WorldWideScience

Sample records for facilitate improved patient

  1. Facilitating communication with patients for improved migraine outcomes.

    Science.gov (United States)

    Buse, Dawn C; Lipton, Richard B

    2008-06-01

    Effective communication is integral to good medical care. Medical professional groups, regulatory agencies, educators, researchers, and patients recognize its importance. Quality of medical communication is directly related to patient satisfaction, improvement in medication adherence, treatment compliance, other outcomes, decreased risk of malpractice, and increase in health care providers' levels of satisfaction. However, skill level and training remain problematic in this area. Fortunately, research has shown that medical communication skills can be successfully taught and acquired, and that improvement in communication skills improves outcomes. The American Migraine Communication Studies I and II evaluated the current state of health care provider-patient communication in headache care and tested a simple educational intervention. They found problematic issues but demonstrated that these areas could be improved. We review theoretical models of effective communication and discuss strategies for improving communication, including active listening, interviewing strategies, and methods for gathering information about headache-related impairment, mood, and quality of life.

  2. What impedes and what facilitates a quality improvement project for older hospitalized patients?

    NARCIS (Netherlands)

    IJkema, R.; Langelaan, M.; Steeg, L. van de; Wagner, C.

    2014-01-01

    Objective: To gain insight into which factors impede, and which facilitate, the implementation of a complex multi-component improvement initiative in hospitalized older patients. Design: A qualitative study based on semi-structured interviews. The three dimensions of Pettigrew and Whipp's theoretica

  3. The art and science of cancer education and evaluation: toward facilitating improved patient outcomes.

    Science.gov (United States)

    Johnson, Lenora; Ousley, Anita; Swarz, Jeffrey; Bingham, Raymond J; Erickson, J Bianca; Ellis, Steven; Moody, Terra

    2011-03-01

    Cancer education is a constantly evolving field, as science continues to advance both our understanding of cancer and its effects on patients, families, and communities. Moving discoveries to practice expeditiously is paramount to impacting cancer outcomes. The continuing education of cancer care professionals throughout their practice life is vital to facilitating the adoption of therapeutic innovations. Meanwhile, more general educational programs serve to keep cancer patients, their families, and the public informed of the latest findings in cancer research. The National Cancer Institute conducted an assessment of the current knowledge base for cancer education which involved two literature reviews, one of the general literature of the evaluation of medical and health education efforts, and the other of the preceding 5 years of the Journal of Cancer Education (JCE). These reviews explored a wide range of educational models and methodologies. In general, those that were most effective used multiple methodologies, interactive techniques, and multiple exposures over time. Less than one third of the articles in the JCE reported on a cancer education or communication product, and of these, only 70% had been evaluated for effectiveness. Recommendations to improve the evaluation of cancer education and the educational focus of the JCE are provided.

  4. Facilitated patient experience feedback can improve nursing care: a pilot study for a phase III cluster randomised controlled trial

    Science.gov (United States)

    2013-01-01

    Control and Feedback Plus = 8.28 ± 7.2 (p = 0.02)). Conclusions This study provides preliminary evidence that facilitated patient feedback can improve patients’ experiences such that a full trial is justified. These findings suggest that merely informing nurses of patient survey results in writing does not stimulate improvements, even if results are disaggregated by ward, but the addition of ward meetings had an important and significant impact. PMID:23826970

  5. Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience.

