the growth of connections at the international level, it is helpful to examine the phenomenon as a communications network and to consider the network as a new organization on the world stage that adds to and complements national systems. When examined as interconnections across the globe over two decades, a global network has grown denser but not more clustered, meaning there are many more connections but they are not grouping into exclusive 'cliques'. This suggests that power relationships are not reproducing those of the political system. The network has features an open system, attracting productive scientists to participate in international projects. National governments could gain efficiencies and influence by developing policies and strategies designed to maximize network benefits-a model different from those designed for national systems.

[Using social network analysis to examine care for older drug users in three major cities in Germany : Results of a pilot study].

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Kuhn, U; Hofmann, L; Hoff, T; Färber, N

2018-05-04

Compared with the general population, chronic drug addicts already start showing typical aging problems by the age of 40 years. The increasing number of older drug addicts leads to questions of what an adequate health and social care should look like. This discussion particularly takes place in the context of a sufficient integration of different care systems. A sufficient integration requires an improvement in the networking of substance treatment, nursing care and medical care services. The purpose of this study was to investigate the care structure of older people who use drugs and the services involved in a social network analysis. This was a descriptive design of the pilot study. The study objective was to gain first-hand knowledge about the health and social care situation, the quality of care concerning this client group and to identify supply gaps. Therefore, the three regions Cologne, Dusseldorf and Frankfurt/Main were exemplarily examined. The data for the social network analysis was gathered by a quantitative online questionnaire. Therefore, especially central network members were contacted and asked to participate. The survey was conducted in two waves. In total, 65 practitioners of all surveyed cities participated in the second wave. The centrality measures assessed indicated that in all regions institutions of the substance abuse service network hold central positions in terms of conveying information. The moderate density values of the networks suggest that there are sufficient cooperation structures. Care deficits were identified most frequently in the areas of housing and nursing care. The results provide the first systematic insights and a description of the cooperation practice in the care system. Because of the limitations, further research and practice issues are raised.

Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care

Science.gov (United States)

2012-01-01

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

Patient-centred communication intervention study to evaluate nurse-patient interactions in complex continuing care

Directory of Open Access Journals (Sweden)

McGilton Katherine S

2012-10-01

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

Stability Analysis of Continuous-Time and Discrete-Time Quaternion-Valued Neural Networks With Linear Threshold Neurons.

Science.gov (United States)

Chen, Xiaofeng; Song, Qiankun; Li, Zhongshan; Zhao, Zhenjiang; Liu, Yurong

2018-07-01

This paper addresses the problem of stability for continuous-time and discrete-time quaternion-valued neural networks (QVNNs) with linear threshold neurons. Applying the semidiscretization technique to the continuous-time QVNNs, the discrete-time analogs are obtained, which preserve the dynamical characteristics of their continuous-time counterparts. Via the plural decomposition method of quaternion, homeomorphic mapping theorem, as well as Lyapunov theorem, some sufficient conditions on the existence, uniqueness, and global asymptotical stability of the equilibrium point are derived for the continuous-time QVNNs and their discrete-time analogs, respectively. Furthermore, a uniform sufficient condition on the existence, uniqueness, and global asymptotical stability of the equilibrium point is obtained for both continuous-time QVNNs and their discrete-time version. Finally, two numerical examples are provided to substantiate the effectiveness of the proposed results.

Continuous measurements of methane from a tower network over Siberia

International Nuclear Information System (INIS)

Sasakawa, M.; Machida, T.; Saeki, T.; Koyama, Y.; Maksyutov, S.; Shimoyama, K.; Tsuda, N.; Suto, H.; Arshinov, M.; Davydov, D.; Fofonov, A.; Krasnov, O.

2010-01-01

We have been conducting continuous measurements of Methane (CH 4 ) concentration from an expanding network of towers (JR-STATION: Japan-Russia Siberian Tall Tower Inland Observation Network) located in taiga, steppe and wetland biomes of Siberia since 2004. High daytime means (>2000 ppb) observed simultaneously at several towers during winter, together with in situ weather data and NCEP/NCAR reanalysis data, indicate that high pressure systems caused CH 4 accumulation at subcontinental scale due to the widespread formation of an inversion layer. Daytime means sometimes exceeded 2000 ppb, particularly in the summer of 2007 when temperature and precipitation rates were anomalously high over West Siberia, which implies that CH 4 emission from wetlands were exceptionally high in 2007. Many hot spots detected by MODIS in the summer of 2007 illustrate that the contribution of biomass burning also cannot be neglected. Daytime mean CH 4 concentrations from the Siberian tower sites were generally higher than CH 4 values reported at NOAA coastal sites in the same latitudinal zone, and the difference in concentrations between two sets of sites was reproduced with a coupled Eulerian-Lagrangian transport model. Simulations of emissions from different CH 4 sources suggested that the major contributor to variation switched from wetlands during summer to fossil fuel during winter.

Online social network use by health care providers in a high traffic patient care environment.

Science.gov (United States)

Black, Erik; Light, Jennifer; Paradise Black, Nicole; Thompson, Lindsay

2013-05-17

The majority of workers, regardless of age or occupational status, report engaging in personal Internet use in the workplace. There is little understanding of the impact that personal Internet use may have on patient care in acute clinical settings. The objective of this study was to investigate the volume of one form of personal Internet use-online social networking (Facebook)-generated by workstations in the emergency department (ED) in contrast to measures of clinical volume and severity. The research team analyzed anonymous network utilization records for 68 workstations located in the emergency medicine department within one academic medical center for 15 consecutive days (12/29/2009 to 1/12/2010). This data was compared to ED work index (EDWIN) data derived by the hospital information systems. Health care workers spent an accumulated 4349 minutes (72.5 hours) browsing Facebook, staff cumulatively visited Facebook 9369 times and spent, on average, 12.0 minutes per hour browsing Facebook. There was a statistically significant difference in the time spent on Facebook according to time of day (19.8 minutes per hour versus 4.3 minutes per hour, P<.001). There was a significant, positive correlation between EDWIN scores and time spent on Facebook (r=.266, P<.001). Facebook use constituted a substantive percentage of staff time during the 15-day observation period. Facebook use increased with increased patient volume and severity within the ED.

The development of medical networks through ICT in Japan

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Tsutomu Nakamura

2016-09-01

Full Text Available This paper examines how medical networks using Information and Communications Technology (ICT have been constructed, and what kind of spatial impact they have on the existing medical care provision system. The results are reported below. In Japan, each prefecture implements its own regional health care program for the appropriate allocation of medical resources. However, regional disparities in such allocation have not yet been resolved. ICT applied to two cases (the Wakashio Medical Network in Chiba Prefecture and the Haniwa Health and Welfare Network in Miyazaki Prefecture has promoted functional division and cooperation among medical institutions as well as the efficient use of resources on medical networks. Factors contributing to the construction of these networks and their continued utilization include strong leadership of central hospitals in the regions, and the fact that they have managed to solve problems related to system development and operation costs. However, differences in medical network awareness between doctors and patients, as well as the constraints of network maintenance costs, force participating doctors in ICT field. In this way, medical networks become a way to complement existing medical delivery systems.

Cumulative Risk and Continuity in Nonparental Care from Infancy to Early Adolescence

OpenAIRE

Colwell, Malinda J.; Pettit, Gregory S.; Meece, Darrell; Bates, John E.; Dodge, Kenneth A.

2001-01-01

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...

Electronic conferencing for continuing medical education: a resource survey.

Science.gov (United States)

Sternberg, R J

1986-10-01

The use of electronic technologies to link participants for education conferences is an option for providers of Continuing Medical Education. In order to profile the kinds of electronic networks currently offering audio- or videoteleconferences for physician audiences, a survey was done during late 1985. The information collected included range of services, fees, and geographic areas served. The results show a broad diversity of providers providing both interactive and didactic programming to both physicians and other health care professionals.

Influence of individual rationality on continuous double auction markets with networked traders

Science.gov (United States)

Zhang, Junhuan

2018-04-01

This paper investigates the influence of individual rationality of buyers and sellers on continuous double auction market outcomes in terms of the proportion of boundedly-rational buyers and sellers. The individual rationality is discussed in a social network artificial stock market model by embedding network formation and information set. Traders automatically select the most profitable trading strategy based on individual and social learning of the profits and trading strategies of themselves and their neighbors, and submit orders to markets. The results show that (i) a higher proportion of boundedly-rational sellers induces a higher market price, higher sellers' profits and a higher market efficiency; (ii) a higher proportion of boundedly-rational sellers induces a lower number of trades and lower buyers' profits; (iii) a higher proportion of boundedly-rational buyers induces a lower market price, a lower number of trades, and lower sellers' profits; (iv) a higher proportion of boundedly-rational buyers induces higher buyers' profits and a higher market efficiency.

"Wan Kanyakla" (We are together): Community transformations in Kenya following a social network intervention for HIV care.

Science.gov (United States)

Salmen, Charles R; Hickey, Matthew D; Fiorella, Kathryn J; Omollo, Dan; Ouma, Gor; Zoughbie, Daniel; Salmen, Marcus R; Magerenge, Richard; Tessler, Robert; Campbell, Harold; Geng, Elvin; Gandhi, Monica; Bukusi, Elizabeth A; Cohen, Craig R

2015-12-01

In sub-Saharan Africa, failure to initiate and sustain HIV treatment contributes to significant health, psychosocial, and economic impacts that burden not only infected individuals but diverse members of their social networks. Yet, due to intense stigma, the responsibility for managing lifelong HIV treatment rests solely, and often secretly, with infected individuals. We introduce the concept of "HIV risk induction" to suggest that social networks of infected individuals share a vested interest in improving long-term engagement with HIV care, and may represent an underutilized resource for improving HIV/AIDS outcomes within high prevalence populations. In 2012, we implemented a 'microclinic' intervention to promote social network engagement in HIV/AIDS care and treatment. A microclinic is a therapy management collective comprised of a small group of neighbors, relatives, and friends who are trained as a team to provide psychosocial and adherence support for HIV-infected members. Our study population included 369 patients on ART and members of their social networks on Mfangano Island, Kenya, where HIV prevalence approaches 30%. Here we report qualitative data from 18 focus group discussions conducted with microclinic participants (n = 82), community health workers (n = 40), and local program staff (n = 39). Participants reported widespread acceptability and enthusiasm for the microclinic intervention. Responses highlight four overlapping community transformations regarding HIV care and treatment, namely (1) enhanced HIV treatment literacy (2) reduction in HIV stigma, (3) improved atmosphere for HIV status disclosure and (4) improved material and psychosocial support for HIV-infected patients. Despite challenges, participants describe an emerging sense of "collective responsibility" for treatment among HIV-infected and HIV-uninfected members of social networks. The lived experiences and community transformations highlighted by participants enrolled in this social

Distress among women taking part in surgical continuity of care for breast cancer - a mixed methods study

DEFF Research Database (Denmark)

Jørgensen, Lone

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...

A telemedicine network to support paediatric care in small hospitals in rural Tanzania.

Science.gov (United States)

Krüger, Carsten; Niemi, Mauri

2012-01-01

We reviewed our experience with the Tanzanian Telemedicine Network in supporting paediatric care at 40 small, rural hospitals in the country. The network began operating in 2008. Store and forward telemedicine was provided via the open source software iPath. The 33 volunteer consultants were based in several countries, although most of them had practical experience in Tanzania. During the first three years of network operation there were 533 referrals. There were 159 paediatric cases (median age five years). Three paediatric specialists provided most consultations (64%), but other specialists provided recommendations when required. The response time was usually less than two days (median 6 h; inter-quartile range 2-24 h). A precise recommendation was not always provided, but since all consultants had an intimate knowledge of the state of health services in Tanzania, their advice was usually well adapted to the local circumstances of the hospitals. Referral to a higher level of care was recommended in 26 cases (16%). A simple web-based telemedicine system combined with email alerts is feasible in remote locations in Tanzania, even where fast Internet connections are not available. Copyright © 2012 by the Royal Society of Medicine Press Ltd

The influence of intrinsic and extrinsic job values on turnover intention among continuing care assistants in Nova Scotia.

Science.gov (United States)

Dill, Donna M; Keefe, Janice M; McGrath, Daniel S

2012-01-01

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.

A Realistic Framework for Delay-Tolerant Network Routing in Open Terrains with Continuous Churn

Science.gov (United States)

Mahendran, Veeramani; Anirudh, Sivaraman K.; Murthy, C. Siva Ram

The conventional analysis of Delay-Tolerant Network (DTN) routing assumes that the terrain over which nodes move is closed implying that when the nodes hit a boundary, they either wrap around or get reflected. In this work, we study the effect of relaxing this closed terrain assumption on the routing performance, where a continuous stream of nodes enter the terrain and get absorbed upon hitting the boundary.

Questionable assumptions hampered interpretation of a network meta-analysis of primary care depression treatments.

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Linde, Klaus; Rücker, Gerta; Schneider, Antonius; Kriston, Levente

2016-03-01

We aimed to evaluate the underlying assumptions of a network meta-analysis investigating which depression treatment works best in primary care and to highlight challenges and pitfalls of interpretation under consideration of these assumptions. We reviewed 100 randomized trials investigating pharmacologic and psychological treatments for primary care patients with depression. Network meta-analysis was carried out within a frequentist framework using response to treatment as outcome measure. Transitivity was assessed by epidemiologic judgment based on theoretical and empirical investigation of the distribution of trial characteristics across comparisons. Homogeneity and consistency were investigated by decomposing the Q statistic. There were important clinical and statistically significant differences between "pure" drug trials comparing pharmacologic substances with each other or placebo (63 trials) and trials including a psychological treatment arm (37 trials). Overall network meta-analysis produced results well comparable with separate meta-analyses of drug trials and psychological trials. Although the homogeneity and consistency assumptions were mostly met, we considered the transitivity assumption unjustifiable. An exchange of experience between reviewers and, if possible, some guidance on how reviewers addressing important clinical questions can proceed in situations where important assumptions for valid network meta-analysis are not met would be desirable. Copyright © 2016 Elsevier Inc. All rights reserved.

Co-Designing a Collaborative Chronic Care Network (C3N) for Inflammatory Bowel Disease: Development of Methods

Science.gov (United States)

Dellal, George; Peterson, Laura E; Provost, Lloyd; Gloor, Peter A; Fore, David Livingstone; Margolis, Peter A

2018-01-01

Background Our health care system fails to deliver necessary results, and incremental system improvements will not deliver needed change. Learning health systems (LHSs) are seen as a means to accelerate outcomes, improve care delivery, and further clinical research; yet, few such systems exist. We describe the process of codesigning, with all relevant stakeholders, an approach for creating a collaborative chronic care network (C3N), a peer-produced networked LHS. Objective The objective of this study was to report the methods used, with a diverse group of stakeholders, to translate the idea of a C3N to a set of actionable next steps. Methods The setting was ImproveCareNow, an improvement network for pediatric inflammatory bowel disease. In collaboration with patients and families, clinicians, researchers, social scientists, technologists, and designers, C3N leaders used a modified idealized design process to develop a design for a C3N. Results Over 100 people participated in the design process that resulted in (1) an overall concept design for the ImproveCareNow C3N, (2) a logic model for bringing about this system, and (3) 13 potential innovations likely to increase awareness and agency, make it easier to collect and share information, and to enhance collaboration that could be tested collectively to bring about the C3N. Conclusions We demonstrate methods that resulted in a design that has the potential to transform the chronic care system into an LHS. PMID:29472173

Evaluating the impact of connectivity, continuity, and topography of sidewalk network on pedestrian safety.

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Osama, Ahmed; Sayed, Tarek

2017-10-01

With the increasing demand for sustainability, walking is being encouraged as one of the main active modes of transportation. However, pedestrians are vulnerable to severe injuries when involved in crashes which can discourage road users from walking. Therefore, studying factors that affect the safety of pedestrians is important. This paper investigates the relationship between pedestrian-motorist crashes and various sidewalk network indicators in the city of Vancouver. The goal is to assess the impact of network connectivity, directness, and topography on pedestrian safety using macro-level collision prediction models. The models were developed using generalized linear regression and full Bayesian techniques. Both walking trips and vehicle kilometers travelled were used as the main traffic exposure variables in the models. The safety models supported the safety in numbers hypothesis showing a non-linear positive association between pedestrian-motorist crashes and the increase in walking trips and vehicle traffic. The model results also suggested that higher continuity, linearity, coverage, and slope of sidewalk networks were associated with lower crash occurrence. However, network connectivity was associated with higher crash occurrence. The spatial effects were accounted for in the full Bayes models and were found significant. The models provide insights about the factors that influence pedestrian safety and the spatial variability of pedestrian crashes within a city, which can be useful for the planning of pedestrian networks. Copyright © 2017 Elsevier Ltd. All rights reserved.

Supervision of care networks for frail community dwelling adults aged 75 years and older: protocol of a mixed methods study

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Verver, Didi; Merten, Hanneke; Robben, Paul; Wagner, Cordula

2015-01-01

Introduction The Dutch healthcare inspectorate (IGZ) supervises the quality and safety of healthcare in the Netherlands. Owing to the growing population of (community dwelling) older adults and changes in the Dutch healthcare system, the IGZ is exploring new methods to effectively supervise care networks that exist around frail older adults. The composition of these networks, where formal and informal care takes place, and the lack of guidelines and quality and risk indicators make supervision complicated in the current situation. Methods and analysis This study consists of four phases. The first phase identifies risks for community dwelling frail older adults in the existing literature. In the second phase, a qualitative pilot study will be conducted to assess the needs and wishes of the frail older adults concerning care and well-being, perception of risks, and the composition of their networks, collaboration and coordination between care providers involved in the network. In the third phase, questionnaires based on the results of phase II will be sent to a larger group of frail older adults (n=200) and their care providers. The results will describe the composition of their care networks and prioritise risks concerning community dwelling older adults. Also, it will provide input for the development of a new supervision framework by the IGZ. During phase IV, a second questionnaire will be sent to the participants of phase III to establish changes of perception in risks and possible changes in the care networks. The framework will be tested by the IGZ in pilots, and the researchers will evaluate these pilots and provide feedback to the IGZ. Ethics and dissemination The study protocol was approved by the Scientific Committee of the EMGO+institute and the Medical Ethical review committee of the VU University Medical Centre. Results will be presented in scientific articles and reports and at meetings. PMID:26307619

Plasma concentrations of midazolam during continuous subcutaneous administration in palliative care.

Science.gov (United States)

Bleasel, M D; Peterson, G M; Dunne, P F

1994-01-01

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.

Asymmetric continuous-time neural networks without local traps for solving constraint satisfaction problems.

Directory of Open Access Journals (Sweden)

Botond Molnár

Full Text Available There has been a long history of using neural networks for combinatorial optimization and constraint satisfaction problems. Symmetric Hopfield networks and similar approaches use steepest descent dynamics, and they always converge to the closest local minimum of the energy landscape. For finding global minima additional parameter-sensitive techniques are used, such as classical simulated annealing or the so-called chaotic simulated annealing, which induces chaotic dynamics by addition of extra terms to the energy landscape. Here we show that asymmetric continuous-time neural networks can solve constraint satisfaction problems without getting trapped in non-solution attractors. We concentrate on a model solving Boolean satisfiability (k-SAT, which is a quintessential NP-complete problem. There is a one-to-one correspondence between the stable fixed points of the neural network and the k-SAT solutions and we present numerical evidence that limit cycles may also be avoided by appropriately choosing the parameters of the model. This optimal parameter region is fairly independent of the size and hardness of instances, this way parameters can be chosen independently of the properties of problems and no tuning is required during the dynamical process. The model is similar to cellular neural networks already used in CNN computers. On an analog device solving a SAT problem would take a single operation: the connection weights are determined by the k-SAT instance and starting from any initial condition the system searches until finding a solution. In this new approach transient chaotic behavior appears as a natural consequence of optimization hardness and not as an externally induced effect.

Exploring Continuity of Care in Patients with Alcohol Use Disorders Using Time-Variant Measures

NARCIS (Netherlands)

S.C. de Vries (Sjoerd); A.I. Wierdsma (André)

2008-01-01

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.

Adolescent pregnancy: networking and the interdisciplinary approach.

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Canada, M J

1986-01-01

The networking approach to providing needed services to pregnant and parenting teenagers has numerous merits. An historical overview of the formation of the Brooklyn Teen Pregnancy Network highlights service agency need for information and resource sharing, and improved client referral systems as key factors in the genesis of the Network. The borough-wide approach and its spread as an agency model throughout New York City's other boroughs and several other northeastern cities is also attributed to its positive client impact, including: improved family communication and cooperation; early prenatal care with its concomitant improved pregnancy outcomes; financial support for teens; continued teen education; and parenting skills development. Resource information is provided regarding networks operating in the Greater New York metropolitan area. A planned Eastern Regional network initiative is under development.