    Science.gov (United States)

    Luxford, Karen; Safran, Dana Gelb; Delbanco, Tom

    2011-10-01

    To investigate organizational facilitators and barriers to patient-centered care in US health care institutions renowned for improving the patient care experience. A qualitative study involving interviews of senior staff and patient representatives. Semi-structured interviews focused on organizational processes, senior leadership, work environment, measurement and feedback mechanisms, patient engagement and information technology and access. Eight health care organizations across the USA with a reputation for successfully promoting patient-centered care. Forty individuals, including chief executives, quality directors, chief medical officers, administrative directors and patient committee representatives. Interviewees reported that several organizational attributes and processes are key facilitators for making care more patient-centered: (i) strong, committed senior leadership, (ii) clear communication of strategic vision, (iii) active engagement of patient and families throughout the institution, (iv) sustained focus on staff satisfaction, (v) active measurement and feedback reporting of patient experiences, (vi) adequate resourcing of care delivery redesign, (vii) staff capacity building, (viii) accountability and incentives and (ix) a culture strongly supportive of change and learning. Interviewees reported that changing the organizational culture from a 'provider-focus' to a 'patient-focus' and the length of time it took to transition toward such a focus were the principal barriers against transforming delivery for patient-centered care. Organizations that have succeeded in fostering patient-centered care have gone beyond mainstream frameworks for quality improvement based on clinical measurement and audit and have adopted a strategic organizational approach to patient focus.

  6. Improvements in Limb Kinetic Apraxia by Repetition of a Newly Designed Facilitation Exercise in a Patient with Corticobasal Degeneration

    Science.gov (United States)

    Kawahira, Kazumi; Noma, Tomokazu; Iiyama, Junichi; Etoh, Seiji; Ogata, Atsuko; Shimodozono, Megumi

    2009-01-01

    Corticobasal degeneration is a progressive neurological disorder characterized by a combination of parkinsonism and cortical dysfunction such as limb kinetic apraxia, alien limb phenomenon, and dementia. To study the effect of repetitive facilitation exercise (RFE) in a patient with corticobasal degeneration, we used a newly designed facilitation…

  7. Patient advocacy: barriers and facilitators

    Directory of Open Access Journals (Sweden)

    Nikravesh Mansoure

    2006-03-01

    Full Text Available Abstract Background During the two recent decades, advocacy has been a topic of much debate in the nursing profession. Although advocacy has embraced a crucial role for nurses, its extent is often limited in practice. While a variety of studies have been generated all over the world, barriers and facilitators in the patient advocacy have not been completely identified. This article presents the findings of a study exploring the barriers and facilitators influencing the role of advocacy among Iranian nurses. Method This study was conducted by grounded theory method. Participants were 24 Iranian registered nurses working in a large university hospital in Tehran, Iran. Semi-structured interviews were used for data collection. All interviews were transcribed verbatim and simultaneously Constant comparative analysis was used according to the Strauss and Corbin method. Results Through data analysis, several main themes emerged to describe the factors that hindered or facilitated patient advocacy. Nurses in this study identified powerlessness, lack of support, law, code of ethics and motivation, limited communication, physicians leading, risk of advocacy, royalty to peers, and insufficient time to interact with patients and families as barriers to advocacy. As for factors that facilitated nurses to act as a patient advocate, it was found that the nature of nurse-patient relationship, recognizing patients' needs, nurses' responsibility, physician as a colleague, and nurses' knowledge and skills could be influential in adopting the advocacy role. Conclusion Participants believed that in this context taking an advocacy role is difficult for nurses due to the barriers mentioned. Therefore, they make decisions and act as a patient's advocate in any situation concerning patient needs and status of barriers and facilitators. In most cases, they can not act at an optimal level; instead they accept only what they can do, which we called 'limited advocacy' in

  8. Barriers and facilitators to evidence based care of type 2 diabetes patients: experiences of general practitioners participating to a quality improvement program

    Directory of Open Access Journals (Sweden)

    Hannes Karen

    2009-07-01

    Full Text Available Abstract Objective To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs who participated in an 18-month quality improvement program (QIP. This QIP was implemented to promote compliance with international guidelines. Methods Twenty out of the 120 participating GPs in the QIP underwent semi-structured interviews that focused on three questions: 'Which changes did you implement or did you observe in the quality of diabetes care during your participation in the QIP?' 'According to your experience, what induced these changes?' and 'What difficulties did you experience in making the changes?' Results Most GPs reported that enhanced knowledge, improved motivation, and a greater sense of responsibility were the key factors that led to greater compliance with diabetes care guidelines and consequent improvements in diabetes care. Other factors were improved communication with patients and consulting specialists and reliance on diabetes nurse educators. Some GPs were reluctant to collaborate with specialists, and especially with diabetes educators and dieticians. Others blamed poor compliance with the guidelines on lack of time. Most interviewees reported that a considerable minority of patients were unwilling to change their lifestyles. Conclusion Qualitative research nested in an experimental trial may clarify the improvements that a QIP may bring about in a general practice, provide insight into GPs' approach to diabetes care and reveal the program's limits. Implementation of a QIP encounters an array of cognitive, motivational, and relational obstacles that are embedded in a patient-healthcare provider relationship.

  9. Barriers and facilitators to evidence based care of type 2 diabetes patients : experiences of general practitioners participating to a quality improvement program

    NARCIS (Netherlands)

    Goderis, G.; Borgermans, L.D.A.; Mathieu, C.; Broeke, C. Van Den; Hannes, K.; Heyrman, J.; Grol, R.P.T.M.

    2009-01-01

    ABSTRACT: OBJECTIVE: To evaluate the barriers and facilitators to high-quality diabetes care as experienced by general practitioners (GPs) who participated in an 18-month quality improvement program (QIP). This QIP was implemented to promote compliance with international guidelines. METHODS: Twenty

  10. Primary care quality improvement from a practice facilitator's perspective.

    Science.gov (United States)

    Liddy, Clare E; Blazhko, Valeriya; Dingwall, Molly; Singh, Jatinderpreet; Hogg, William E

    2014-02-03

    Practice facilitation has proven to be effective at improving care delivery. Practice facilitators are healthcare professionals who work with and support other healthcare providers. To the best of our knowledge, very few studies have explored the perspective of facilitators. The objective of this study was to gain insight into the barriers that facilitators face during the facilitation process and to identify approaches used to overcome these barriers to help practices move towards positive change. We conducted semi-structured interviews with four practice facilitators who worked with 84 primary care practices in Eastern Ontario, Canada over a period of five years (2007-2012). The transcripts were analyzed independently by three members of the research team using an open coding technique. A qualitative data analysis using immersion/crystallization technique was applied to interpret the interview transcripts. Common barriers identified by the facilitators included accessibility to the practice (e.g., difficulty scheduling meetings, short meetings), organizational behaviour (team organization, team conflicts, etc.), challenges with practice engagement (e.g., lack of interest, lack of trust), resistance to change, and competing priorities. To help practices move towards positive change the facilitators had to tailor their approach, integrate themselves, be persistent with practices, and exhibit flexibility. The consensus on redesigning and transforming primary care in North America and around the world is rapidly growing. Practice facilitation has been pivotal in materializing the transformation in the way primary care practices deliver care. This study provides an exclusive insight into facilitator approaches which will assist the design and implementation of small- and large-scale facilitation interventions.

  11. What strategies do ulcerative colitis patients employ to facilitate adherence?

    Science.gov (United States)

    Kawakami, Aki; Tanaka, Makoto; Naganuma, Makoto; Maeda, Shin; Kunisaki, Reiko; Yamamoto-Mitani, Noriko