Weaving the West Psychosocial Care Network of the municipality of São Paulo.

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Nóbrega, Maria do Perpétuo Socorro de Sousa; Domingos, Alessandra Matheus; Silveira, Ana Stella de Azevedo; Santos, Jussara Carvalho Dos

2017-01-01

to understand how health service professionals involved in the care of users in psychic distress perceive the organization of the Psychosocial Care Network (RAPS - Rede de Atenção Psicossocial) in the western region of the city of São Paulo. qualitative approach study conducted with 123 professionals with higher education who work in the care points of the network. A semi-structured interview was performed and data were submitted to the Alceste program for lexical analysis. the network is in process of alignment with the mental health policy and the psychosocial rehabilitation strategy. However, the weaknesses in the work process of teams are related to deficits in human resources, structure, and communication, and to the limited appropriation of their guidelines. there are intense efforts of workers to weave the network, and barriers need to be overcome to support successful actions in mental health care in the territory. compreender como profissionais de serviços de saúde envolvidos no cuidado dos usuários em sofrimento psíquico percebem a organização da Rede de Atenção Psicossocial (RAPS) da região Oeste do Município de São Paulo. abordagem qualitativa realizada com 123 profissionais de nível superior que atuam nos pontos de atenção da rede. Realizou-se entrevista semiestruturada e os dados foram submetidos ao programa Alceste com aplicação de análise lexical. A rede está em processo de alinhamento com a política de saúde mental e estratégia de reabilitação psicossocial. No entanto, há fragilidades no processo de trabalho das equipes relacionadas ao déficit de recursos humanos, estruturais, de comunicação, e à apropriação limitada sobre suas diretrizes. Compreendeu-se que há intensidade de esforços dos trabalhadores para tecer a rede e que é necessário superar barreiras para fomentar ações exitosas no cuidado em saúde mental no território.

Communication and interoperability for serial comparison in continuous health care--the new challenges.

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Zywietz, Christoph

2004-01-01

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.

Expanding Continuous Quality Improvement Capacity in the Medical Intensive Care Unit: Prehealth Volunteers as a Solution.

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Priest, Kelsey C; Lobingier, Hannah; McCully, Nancy; Lombard, Jackie; Hansen, Mark; Uchiyama, Makoto; Hagg, Daniel S

2016-01-01

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.

Social care networks and older LGBT adults: challenges for the future.

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Brennan-Ing, Mark; Seidel, Liz; Larson, Britta; Karpiak, Stephen E

2014-01-01

Research on service needs among older adults rarely addresses the special circumstances of lesbian, gay, bisexual, and transgender (LGBT) individuals, such as their reliance on friend-centered social networks or the experience of discrimination from service providers. Limited data suggests that older LGBT adults underutilize health and social services that are important in maintaining independence and quality of life. This study explored the social care networks of this population using a mixed-methods approach. Data were obtained from 210 LGBT older adults. The average age was 60 years, and 71% were men, 24% were women, and 5% were transgender or intersex. One-third was Black, and 62% were Caucasian. Quantitative assessments found high levels of morbidity and friend-centered support networks. Need for and use of services was frequently reported. Content analysis revealed unmet needs for basic supports, including housing, economic supports, and help with entitlements. Limited opportunities for socialization were strongly expressed, particularly among older lesbians. Implications for senior programs and policies are discussed.

Social Network Structures of Breast Cancer Patients and the Contributing Role of Patient Navigators.

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Gunn, Christine M; Parker, Victoria A; Bak, Sharon M; Ko, Naomi; Nelson, Kerrie P; Battaglia, Tracy A

2017-08-01

Minority women in the U.S. continue to experience inferior breast cancer outcomes compared with white women, in part due to delays in care delivery. Emerging cancer care delivery models like patient navigation focus on social barriers, but evidence demonstrating how these models increase social capital is lacking. This pilot study describes the social networks of newly diagnosed breast cancer patients and explores the contributing role of patient navigators. Twenty-five women completed a one hour interview about their social networks related to cancer care support. Network metrics identified important structural attributes and influential individuals. Bivariate associations between network metrics, type of network, and whether the network included a navigator were measured. Secondary analyses explored associations between network structures and clinical outcomes. We identified three types of networks: kin-based, role and/or affect-based, or heterogeneous. Network metrics did not vary significantly by network type. There was a low prevalence of navigators included in the support networks (25%). Network density scores were significantly higher in those networks without a navigator. Network metrics were not predictive of clinical outcomes in multivariate models. Patient navigators were not frequently included in support networks, but provided distinctive types of support. If navigators can identify patients with poorly integrated (less dense) social networks, or who have unmet tangible support needs, the intensity of navigation services could be tailored. Services and systems that address gaps and variations in patient social networks should be explored for their potential to reduce cancer health disparities. This study used a new method to identify the breadth and strength of social support following a diagnosis of breast cancer, especially examining the role of patient navigators in providing support. While navigators were only included in one quarter of patient

Evaluation of a Continuing Educational Intervention for Primary Health Care Professionals about Nutritional Care of Patients at Home.

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Berggren, E; Orrevall, Y; Olin, A Ödlund; Strang, P; Szulkin, R; Törnkvist, L

2016-04-01

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.

Continuous measurements of methane from a tower network over Siberia

Energy Technology Data Exchange (ETDEWEB)

Sasakawa, M.; Machida, T.; Saeki, T.; Koyama, Y.; Maksyutov, S. (Center for Global Environmental Research, National Inst. for Environmental Studies, Tsukuba, Ibaraki (Japan)); Shimoyama, K. (Inst. of Low Temperature Science, Hokkaido Univ., Hokkaido (Japan)); Tsuda, N. (Global Environmental Forum, Tokyo (Japan)); Suto, H. (Japan Aerospace Exploration Agency (Japan)); Arshinov, M.; Davydov, D.; Fofonov, A.; Krasnov, O. (Inst. of Atmospheric Optics, Russian Academy of Sciences, Siberian Branch (Russian Federation))

2010-11-15

We have been conducting continuous measurements of Methane (CH{sub 4}) concentration from an expanding network of towers (JR-STATION: Japan-Russia Siberian Tall Tower Inland Observation Network) located in taiga, steppe and wetland biomes of Siberia since 2004. High daytime means (>2000 ppb) observed simultaneously at several towers during winter, together with in situ weather data and NCEP/NCAR reanalysis data, indicate that high pressure systems caused CH{sub 4} accumulation at subcontinental scale due to the widespread formation of an inversion layer. Daytime means sometimes exceeded 2000 ppb, particularly in the summer of 2007 when temperature and precipitation rates were anomalously high over West Siberia, which implies that CH{sub 4} emission from wetlands were exceptionally high in 2007. Many hot spots detected by MODIS in the summer of 2007 illustrate that the contribution of biomass burning also cannot be neglected. Daytime mean CH{sub 4} concentrations from the Siberian tower sites were generally higher than CH{sub 4} values reported at NOAA coastal sites in the same latitudinal zone, and the difference in concentrations between two sets of sites was reproduced with a coupled Eulerian-Lagrangian transport model. Simulations of emissions from different CH{sub 4} sources suggested that the major contributor to variation switched from wetlands during summer to fossil fuel during winter.

Dementia-Related Work Activities of Home Care Nurses and Aides: Frequency, Perceived Competence, and Continuing Education Priorities

Science.gov (United States)

Morgan, Debra G.; Kosteniuk, Julie G.; O'Connell, Megan E.; Dal Bello-Haas, Vanina; Stewart, Norma J.; Karunanayake, Chandima

2016-01-01

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…

Effects of Knowledge Sharing and Social Presence on the Intention to Continuously Use Social Networking Sites: The Case of Twitter in Korea

Science.gov (United States)

Park, Bong-Won; Lee, Kun Chang

Recent surge of social networking websites in the world supports a widely accepted assumption that people aspires to be recognized online by sharing information with others, perceive enjoyment and keeps to use their social networking site continuously. Different from traditional social networking sites (SNSs) like Cyworld and Facebook, Twitter is famous for its short message and ease of sharing knowledge with others in a prompt manner. Therefore, Twitter is preferred most by many people who seem innovative generically. In this sense, Twitter accumulates its fame as the most influential SNS media among users. However, there is no study to investigate why people holds continuous intention to use the Twitter from the perspective of knowledge-sharing and social presence. To resolve this research issue, this paper adopts six constructs such as personal innovativeness, knowledge-sharing intention, perceived ease of use, perceived enjoyment, social presence, and intention to continuously use. Empirical results with 105 valid questionnaires revealed that the proposed research model is statistically significant, and people's intention to use the Twitter continuously is influenced by social presence, perceived enjoyment, and perceived ease of use.

Continuous Palliative Sedation for Existential Distress? A Survey of Canadian Palliative Care Physicians' Views.

Science.gov (United States)

Voeuk, Anna; Nekolaichuk, Cheryl; Fainsinger, Robin; Huot, Ann

2017-01-01

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.

Standardized nomenclatures: keys to continuity of care, nursing accountability and nursing effectiveness.

Science.gov (United States)

Keenan, G; Aquilino, M L

1998-01-01

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.

A sensor network to iPhone interface separating continuous and sporadic processes in mobile telemedicine.

Science.gov (United States)

D'Angelo, Lorenzo T; Schneider, Michael; Neugebauer, Paul; Lueth, Tim C

2011-01-01

In this contribution, a new concept for interfacing sensor network nodes (motes) and smartphones is presented for the first time. In the last years, a variety of telemedicine applications on smartphones for data reception, display and transmission have been developed. However, it is not always practical or possible to have a smartphone application running continuously to accomplish these tasks. The presented system allows receiving and storing data continuously using a mote and visualizing or sending it on the go using the smartphone as user interface only when desired. Thus, the processes of data reception and storage run on a safe system consuming less energy and the smartphone's potential along with its battery are not demanded continuously. Both, system concept and realization with an Apple iPhone are presented.

Development of a wearable wireless body area network for health monitoring of the elderly and disabled

Science.gov (United States)

Rushambwa, Munyaradzi C.; Gezimati, Mavis; Jeeva, J. B.

2017-11-01

Novel advancements in systems miniaturization, electronics in health care and communication technologies are enabling the integration of both patients and doctors involvement in health care system. A Wearable Wireless Body Area Network (WWBAN) provides continuous, unobtrusive ambulatory, ubiquitous health monitoring, and provide real time patient’s status to the physician without any constraint on their normal daily life activities. In this project we developed a wearable wireless body area network system that continuously monitor the health of the elderly and the disabled and provide them with independent, safe and secure living. The WWBAN system monitors the following parameters; blood oxygen saturation using a pulse oximeter sensor (SpO2), heart rate (HR) pulse sensor, Temperature, hydration, glucose level and fall detection. When the wearable system is put on, the sensor values are processed and analysed. If any of the monitored parameter values falls below or exceeds the normal range, there is trigger of remote alert by which an SMS is send to a doctor or physician via GSM module and network. The developed system offers flexibility and mobility to the user; it is a real time system and has significance in revolutionizing health care system by enabling non-invasive, inexpensive, continuous health monitoring.

Nursing supervision for care comprehensiveness

Directory of Open Access Journals (Sweden)

Lucieli Dias Pedreschi Chaves

Full Text Available ABSTRACT Objective: To reflect on nursing supervision as a management tool for care comprehensiveness by nurses, considering its potential and limits in the current scenario. Method: A reflective study based on discourse about nursing supervision, presenting theoretical and practical concepts and approaches. Results: Limits on the exercise of supervision are related to the organization of healthcare services based on the functional and clinical model of care, in addition to possible gaps in the nurse training process and work overload. Regarding the potential, researchers emphasize that supervision is a tool for coordinating care and management actions, which may favor care comprehensiveness, and stimulate positive attitudes toward cooperation and contribution within teams, co-responsibility, and educational development at work. Final considerations: Nursing supervision may help enhance care comprehensiveness by implying continuous reflection on including the dynamics of the healthcare work process and user needs in care networks.

Measuring horizontal integration among health care providers in the community: an examination of a collaborative process within a palliative care network.

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Bainbridge, Daryl; Brazil, Kevin; Krueger, Paul; Ploeg, Jenny; Taniguchi, Alan; Darnay, Julie

2015-05-01

In many countries formal or informal palliative care networks (PCNs) have evolved to better integrate community-based services for individuals with a life-limiting illness. We conducted a cross-sectional survey using a customized tool to determine the perceptions of the processes of palliative care delivery reflective of horizontal integration from the perspective of nurses, physicians and allied health professionals working in a PCN, as well as to assess the utility of this tool. The process elements examined were part of a conceptual framework for evaluating integration of a system of care and centred on interprofessional collaboration. We used the Index of Interdisciplinary Collaboration (IIC) as a basis of measurement. The 86 respondents (85% response rate) placed high value on working collaboratively and most reported being part of an interprofessional team. The survey tool showed utility in identifying strengths and gaps in integration across the network and in detecting variability in some factors according to respondent agency affiliation and profession. Specifically, support for interprofessional communication and evaluative activities were viewed as insufficient. Impediments to these aspects of horizontal integration may be reflective of workload constraints, differences in agency operations or an absence of key structural features.

Health care for women in situations of violence: discoordination of network professionals.

Science.gov (United States)

Arboit, Jaqueline; Padoin, Stela Maris de Mello; Vieira, Letícia Becker; Paula, Cristiane Cardoso de; Costa, Marta Cocco da; Cortes, Laura Ferreira

2017-04-03

To learn the conceptions and actions of health professionals on the care network for women in situations of violence. A qualitative, descriptive, exploratory study was conducted between April and July 2015 with the participation of 21 health professionals from four primary health care teams in a city of the central region of the state of Rio Grande do Sul. Data were collected by means of individual semi-structured interviews. Content analysis was used for data systematization. Health professionals recognized the importance of the health care network for coping with the problem of violence against women. However, their conceptions and actions were limited by the discoordination or absence of integration among professionals and services of the care network. The conceptions and actions of health professionals contribute to the discoordination among the services. It is necessary to reflect on the daily practices of care for women in situations of violence. Conhecer as concepções e ações de profissionais de saúde sobre a rede de atenção às mulheres em situação de violência. Estudo qualitativo, descritivo e exploratório, realizado no período de abril a julho de 2015. Participaram 21 profissionais de saúde de quatro equipes da Atenção Primária à Saúde em um município da região central do estado do Rio Grande do Sul. A coleta de dados ocorreu mediante entrevistas semiestruturadas e individuais. Para sistematização dos dados, empregou-se a análise de conteúdo. Os profissionais de saúde reconheciam a importância da rede de atenção à saúde no enfrentamento da problemática da violência contra as mulheres. Contudo, suas concepções e ações eram limitadas pela desarticulação ou ausência de integração entre os profissionais e serviços da rede de atenção. As concepções e ações dos profissionais de saúde contribuem para a desarticulação entre os serviços. Faz-se necessário refletir acerca das práticas cotidianas de cuidados

Patient, resident, or person: Recognition and the continuity of self in long-term care for older people.

Science.gov (United States)

Pirhonen, Jari; Pietilä, Ilkka

2015-12-01

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.

Communication, advice exchange and job satisfaction of nursing staff: a social network analyses of 35 long-term care units.

Science.gov (United States)

van Beek, Adriana P A; Wagner, Cordula; Spreeuwenberg, Peter P M; Frijters, Dinnus H M; Ribbe, Miel W; Groenewegen, Peter P

2011-06-01

The behaviour of individuals is affected by the social networks in which they are embedded. Networks are also important for the diffusion of information and the influence of employees in organisations. Yet, at the moment little is known about the social networks of nursing staff in healthcare settings. This is the first study that investigates informal communication and advice networks of nursing staff in long-term care. We examine the structure of the networks, how they are related to the size of units and characteristics of nursing staff, and their relationship with job satisfaction. We collected social network data of 380 nursing staff of 35 units in group projects and psychogeriatric units in nursing homes and residential homes in the Netherlands. Communication and advice networks were analyzed in a social network application (UCINET), focusing on the number of contacts (density) between nursing staff on the units. We then studied the correlation between the density of networks, size of the units and characteristics of nursing staff. We used multilevel analyses to investigate the relationship between social networks and job satisfaction of nursing staff, taking characteristics of units and nursing staff into account. Both communication and advice networks were negatively related to the number of residents and the number of nursing staff of the units. Communication and advice networks were more dense when more staff worked part-time. Furthermore, density of communication networks was positively related to the age of nursing staff of the units. Multilevel analyses showed that job satisfaction differed significantly between individual staff members and units and was influenced by the number of nursing staff of the units. However, this relationship disappeared when density of communication networks was added to the model. Overall, communication and advice networks of nursing staff in long-term care are relatively dense. This fits with the high level of cooperation

Hospitalized Patients' Perceptions of Resident Fatigue, Duty Hours, and Continuity of Care.

Science.gov (United States)

Drolet, Brian C; Hyman, Charles H; Ghaderi, Kimeya F; Rodriguez-Srednicki, Joshua; Thompson, Jordan M; Fischer, Staci A

2014-12-01

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.

[Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA].

Science.gov (United States)

Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I

2010-01-01

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.

Continuous-time random walks on networks with vertex- and time-dependent forcing.

Science.gov (United States)

Angstmann, C N; Donnelly, I C; Henry, B I; Langlands, T A M

2013-08-01

We have investigated the transport of particles moving as random walks on the vertices of a network, subject to vertex- and time-dependent forcing. We have derived the generalized master equations for this transport using continuous time random walks, characterized by jump and waiting time densities, as the underlying stochastic process. The forcing is incorporated through a vertex- and time-dependent bias in the jump densities governing the random walking particles. As a particular case, we consider particle forcing proportional to the concentration of particles on adjacent vertices, analogous to self-chemotactic attraction in a spatial continuum. Our algebraic and numerical studies of this system reveal an interesting pair-aggregation pattern formation in which the steady state is composed of a high concentration of particles on a small number of isolated pairs of adjacent vertices. The steady states do not exhibit this pair aggregation if the transport is random on the vertices, i.e., without forcing. The manifestation of pair aggregation on a transport network may thus be a signature of self-chemotactic-like forcing.

The Pediatric Emergency Care Applied Research Network: a history of multicenter collaboration in the United States.

Science.gov (United States)

Tzimenatos, Leah; Kim, Emily; Kuppermann, Nathan

2015-01-01

In this article, we review the history and progress of a large multicenter research network pertaining to emergency medical services for children. We describe the history, organization, infrastructure, and research agenda of the Pediatric Emergency Care Applied Research Network and highlight some of the important accomplishments since its inception. We also describe the network's strategy to grow its research portfolio, train new investigators, and study how to translate new evidence into practice. This strategy ensures not only the sustainability of the network in the future but the growth of research in emergency medical services for children in general.

Secure and Efficient Two-Factor User Authentication Scheme with User Anonymity for Network Based E-Health Care Applications.

Science.gov (United States)

Li, Xiong; Niu, Jianwei; Karuppiah, Marimuthu; Kumari, Saru; Wu, Fan

2016-12-01

Benefited from the development of network and communication technologies, E-health care systems and telemedicine have got the fast development. By using the E-health care systems, patient can enjoy the remote medical service provided by the medical server. Medical data are important privacy information for patient, so it is an important issue to ensure the secure of transmitted medical data through public network. Authentication scheme can thwart unauthorized users from accessing services via insecure network environments, so user authentication with privacy protection is an important mechanism for the security of E-health care systems. Recently, based on three factors (password, biometric and smart card), an user authentication scheme for E-health care systems was been proposed by Amin et al., and they claimed that their scheme can withstand most of common attacks. Unfortunate, we find that their scheme cannot achieve the untraceability feature of the patient. Besides, their scheme lacks a password check mechanism such that it is inefficient to find the unauthorized login by the mistake of input a wrong password. Due to the same reason, their scheme is vulnerable to Denial of Service (DoS) attack if the patient updates the password mistakenly by using a wrong password. In order improve the security level of authentication scheme for E-health care application, a robust user authentication scheme with privacy protection is proposed for E-health care systems. Then, security prove of our scheme are analysed. Security and performance analyses show that our scheme is more powerful and secure for E-health care systems when compared with other related schemes.

Relational continuity with primary and secondary care doctors: a qualitative study of perceptions of users of the Catalan national health system.