    2017-01-01

    Overall, 30%-45% of patients with ulcerative colitis (UC) are non-adherent and have difficulties taking their medications; this non-adherence increases the risk of clinical relapse 1.4- to 5.5-fold. This study aimed to clarify the strategies patients employ to facilitate adherence and determine whether the strategies had an impact on good adherence. This was a cross-sectional survey using a self-administered questionnaire and review of medical records. Patients diagnosed as having UC and attending one of the outpatient clinics of four urban hospitals from June 2009 to December 2012 were enrolled. A questionnaire was developed to identify the strategies patients employ to facilitate adherence and then administered to patients with UC. Adherence to 5-aminosalicylic acid was calculated, and univariate and multiple logistic regression analyses were performed to determine the strategies that were associated with good adherence. The final analyses included 671 participants (mean age 40.2 years; 54.3% males). The valid response rate was 96.9%; 186 (27.7%) participants were classified as non-adherent, the mean adherence rate being 86.1% (standard deviation [SD] 17.9). Seven strategies that patients employ to facilitate adherence were identified, the following two being significantly associated with good adherence: "I keep my medicines where I eat meals" and "I keep each day's medicine in a pill case or something similar to make sure I have taken them". The identified strategies might be used to develop a program to improve medication adherence in patients with UC.

  12. What strategies do ulcerative colitis patients employ to facilitate adherence?

    Science.gov (United States)

    Kawakami, Aki; Tanaka, Makoto; Naganuma, Makoto; Maeda, Shin; Kunisaki, Reiko; Yamamoto-Mitani, Noriko

    2017-01-01

    Background Overall, 30%–45% of patients with ulcerative colitis (UC) are non-adherent and have difficulties taking their medications; this non-adherence increases the risk of clinical relapse 1.4- to 5.5-fold. This study aimed to clarify the strategies patients employ to facilitate adherence and determine whether the strategies had an impact on good adherence. Methods This was a cross-sectional survey using a self-administered questionnaire and review of medical records. Patients diagnosed as having UC and attending one of the outpatient clinics of four urban hospitals from June 2009 to December 2012 were enrolled. A questionnaire was developed to identify the strategies patients employ to facilitate adherence and then administered to patients with UC. Adherence to 5-aminosalicylic acid was calculated, and univariate and multiple logistic regression analyses were performed to determine the strategies that were associated with good adherence. Results The final analyses included 671 participants (mean age 40.2 years; 54.3% males). The valid response rate was 96.9%; 186 (27.7%) participants were classified as non-adherent, the mean adherence rate being 86.1% (standard deviation [SD] 17.9). Seven strategies that patients employ to facilitate adherence were identified, the following two being significantly associated with good adherence: “I keep my medicines where I eat meals” and “I keep each day’s medicine in a pill case or something similar to make sure I have taken them”. Conclusion The identified strategies might be used to develop a program to improve medication adherence in patients with UC. PMID:28203059

  13. Facilitation: A Novel Way to Improve Students' Well-being

    DEFF Research Database (Denmark)

    Adriansen, Hanne Kirstine Olesen; Madsen, Lene Møller

    2013-01-01

    In this article we analyze a project that used facilitation techniques, which are known from training in industry, to improve the study environment at a public research university in Denmark. In 2009, the project was initiated in one graduate program; and it has subsequently been modified and ins...

  14. Facilitation: a novel way to improve students' well-being

    DEFF Research Database (Denmark)

    Adriansen, Hanne Kirstine; Madsen, Lene Møller

    2013-01-01

    In this article we analyze a project that used facilitation techniques, which are known from training in industry, to improve the study environment at a public research university in Denmark. In 2009, the project was initiated in one graduate program; and it has subsequently been modified and ins...

  15. Rehabilitation therapy centralized on facilitation improving ADL in stroke patients%以易化技术为主的康复治疗对脑卒中患者ADL能力的影响

    Institute of Scientific and Technical Information of China (English)

    刘艳; 崔树勤

    2002-01-01

    To improve ADL,quality of life,and realize goal of returning society,we performed rehabilitation therapy centralized on facilitation on 40 stroke patients and obtained good therapeutic effect.Here is the report. 1 Subject and method 1.1 Subject 80 inpatients with stroke recruited during 1997~ 2000 were randomly divided into rehabilitation group and control group,each group having 40 cases.Patients in rehabilitation group were 45~ 74 years of age(mean age:56 years) including 32 men and 8 women.13 cases in rehabilitation group suffered from cerebral hemorrhage,27 from cerebral infarction,22 from left paralysis,and 18 from right paralysis.Patients in control group were 43~ 75 years of age(mean age:55 years) including 29 men and 11 women.24 cases in rehabilitation group suffered from cerebral hemorrhage,18 from cerebral infarction,24 from left paralysis,and 18 from right paralysis.All diagnoses were carried out according with 4th national cerebrovascular disease meeting of China in 1995[1] and confirmed by CT or MRI.

  16. What strategies do ulcerative colitis patients employ to facilitate adherence?

    Directory of Open Access Journals (Sweden)

    Kawakami A

    2017-01-01

    Full Text Available Aki Kawakami,1,2 Makoto Tanaka,3 Makoto Naganuma,4 Shin Maeda,5 Reiko Kunisaki,1 Noriko Yamamoto-Mitani2 1Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan; 2Department of Gerontological Home Care and Long-term Care Nursing, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan; 3Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand; 4Division of Gastroenterology and Hepatology, Keio University, Shinjuku-ku, Tokyo, Japan; 5Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama, Japan Background: Overall, 30%–45% of patients with ulcerative colitis (UC are non-adherent and have difficulties taking their medications; this non-adherence increases the risk of clinical relapse 1.4- to 5.5-fold. This study aimed to clarify the strategies patients employ to facilitate adherence and determine whether the strategies had an impact on good adherence.Methods: This was a cross-sectional survey using a self-administered questionnaire and review of medical records. Patients diagnosed as having UC and attending one of the outpatient clinics of four urban hospitals from June 2009 to December 2012 were enrolled. A questionnaire was developed to identify the strategies patients employ to facilitate adherence and then administered to patients with UC. Adherence to 5-aminosalicylic acid was calculated, and univariate and multiple logistic regression analyses were performed to determine the strategies that were associated with good adherence.Results: The final analyses included 671 participants (mean age 40.2 years; 54.3% males. The valid response rate was 96.9%; 186 (27.7% participants were classified as non-adherent, the mean adherence rate being 86.1% (standard deviation [SD] 17.9. Seven strategies that patients employ to facilitate adherence were identified, the

  17. How Workflow Systems Facilitate Business Process Reengineering and Improvement

    Directory of Open Access Journals (Sweden)

    Mohamed El Khadiri

    2012-03-01

    Full Text Available This paper investigates the relationship between workflow systems and business process reengineering and improvement. The study is based on a real case study at the “Centre Rgional dInvestissement” (CRI of Marrakech, Morocco. The CRI is entrusted to coordinate various investment projects at the regional level. Our previous work has shown that workflow system can be a basis for business process reengineering. However, for continuous process improvement, the system has shown to be insufficient as it fails to deal with exceptions and problem resolutions that informal communications provide. However, when this system is augmented with an expanded corporate memory system that includes social tools, to capture informal communication and data, we are closer to a more complete system that facilitates business process reengineering and improvement.

  18. The Skills of Facilitator Nurses in Psycho-Social Group Intervention for Cancer Patients.

    Science.gov (United States)

    Chujo, Masami; Okamura, Hitoshi

    2015-06-01

    The objective of this study was to provide cancer patients with a psychosocial group intervention consisting of 3 parts, i.e., education on how to cope with stress and solve problems, group discussions, and progressive muscle relaxation, and to investigate the intervention techniques of Japanese facilitators. Group interventions for breast cancer patients performed by 3 facilitators were analyzed qualitatively and inductively using a phenomenological approach. The skills of facilitators included 10 intervention techniques and 1 problem in interventions. Intervention techniques, which promote group dynamics and thereby help participants acquire improvements in their coping abilities and quality of life (QOL), were somewhat different between new and experienced facilitators, with the content showing immaturity and maturity in the new and experienced facilitators, respectively. Both experienced and new facilitators faced the risk of experiencing problems in interventions, which countered the purpose of the intervention of improving the participants' coping abilities or QOL. While intervention skills are necessary for facilitators to execute group interventions, it must be borne in mind, that even well-experienced facilitators may not always be able to accomplish skillful intervention.