Science.gov (United States)

Waibel, Sina; Vargas, Ingrid; Coderch, Jordi; Vázquez, María-Luisa

2018-04-10

In the current context of increasingly fragmented healthcare systems where patients are seen by multiple doctors in different settings, patients' relational continuity with one doctor is regaining relevance; however little is known about relational continuity with specialists. The aim of this study is to explore perceptions of relational continuity with primary care and secondary care doctors, its influencing factors and consequences from the viewpoint of users of the Catalan national health system (Spain). We conducted a descriptive-interpretative qualitative study using a two-stage theoretical sample; (i) contexts: three healthcare areas in the Catalan national health system with differing characteristics; (ii) informants: users 18 years or older attended to at both care levels. Sample size (n = 49) was reached by saturation. Data were collected by individual semi-structured interviews, which were audio recorded and transcribed. A thematic content analysis was carried out segmenting data by study area, and leaving room for new categories to emerge from the data. Patients across the areas studied generally experienced consistency of primary care doctors (PCD), alongside some inconsistency of specialists. Consistency of specialists did not seem to be relevant to some patients when their clinical information was shared and used. Patients who experienced consistency and frequent visits with the same PCD or specialist described and valued having established an ongoing relationship characterised by personal trust and mutual accumulated knowledge. Identified consequences were diverse and included, for example, facilitated diagnosis or improved patient-doctor communication. The ascription to a PCD, a health system-related factor, facilitated relational continuity with the PCD, whereas organizational factors (for instance, the size of the primary care centre) favoured consistency of PCD and specialists. Doctor-related factors (for example, high technical competence or

The effects of nursing turnover on continuity of care in isolated First Nation communities.

Science.gov (United States)

Minore, Bruce; Boone, Margaret; Katt, Mae; Kinch, Peggy; Birch, Stephen; Mushquash, Christopher

2005-03-01

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.

Specialist medication review does not benefit short-term outcomes and net costs in continuing-care patients.

LENUS (Irish Health Repository)

Pope, George

2012-01-31

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.

A Comprehensive Sensitivity Analysis of a Data Center Network with Server Virtualization for Business Continuity

Directory of Open Access Journals (Sweden)

Tuan Anh Nguyen

2015-01-01

Full Text Available Sensitivity assessment of availability for data center networks (DCNs is of paramount importance in design and management of cloud computing based businesses. Previous work has presented a performance modeling and analysis of a fat-tree based DCN using queuing theory. In this paper, we present a comprehensive availability modeling and sensitivity analysis of a DCell-based DCN with server virtualization for business continuity using stochastic reward nets (SRN. We use SRN in modeling to capture complex behaviors and dependencies of the system in detail. The models take into account (i two DCell configurations, respectively, composed of two and three physical hosts in a DCell0 unit, (ii failure modes and corresponding recovery behaviors of hosts, switches, and VMs, and VM live migration mechanism within and between DCell0s, and (iii dependencies between subsystems (e.g., between a host and VMs and between switches and VMs in the same DCell0. The constructed SRN models are analyzed in detail with regard to various metrics of interest to investigate system’s characteristics. A comprehensive sensitivity analysis of system availability is carried out in consideration of the major impacting parameters in order to observe the system’s complicated behaviors and find the bottlenecks of system availability. The analysis results show the availability improvement, capability of fault tolerance, and business continuity of the DCNs complying with DCell network topology. This study provides a basis of designing and management of DCNs for business continuity.

Use of social network analysis in maternity care to identify the profession most suited for case manager role

NARCIS (Netherlands)

Groenen, C.J.M.; Duijnhoven, N.T.L. van; Faber, M.J.; Koetsenruijter, J.; Kremer, J.A.M.; Vandenbussche, F.P.H.A.

2017-01-01

OBJECTIVE: To improve Dutch maternity care, professionals start working in interdisciplinary patient-centred networks, which includes the patients as a member. The introduction of the case manager is expected to work positively on both the individual and the network level. However, case management

Cardiac Rehabilitation for Patients With Coronary Artery Disease: A Practical Guide to Enhance Patient Outcomes Through Continuity of Care

Directory of Open Access Journals (Sweden)

Catherine Giuliano

2017-06-01

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.

Corporate and supply chain network governance of third party logistics service providers: Effects on buyers’ intention to continue the relationship

Directory of Open Access Journals (Sweden)

Salih Börteçine Avci

2017-06-01

Full Text Available This study focuses on the impact of corporate governance, supply chain network governance and competencies such as sales and logistics competence on buyers’ intention to relationship continuity. A total number of 258 questionnaires were distributed to Turkish manufacturing firms, selected using cross-sectional sampling method from the Istanbul and Edirne Chamber of Commerce and Industry in Turkey. The data of survey was analysed using PLS-SEM model with WARP PLS 5.0 software. Our findings indicate that corporate governance and supply chain network governance seem to have a positive effect on sales competence and logistics competence, and together, they influence buyers’ intention to relationship continuity. In this respect, the outcomes of this study may provide valuable insights for the third-party logistics (3PL literature in terms of buyers’ intention to relationship continuity.

Providing Telehealth Services to a Public Primary Care Network: The Experience of RedeNUTES in Pernambuco, Brazil.

Science.gov (United States)

Diniz, Paula Rejane Beserra; Ribeiro Sales, Fernando José; de Araújo Novaes, Magdala

2016-08-01

Information technologies have been applied in primary care domains to improve the delivery of health services. This article reports the telehealth network experience in Pernambuco, Brazil. Five different data sets were used, one by each service and the structural aspects of the network, collected from 2008 until August 2015. The data include solicited themes for educational activities, users' evaluation of services, numbers of sites, municipalities participating, participants in tele-education activities, teleconsultations, telediagnosis, and remote screenings. The analysis was done in absolute and percentage values using Microsoft Excel (version 2007). The indicators show high utilization of tele-education resources, followed by the teleconsultation service. The synchronous modality was the most used and the general clinical question was the most frequent type of question. Nurses are the professional category that most used the teleconsultation services (36%). Telediagnosis of electrocardiography has growth utilization, overcoming teleconsulting more recently. The satisfaction rate was 89%, and 68.5% of professionals changed their planning to patients' referrals to specialists. Telehealth has been considered effective since it avoids inappropriate referrals of the patient and provides continuous actualization to health professionals. Our results provide evidence of the feasibility and importance of using telehealth as a tool to ensure the universality, equality, and completeness in the health system.

Application of neural network and pattern recognition software to the automated analysis of continuous nuclear monitoring of on-load reactors

Energy Technology Data Exchange (ETDEWEB)

Howell, J.A.; Eccleston, G.W.; Halbig, J.K.; Klosterbuer, S.F. [Los Alamos National Lab., NM (United States); Larson, T.W. [California Polytechnic State Univ., San Luis Obispo, CA (US)

1993-08-01

Automated analysis using pattern recognition and neural network software can help interpret data, call attention to potential anomalies, and improve safeguards effectiveness. Automated software analysis, based on pattern recognition and neural networks, was applied to data collected from a radiation core discharge monitor system located adjacent to an on-load reactor core. Unattended radiation sensors continuously collect data to monitor on-line refueling operations in the reactor. The huge volume of data collected from a number of radiation channels makes it difficult for a safeguards inspector to review it all, check for consistency among the measurement channels, and find anomalies. Pattern recognition and neural network software can analyze large volumes of data from continuous, unattended measurements, thereby improving and automating the detection of anomalies. The authors developed a prototype pattern recognition program that determines the reactor power level and identifies the times when fuel bundles are pushed through the core during on-line refueling. Neural network models were also developed to predict fuel bundle burnup to calculate the region on the on-load reactor face from which fuel bundles were discharged based on the radiation signals. In the preliminary data set, which was limited and consisted of four distinct burnup regions, the neural network model correctly predicted the burnup region with an accuracy of 92%.

When health care workers perceive high-commitment HRM will they be motivated to continue working in health care? It may depend on their supervisor and intrinsic motivation

NARCIS (Netherlands)

drs Limke Schopman; dr Corine Boon; dr Karianne Kalshoven

2015-01-01

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

When health care workers perceive high-commitment HRM will they be motivated to continue working in health care? It may depend on their supervisor and intrinsic motivation.

NARCIS (Netherlands)

Schopman, L.M.; Kalshoven, K.; Boon, C.

2017-01-01

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

Indicators for continuous quality improvement for otitis media in primary health care for Aboriginal and Torres Strait Islander children.

Science.gov (United States)

Sibthorpe, Beverly; Agostino, Jason; Coates, Harvey; Weeks, Sharon; Lehmann, Deborah; Wood, Marianne; Lannigan, Francis; McAullay, Daniel

2017-04-01

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.

Lexical decoder for continuous speech recognition: sequential neural network approach

International Nuclear Information System (INIS)

Iooss, Christine

1991-01-01

The work presented in this dissertation concerns the study of a connectionist architecture to treat sequential inputs. In this context, the model proposed by J.L. Elman, a recurrent multilayers network, is used. Its abilities and its limits are evaluated. Modifications are done in order to treat erroneous or noisy sequential inputs and to classify patterns. The application context of this study concerns the realisation of a lexical decoder for analytical multi-speakers continuous speech recognition. Lexical decoding is completed from lattices of phonemes which are obtained after an acoustic-phonetic decoding stage relying on a K Nearest Neighbors search technique. Test are done on sentences formed from a lexicon of 20 words. The results are obtained show the ability of the proposed connectionist model to take into account the sequentiality at the input level, to memorize the context and to treat noisy or erroneous inputs. (author) [fr

Continuous wireless pressure monitoring and mapping with ultra-small passive sensors for health monitoring and critical care.

Science.gov (United States)

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

2014-10-06

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.

Emerging tools for continuous nutrient monitoring networks: Sensors advancing science and water resources protection

Science.gov (United States)

Pellerin, Brian; Stauffer, Beth A; Young, Dwane A; Sullivan, Daniel J.; Bricker, Suzanne B.; Walbridge, Mark R; Clyde, Gerard A; Shaw, Denice M

2016-01-01

Sensors and enabling technologies are becoming increasingly important tools for water quality monitoring and associated water resource management decisions. In particular, nutrient sensors are of interest because of the well-known adverse effects of nutrient enrichment on coastal hypoxia, harmful algal blooms, and impacts to human health. Accurate and timely information on nutrient concentrations and loads is integral to strategies designed to minimize risk to humans and manage the underlying drivers of water quality impairment. Using nitrate sensors as an example, we highlight the types of applications in freshwater and coastal environments that are likely to benefit from continuous, real-time nutrient data. The concurrent emergence of new tools to integrate, manage and share large data sets is critical to the successful use of nutrient sensors and has made it possible for the field of continuous nutrient monitoring to rapidly move forward. We highlight several near-term opportunities for Federal agencies, as well as the broader scientific and management community, that will help accelerate sensor development, build and leverage sites within a national network, and develop open data standards and data management protocols that are key to realizing the benefits of a large-scale, integrated monitoring network. Investing in these opportunities will provide new information to guide management and policies designed to protect and restore our nation’s water resources.

Indian-ink perfusion based method for reconstructing continuous vascular networks in whole mouse brain.

Directory of Open Access Journals (Sweden)

Songchao Xue

Full Text Available The topology of the cerebral vasculature, which is the energy transport corridor of the brain, can be used to study cerebral circulatory pathways. Limited by the restrictions of the vascular markers and imaging methods, studies on cerebral vascular structure now mainly focus on either observation of the macro vessels in a whole brain or imaging of the micro vessels in a small region. Simultaneous vascular studies of arteries, veins and capillaries have not been achieved in the whole brain of mammals. Here, we have combined the improved gelatin-Indian ink vessel perfusion process with Micro-Optical Sectioning Tomography for imaging the vessel network of an entire mouse brain. With 17 days of work, an integral dataset for the entire cerebral vessels was acquired. The voxel resolution is 0.35×0.4×2.0 µm(3 for the whole brain. Besides the observations of fine and complex vascular networks in the reconstructed slices and entire brain views, a representative continuous vascular tracking has been demonstrated in the deep thalamus. This study provided an effective method for studying the entire macro and micro vascular networks of mouse brain simultaneously.

76 FR 41261 - Notice of Intent To Award Affordable Care Act (ACA) Funding, EH10-1003

Science.gov (United States)

2011-07-13

...): 93.070. Approximately $124,995.00 in ACA funding will be awarded to the grantee for network expansion... Intent To Award Affordable Care Act (ACA) Funding, EH10-1003 Notice of Intent to award Affordable Care Act (ACA) funding to National Association for Health Data Organizations (NAHDO) to continue with the...

[Dynamics of interdisciplinary around a health care network: simultaneous programme design and evaluation planning].

Science.gov (United States)

Bocquet, H; Mantovani, J; Raffy, C; Cayla, F; Clément, S

2005-12-01

This article reports on the evaluation experience of a multiple sclerosis care network in the Midi-Pyrénées region (MIPSEP). It shows how an evaluation team composed of public health doctors and sociologists progressively and naturally evolved from having a purely external observation role towards having a collaborative role actively working with the network's members and partners. A qualitative method was chosen for the data collection through interviews with the network's actors, and the frameworks for reference were constituted from official texts which defined the networks and their missions. Coming from a curative and healing culture, the network's actors were concerned primarily about how to organise themselves in order to better respond to the needs expressed by the patients. The various professional backgrounds and cultures, faced with different perspectives from innovation and confronted with the related difficulties, participated in a collective expertise exercise and collaborated in the construction process. This example supports an open, qualitative, evolutionary evaluation approach which is done in close proximity to the field and work on the ground. The study is timely given the current explosion of debate on evaluation methods. With a great deal of exchange and reflection on suitable tools and indicators as well as the respective roles of researchers, care givers and decision-makers, the results of this study advocate to favour multidisciplinary approaches, including opening up this process to funders and planning authorities rather than over-theorising about it, which only serves to enclose and paralyse a process that, on the contrary, should aim to be more inclusive. This could be a useful way to decompartmentalise and break down existing barriers within the health system.

Access to emergency care services: a transversal ecological study about Brazilian emergency health care network.

Science.gov (United States)

Rocha, T A H; da Silva, N C; Amaral, P V; Barbosa, A C Q; Rocha, J V M; Alvares, V; de Almeida, D G; Thumé, E; Thomaz, E B A F; de Sousa Queiroz, R C; de Souza, M R; Lein, A; Toomey, N; Staton, C A; Vissoci, J R N; Facchini, L A

2017-12-01

Studies of health geography are important in the planning and allocation of emergency health services. The geographical distribution of health facilities is an important factor in timely and quality access to emergency services; therefore, the present study analyzed the emergency health care network in Brazil, focusing the analysis at the roles of small hospitals (SHs). Cross-sectional ecological study. Data were collected from 9429 hospitals of which 3524 were SHs and 5905 were high-complexity centers (HCCs). For analytical purposes, we considered four specialties when examining the proxies of emergency care capability: adult, pediatrics, neonatal, and obstetric. We analyzed the spatial distribution of hospitals, identifying municipalities that rely exclusively on SHs and the distance of these cities from HCCs. More than 14 and 30 million people were at least 120 km away from HCCs with an adult intensive care unit (ICU) and pediatric ICU, respectively. For neonatal care distribution, 12% of the population was more than 120 km away from a health facility with a neonatal ICU. The maternities situation is different from other specialties, where 81% of the total Brazilian population was within 1 h or less from such health facilities. Our results highlighted a polarization in distribution of Brazilian health care facilities. There is a concentration of hospitals in urban areas more developed and access gaps in rural areas and the Amazon region. Our results demonstrate that the distribution of emergency services in Brazil is not facilitating access to the population due to geographical barriers associated with great distances. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Identifying changes in the support networks of end-of-life carers using social network analysis.

Science.gov (United States)

Leonard, Rosemary; Horsfall, Debbie; Noonan, Kerrie

2015-06-01

End-of-life caring is often associated with reduced social networks for both the dying person and for the carer. However, those adopting a community participation and development approach, see the potential for the expansion and strengthening of networks. This paper uses Knox, Savage and Harvey's definitions of three generations social network analysis to analyse the caring networks of people with a terminal illness who are being cared for at home and identifies changes in these caring networks that occurred over the period of caring. Participatory network mapping of initial and current networks was used in nine focus groups. The analysis used key concepts from social network analysis (size, density, transitivity, betweenness and local clustering) together with qualitative analyses of the group's reflections on the maps. The results showed an increase in the size of the networks and that ties between the original members of the network strengthened. The qualitative data revealed the importance between core and peripheral network members and the diverse contributions of the network members. The research supports the value of third generation social network analysis and the potential for end-of-life caring to build social capital. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Non-homogeneous dynamic Bayesian networks for continuous data

NARCIS (Netherlands)

Grzegorczyk, Marco; Husmeier, Dirk

Classical dynamic Bayesian networks (DBNs) are based on the homogeneous Markov assumption and cannot deal with non-homogeneous temporal processes. Various approaches to relax the homogeneity assumption have recently been proposed. The present paper presents a combination of a Bayesian network with

TLALOCNet continuous GPS-Met Array in Mexico supporting the 2017 NAM GPS Hydrometeorological Network.

Science.gov (United States)

Cabral-Cano, E.; Salazar-Tlaczani, L.; Adams, D. K.; Vivoni, E. R.; Grutter, M.; Serra, Y. L.; DeMets, C.; Galetzka, J.; Feaux, K.; Mattioli, G. S.; Miller, M. M.

2017-12-01

TLALOCNet is a network of continuous GPS and meteorology stations in Mexico to study atmospheric and solid earth processes. This recently completed network spans most of Mexico with a strong coverage emphasis on southern and western Mexico. This network, funded by NSF, CONACyT and UNAM, recently built 40 cGPS-Met sites to EarthScope Plate Boundary Observatory standards and upgraded 25 additional GPS stations. TLALOCNet provides open and freely available raw GPS data, and high frequency surface meteorology measurements, and time series of daily positions. This is accomplished through the development of the TLALOCNet data center (http://tlalocnet.udg.mx) that serves as a collection and distribution point. This data center is based on UNAVCO's Dataworks-GSAC software and also works as part of UNAVCO's seamless archive for discovery, sharing, and access to GPS data. The TLALOCNet data center also contains contributed data from several regional GPS networks in Mexico for a total of 100+ stations. By using the same protocols and structure as the UNAVCO and other COCONet regional data centers, the scientific community has the capability of accessing data from the largest Mexican GPS network. This archive provides a fully queryable and scriptable GPS and Meteorological data retrieval point. In addition, real-time 1Hz streams from selected TLALOCNet stations are available in BINEX, RTCM 2.3 and RTCM 3.1 formats via the Networked Transport of RTCM via Internet Protocol (NTRIP) for real-time seismic and weather forecasting applications. TLALOCNet served as a GPS-Met backbone for the binational Mexico-US North American Monsoon GPS Hydrometeorological Network 2017 campaign experiment. This innovative experiment attempts to address water vapor source regions and land-surface water vapor flux contributions to precipitation (i.e., moisture recycling) during the 2017 North American Monsoon in Baja California, Sonora, Chihuahua, and Arizona. Models suggest that moisture recycling is

[Transfer and Implementation of Innovative Awareness and Education Measures, e-Mental Health and Care Models in psychenet - Hamburg Network for Mental Health].

Science.gov (United States)

Lambert, Martin; Härter, Martin; Brandes, Andreas; Hillebrandt, Bernd; Schlüter, Catarina; Quante, Susanne

2015-07-01

The Hamburg Network for Mental Health belongs to the healthcare regions in Germany, funded by the Federal Ministry of Education and Research from 2011 to 2015. More than 330 partners from research, health care, health industry and government are promoting innovative health care models and products to improve mental health care in Hamburg. The main objectives comprise the sustained implementation of the Network itself and of successful health care models and products. The article describes current and future implementation possibilities and the present state of the implementation process. © Georg Thieme Verlag KG Stuttgart · New York.

Association between Continuing Education and Job Satisfaction of Nurses Employed in Long-Term Care Facilities.

Science.gov (United States)

Robertson, Ethel M.; Higgins, Leslie; Rozmus, Cathy; Robinson, James P.

1999-01-01

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)

Italian public health care organizations: specialization, institutional deintegration, and public networks relationships.

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Del Vecchio, Mario; De Pietro, Carlo

2011-01-01

The Italian National Health Service (INHS) has undergone profound changes over the past three decades. With establishment of the INHS in 1978--a tax-based public health care system with universal coverage--one of the underlying principles was integration. The recognition of health and health care as requiring integrated answers led to the creation of a single public organization, the Local Health Unit, responsible for the health status of the population of its catchment area. At the beginning of the 1990s, the scenario radically changed. The creation of hospital trusts, the development of quasi-market mechanisms and management control tools, the adoption of a prospective payment system for reimbursing health care providers--all were signs of deintegration and institutional unbundling. Two structural changes have deeply sustained this deintegration: patients' empowerment and the increased possibilities for outsourcing practices. In more recent years, a new reintegration effort has occurred, often led by regional governments and based on institutional cooperation and network relationships. However, the earlier structural changes require innovative approaches and solutions if public health care organizations want to retain their leading role.

Governance of health care networks: Assessment of the health care integrating councils in the context of the health sector reform in Chile.

Directory of Open Access Journals (Sweden)

Osvaldo Artaza-Barrios

2013-11-01

Full Text Available Objective. This paper aims at assessing the contribution of Chile’s Health Care Integrating Councils (CIRA, Spanish acronym to strengthening governance in health. Materials and methods. A literature review on the official documents related to the process of creation and development of CIRA was carried out; an ad hoc questionnaire was applied to all 29 health services of the country; finally, 35 semi-structure in-depth interviews were carried on a sample of six CIRA. Results. The CIRAs have become a tool for functional integration and a valuable space for dialogue, cooperation and learning for all of the actors of the Chilean public health network. Conclusions. In this study, we conclude that there is room for improvements of CIRA’s role regarding governance of the health care network as long as CIRA is authorized to deal with strategic topics, such as investment in infrastructure, technology and human resources, and budgeting.

Cardiorespiratory dynamics measured from continuous ECG monitoring improves detection of deterioration in acute care patients: A retrospective cohort study

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Clark, Matthew T.; Calland, James Forrest; Enfield, Kyle B.; Voss, John D.; Lake, Douglas E.; Moorman, J. Randall

2017-01-01

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

Current state of information technology use in a US primary care practice-based research network.

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Andrews, James E; Pearce, Kevin A; Sydney, Carey; Ireson, Carol; Love, Margaret

2004-01-01

To examine the current levels of information technology (IT) use in a primary care practice-based research network (PBRN) in order to inform future development of its infrastructure. Every primary care practitioner who is a member of the Kentucky Ambulatory Network (KAN),as well as the office managers of each practice. Practitioners included family practitioners, general practitioners, nurse practitioners and physician assistants. A cross-sectional study using two survey instruments: one for office managers and one for practitioners. The office manager survey included questions related to the current state of IT within the practice, plans for enhancement and general IT issues from the perspective of managing a practice. The practitioner survey was designed to measure current IT use and attitudes of primary care practitioners. Response rates for the surveys were 46% (n = 68) for the office managers and 51% (n = 116) for practitioners. All but one practice had internet access; however, 43% had only dial-up service. Only 21% of practitioners use an electronic medical record (EMR), with dollar cost being the barrier reported most frequently (58%). More than half of the office managers were either 'somewhat interested' (45%) or 'very interested' (17%) in a low-cost, standardised EMR that was, at the time, to be sponsored by the American Academy of Family Physicians. For practitioners, 71% were either 'somewhat' or 'very' interested in such a system. Responses to other IT issues are reported. While interest in enabling information technologies was high in KAN, adoption was variable, with use of several key technologies reported as low.The results suggest that research in this network that would be dependent on or enhanced by IT might be impeded and, generally, greater attention should be given to enhancing the IT infrastructure in primary care.

Characteristics and lessons learned from practice-based research networks (PBRNs in the United States

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Keller S

2012-09-01

Full Text Available Melinda M Davis,1,2 Sara Keller,1 Jennifer E DeVoe,1,3 Deborah J Cohen11Department of Family Medicine, 2Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR, USA; 3OCHIN Practice-based Research Network, Portland, OR, USAAbstract: Practice-based research networks (PBRNs are organizations that involve practicing clinicians in asking and answering clinically relevant research questions. This review explores the origins, characteristics, funding, and lessons learned through practice-based research in the United States. Primary care PBRNs emerged in the USA in the 1970s. Early studies explored the etiology of common problems encountered in primary care practices (eg, headache, miscarriage, demonstrating the gap between research conducted in controlled specialty settings and real-world practices. Over time, national initiatives and an evolving funding climate have shaped PBRN development, contributing to larger networks, a push for shared electronic health records, and the use of a broad range of research methodologies (eg, observational studies, pragmatic randomized controlled trials, continuous quality improvement, participatory methods. Today, there are over 160 active networks registered with the Agency for Healthcare Research and Quality's PBRN Resource Center that engage primary care clinicians, pharmacists, dentists, and other health care professionals in research and quality-improvement initiatives. PBRNs provide an important laboratory for encouraging collaborative research partnerships between academicians and practices or communities to improve population health, conduct comparative effectiveness and patient-centered outcomes research, and study health policy reform. PBRNs continue to face critical challenges that include: (1 adapting to a changing landscape; (2 recruiting and retaining membership; (3 securing infrastructure support; (4 straddling two worlds (academia and community and managing

Protocol for a thematic synthesis to identify key themes and messages from a palliative care research network.

LENUS (Irish Health Repository)

Nicholson, Emma

2016-10-21

Research networks that facilitate collaborative research are increasing both regionally and globally and such collaborations contribute greatly to knowledge transfer particularly in health research. The Palliative Care Research Network is an Irish-based network that seeks to create opportunities and engender a collaborative environment to encourage innovative research that is relevant for policy and practice. The current review outlines a methodology to identify cross-cutting messages to identify how dissemination outputs can be optimized to ensure that key messages from this research reaches all knowledge users.

The dentist's care-taking perspective of dental fear patients - a continuous and changing challenge.

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Gyllensvärd, K; Qvarnström, M; Wolf, E

2016-08-01

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.

Sociolegal and practice implications of caring for LGBT people with dementia.

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Peel, Elizabeth; Taylor, Helen; Harding, Rosie

2016-11-30

The needs of lesbian, gay, bisexual and trans (LGBT) people with dementia are poorly recognised. This is due partly to assumptions that all older people are heterosexual or asexual. One quarter of gay or bisexual men and half of lesbian or bisexual women have children, compared with 90% of heterosexual women and men, which means LGBT older adults are more likely to reside in care homes. Older LGBT people may be unwilling to express their sexual identities in care settings and this can affect their care. Members of older people's informal care networks must be recognised to ensure their involvement in the lives of residents in care settings continues. However, healthcare professionals may not always realise that many LGBT people rely on their families of choice or wider social networks more than on their families of origin. This article explores sociolegal issues that can arise in the care of older LGBT people with dementia, including enabling autonomy, capacity and applying legal frameworks to support their identities and relationships. It also highlights implications for practice.

From computers to ubiquitous computing by 2010: health care.

Science.gov (United States)

Aziz, Omer; Lo, Benny; Pansiot, Julien; Atallah, Louis; Yang, Guang-Zhong; Darzi, Ara

2008-10-28

Over the past decade, miniaturization and cost reduction in semiconductors have led to computers smaller in size than a pinhead with powerful processing abilities that are affordable enough to be disposable. Similar advances in wireless communication, sensor design and energy storage have meant that the concept of a truly pervasive 'wireless sensor network', used to monitor environments and objects within them, has become a reality. The need for a wireless sensor network designed specifically for human body monitoring has led to the development of wireless 'body sensor network' (BSN) platforms composed of tiny integrated microsensors with on-board processing and wireless data transfer capability. The ubiquitous computing abilities of BSNs offer the prospect of continuous monitoring of human health in any environment, be it home, hospital, outdoors or the workplace. This pervasive technology comes at a time when Western world health care costs have sharply risen, reflected by increasing expenditure on health care as a proportion of gross domestic product over the last 20 years. Drivers of this rise include an ageing post 'baby boom' population, higher incidence of chronic disease and the need for earlier diagnosis. This paper outlines the role of pervasive health care technologies in providing more efficient health care.

Development of a questionnaire encompassing indicators of distress: a tool for use with women in surgical continuity of care for breast cancer.

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Jørgensen, L; Garne, J P; Søgaard, M; Laursen, B S

2015-04-01

Women with breast cancer often experience significant distress. Currently, there are no questionnaires aimed at identifying women's unique and possible changing indicators for distress in surgical continuity of care for breast cancer. We developed and tested three questionnaires specifically for this use. We first searched PubMed, CINAHL and PsycINFO to retrieve information on previously described indicators. Next, we conducted a focus group interview with 6 specialised nurses, who have extensive experience about consequences of breast cancer for women in surgical continuity of care. The questionnaire was tested on 18 women scheduled for breast cancer surgery. Subsequently, the women were debriefed to gain knowledge about comprehensibility, readability and relevance of items, and the time needed to complete the questionnaire. After adjustment, the questionnaires were field-tested concomitantly with a clinical study, which both consisted of a survey and an interview study. Three multi-item questionnaires were developed specific to different time points in surgical continuity of care. The questionnaires share a core of statements divided into seven sub-scales: emotional and physical situation, social condition, sexuality, body image, religion and organisational factors. Besides the core of statements, each questionnaire has different statements depending on the time point of surgical continuity of care when it was to be responded to. The questionnaires contain comprehensive items that can identify indicators for distress in individual women taking part in surgical continuity of care. The items were understandable and the time used for filling in the questionnaires was reasonable. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

Science.gov (United States)

1984-08-01

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

Assimilation of Spatially Sparse In Situ Soil Moisture Networks into a Continuous Model Domain

Science.gov (United States)

Gruber, A.; Crow, W. T.; Dorigo, W. A.

2018-02-01

Growth in the availability of near-real-time soil moisture observations from ground-based networks has spurred interest in the assimilation of these observations into land surface models via a two-dimensional data assimilation system. However, the design of such systems is currently hampered by our ignorance concerning the spatial structure of error afflicting ground and model-based soil moisture estimates. Here we apply newly developed triple collocation techniques to provide the spatial error information required to fully parameterize a two-dimensional (2-D) data assimilation system designed to assimilate spatially sparse observations acquired from existing ground-based soil moisture networks into a spatially continuous Antecedent Precipitation Index (API) model for operational agricultural drought monitoring. Over the contiguous United States (CONUS), the posterior uncertainty of surface soil moisture estimates associated with this 2-D system is compared to that obtained from the 1-D assimilation of remote sensing retrievals to assess the value of ground-based observations to constrain a surface soil moisture analysis. Results demonstrate that a fourfold increase in existing CONUS ground station density is needed for ground network observations to provide a level of skill comparable to that provided by existing satellite-based surface soil moisture retrievals.

[Prevention and Treatment of Eating Disorders: The Health Care Network Anorexia and Bulimia nervosa].

Science.gov (United States)

Weigel, Angelika; Gumz, Antje; Kästner, Denise; Romer, Georg; Wegscheider, Karl; Löwe, Bernd

2015-07-01

The "Health care network anorexia and bulimia nervosa", a subproject of psychenet - the Hamburg network for mental health - aims to decrease the incidence of eating disorders as well as the risk for chronic illness courses. One focal project, therefore, evaluates a school-based prevention manual in a randomized controlled trial. The other one examines the impact of a systemic public health intervention on early treatment initiation in anorexia nervosa. The present article provides an overview about study design and interventions in both focal projects as well as preliminary results. © Georg Thieme Verlag KG Stuttgart · New York.

A Health Collaborative Network Focus on Self-care Processes in Personal Assistant Practice

Science.gov (United States)

de La Fuente, Ma Victoria; Ros, Lorenzo

Public health is oriented to the management of an adequate health atmosphere which acts directly on health, as well as health education work and the supervision of environmental health threats. The work presented in this paper aims to reduce inequality, and give disabled people the tools to be integrated more effectively, reducing social exclusion, removing obstacles and barriers, and facilitating mobility and the use of technology. The work is planned to design a special healthcare collaborative network as the best solution for addressing the needs of the disabled self-care and health care community through the creation and implementation of an interconnected, electronic information infrastructure and adoption of open data standards.

The LHIN adventure: The journey continues.

Science.gov (United States)

Huras, Paul; Switzer, Gary; Eliasoph, Hy

2015-11-01

The Local Health Integration Network (LHIN) adventure began 10 years ago with the intent of transforming the Ontario health system by providing system-based leadership and building collaborative capacity among health service providers. The LHIN construct has continued its evolution during this time and is still in the midst of testing and reshaping the boundaries of its mandate and authority. Working closely and in tandem with the Ministry of Health and Long-Term Care, LHINs have grappled with governance, funding, integration, and engagement, changing the nature of relationships and the dynamics inherent across the health system. The next decade holds considerable promise for LHINs and the health system in Ontario as a whole. © 2015 The Canadian College of Health Leaders.

Topological Effects and Performance Optimization in Transportation Continuous Network Design

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Jianjun Wu

2014-01-01

Full Text Available Because of the limitation of budget, in the planning of road works, increased efforts should be made on links that are more critical to the whole traffic system. Therefore, it would be helpful to model and evaluate the vulnerability and reliability of the transportation network when the network design is processing. This paper proposes a bilevel transportation network design model, in which the upper level is to minimize the performance of the network under the given budgets, while the lower level is a typical user equilibrium assignment problem. A new solution approach based on particle swarm optimization (PSO method is presented. The topological effects on the performance of transportation networks are studied with the consideration of three typical networks, regular lattice, random graph, and small-world network. Numerical examples and simulations are presented to demonstrate the proposed model.

Benefiting from networks by occupying central positions: an empirical study of the Taiwan health care industry.

Science.gov (United States)

Peng, Tzu-Ju Ann; Lo, Fang-Yi; Lin, Chin-Shien; Yu, Chwo-Ming Joseph

2006-01-01

At issue is whether network resources imply some resources available to all members in networks or available only to those occupying structurally central positions in networks. In this article, two conceptual models, the additive and interaction models of the firm, are empirically tested regarding the impact of hospital resources, network resources, and centrality on hospital performance in the Taiwan health care industry. The results demonstrate that: (1) in the additive model, hospital resources and centrality independently affect performance, whereas network resources do not; and (2) no evidence supports the interaction effect of centrality and resources on performance. Based on our findings in Taiwanese practices, the extent to which the resources are acquired externally from networks, we suggest that while adopting interorganizational strategies, hospitals should clearly identify those important resources that reside in-house and those transferred from network partners. How hospitals access resources from central positions is more important than what network resources can hospitals acquire from networks. Hospitals should improve performance by exploiting its in-house resources rather than obtaining network resources externally. In addition, hospitals should not only invest in hospital resources for better performance but should also move to central positions in networks to benefit from collaborations.

Evaluating the effectiveness of care integration strategies in different healthcare systems in Latin America: the EQUITY-LA II quasi-experimental study protocol

Science.gov (United States)

Vázquez, María-Luisa; Vargas, Ingrid; Unger, Jean-Pierre; De Paepe, Pierre; Mogollón-Pérez, Amparo Susana; Samico, Isabella; Albuquerque, Paulette; Eguiguren, Pamela; Cisneros, Angelica Ivonne; Rovere, Mario; Bertolotto, Fernando

2015-01-01

Introduction Although fragmentation in the provision of healthcare is considered an important obstacle to effective care, there is scant evidence on best practices in care coordination in Latin America. The aim is to evaluate the effectiveness of a participatory shared care strategy in improving coordination across care levels and related care quality, in health services networks in six different healthcare systems of Latin America. Methods and analysis A controlled before and after quasi-experimental study taking a participatory action research approach. In each country, two comparable healthcare networks were selected—intervention and control. The study contains four phases: (1) A baseline study to establish network performance in care coordination and continuity across care levels, using (A) qualitative methods: semi-structured interviews and focus groups with a criterion sample of health managers, professionals and users; and (B) quantitative methods: two questionnaire surveys with samples of 174 primary and secondary care physicians and 392 users with chronic conditions per network. Sample size was calculated to detect a proportion difference of 15% and 10%, before and after intervention (α=0.05; β=0.2 in a two-sided test); (2) a bottom-up participatory design and implementation of shared care strategies involving micro-level care coordination interventions to improve the adequacy of patient referral and information transfer. Strategies are selected through a participatory process by the local steering committee (local policymakers, health care network professionals, managers, users and researchers), supported by appropriate training; (3) Evaluation of the effectiveness of interventions by measuring changes in levels of care coordination and continuity 18 months after implementation, applying the same design as in the baseline study; (4) Cross-country comparative analysis. Ethics and dissemination This study complies with international and national legal

Bi-Criteria System Optimum Traffic Assignment in Networks With Continuous Value of Time

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Xin Wang

2013-04-01

Full Text Available For an elastic demand transportation network with continuously distributed value of time, the system disutility can be measured either in time units or in cost units. The user equilibrium model and the system optimization model are each formulated in two different criteria. The conditions required for making the system optimum link flow pattern equivalent to the user equilibrium link flow pattern are derived. Furthermore, a bi-objective model has been developed which minimizes simultaneously the system travel time and the system travel cost. The existence of a pricing scheme with anonymous link tolls which can decentralize a Pareto system optimum into the user equilibrium has been investigated.

Bayesian networks for clinical decision support in lung cancer care.

Directory of Open Access Journals (Sweden)

M Berkan Sesen

Full Text Available Survival prediction and treatment selection in lung cancer care are characterised by high levels of uncertainty. Bayesian Networks (BNs, which naturally reason with uncertain domain knowledge, can be applied to aid lung cancer experts by providing personalised survival estimates and treatment selection recommendations. Based on the English Lung Cancer Database (LUCADA, we evaluate the feasibility of BNs for these two tasks, while comparing the performances of various causal discovery approaches to uncover the most feasible network structure from expert knowledge and data. We show first that the BN structure elicited from clinicians achieves a disappointing area under the ROC curve of 0.75 (± 0.03, whereas a structure learned by the CAMML hybrid causal discovery algorithm, which adheres with the temporal restrictions, achieves 0.81 (± 0.03. Second, our causal intervention results reveal that BN treatment recommendations, based on prescribing the treatment plan that maximises survival, can only predict the recorded treatment plan 29% of the time. However, this percentage rises to 76% when partial matches are included.

Genetic optimization of neural network architecture

International Nuclear Information System (INIS)

Harp, S.A.; Samad, T.

1994-03-01

Neural networks are now a popular technology for a broad variety of application domains, including the electric utility industry. Yet, as the technology continues to gain increasing acceptance, it is also increasingly apparent that the power that neural networks provide is not an unconditional blessing. Considerable care must be exercised during application development if the full benefit of the technology is to be realized. At present, no fully general theory or methodology for neural network design is available, and application development is a trial-and-error process that is time-consuming and expertise-intensive. Each application demands appropriate selections of the network input space, the network structure, and values of learning algorithm parameters-design choices that are closely coupled in ways that largely remain a mystery. This EPRI-funded exploratory research project was initiated to take the key next step in this research program: the validation of the approach on a realistic problem. We focused on the problem of modeling the thermal performance of the TVA Sequoyah nuclear power plant (units 1 and 2)

Entanglement-continuous unitary transformations

Energy Technology Data Exchange (ETDEWEB)

Sahin, Serkan; Orus, Roman [Institute of Physics, Johannes Gutenberg University, 55099 Mainz (Germany)

2016-07-01

In this talk we present a new algorithm for quantum many-body systems using continuous unitary transformations (CUT) and tensor networks (TNs). With TNs we are able to approximate the solution to the flow equations that lie at the heart of continuous unitary transformations. We call this method Entanglement-Continuous Unitary Transformations (eCUT). It allows us to compute expectation values of local observables as well as tensor network representations of ground states and low-energy excited states. An implementation of the method is shown for 1d systems using matrix product operators. We show preliminary results for the 1d transverse-field Ising model to demonstrate the feasibility of the method.

A Distributed Approach to Continuous Monitoring of Constrained k-Nearest Neighbor Queries in Road Networks

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Hyung-Ju Cho

2012-01-01

Full Text Available Given two positive parameters k and r, a constrained k-nearest neighbor (CkNN query returns the k closest objects within a network distance r of the query location in road networks. In terms of the scalability of monitoring these CkNN queries, existing solutions based on central processing at a server suffer from a sudden and sharp rise in server load as well as messaging cost as the number of queries increases. In this paper, we propose a distributed and scalable scheme called DAEMON for the continuous monitoring of CkNN queries in road networks. Our query processing is distributed among clients (query objects and server. Specifically, the server evaluates CkNN queries issued at intersections of road segments, retrieves the objects on the road segments between neighboring intersections, and sends responses to the query objects. Finally, each client makes its own query result using this server response. As a result, our distributed scheme achieves close-to-optimal communication costs and scales well to large numbers of monitoring queries. Exhaustive experimental results demonstrate that our scheme substantially outperforms its competitor in terms of query processing time and messaging cost.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

Science.gov (United States)

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

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.