  19. Improving care for people after stroke: how change was actively facilitated.

    Science.gov (United States)

    Bamford, David; Rothwell, Katy; Tyrrell, Pippa; Boaden, Ruth

    2013-01-01

    This paper aims to report on the approach to change used in the development of a tool to assess patient status six months after stroke (the Greater Manchester Stroke Assessment Tool: GM-SAT). The overall approach to change is based on the Promoting Action on Research Implementation in Health Services (PARiHS) Framework, which involves extensive stakeholder engagement before implementation. A key feature was the use of a facilitator without previous clinical experience. The active process of change involved a range of stakeholders--commissioners, patients and professionals--as well as review of published research evidence. The result of this process was the creation of the GM-SAT. The details of the decision processes within the tool included a range of perspectives; the process of localisation led commissioners to identify gaps in care provision as well as learning from others in terms of how services might be provided and organised. The facilitator role was key at all stages in bringing together the wide range of perspectives; the relatively neutral perceived status of the facilitator enabled resistance to change to be minimised. The output of this project, the GM-SAT, has the potential to significantly improve patients' physical, psychological and social outcomes and optimise their quality of life. This will be explored further in future phases of work. A structured process of change which included multiple stakeholder involvement throughout, localisation of approaches and a dedicated independent facilitator role was effective in achieving the development of a useful tool (GM-SAT).

  20. IMPROVING PATIENT SAFETY:

    DEFF Research Database (Denmark)

    Bagger, Bettan; Taylor Kelly, Hélène; Hørdam, Britta

    2013-01-01

    Every year millions of patients worldwide suffer injury or death due to unsafe care, thus improving patient safety is both a national and international priority. A developmental project involving University College Zealand and clinical partners in the region focused upon the improvement of patient...... safety by optimizing the theory-practice connection with respect to the development of students’ competencies and the reporting of clinical errors. Population: 2nd year nursing students at University College Zealand (N: 56). Informed consent and full anonymity. Aims: - To increase patient safety...... errors. An interesting finding though is that despite the legal requirements concerning the mandatory reporting of all clinical errors, 37% of the students participating in this study report that they perhaps would be reluctant to report an eventual clinical error. Further initiatives are thus necessary...

  1. IMPROVING PATIENT SAFETY:

    DEFF Research Database (Denmark)

    Bagger, Bettan; Taylor Kelly, Hélène; Hørdam, Britta

    2013-01-01

    , social and cultural factors have resulted in a greater emphasis upon digital technology. Attempts to improve patient safety by optimizing students’ competencies in relation to the reporting of clinical errors, has resulted in the development of an interdisciplinary e-learning concept. The program makes......Improving patient safety is both a national and international priority as millions of patients Worldwide suffer injury or death every year due to unsafe care. University College Zealand employs innovative pedagogical approaches in educational design. Regional challenges related to geographic...... it possible for the students to train and test their knowledge and understanding independent of time and place. Data accumulated from the e-learning program will be used to further develop digital learning initiatives....

  2. Facilitators and Threats to the Patient Dignity in Hospitalized Patients with Heart Diseases: A Qualitative Study

    OpenAIRE

    Fariba Borhani; Abbas Abbaszadeh; Roghayeh Mehdipour Rabori

    2016-01-01

    Background: Patient’s dignity is an important issue which is highlighted in nursing It is an issue that is highly dependent on context and culture. Heart disease is the most common disease in Iran and the world. Identification of facilitator and threatening patient dignity in heart patients is vital. This study aimed to explore facilitator and threatening patient dignity in hospitalized patients with heart disease. Methods: This qualitative content analysis study was performed in 2014 in ...

  3. [Barriers and facilitators to implementing shared decision-making in oncology: Patient perceptions].

    Science.gov (United States)

    Ortega-Moreno, M; Padilla-Garrido, N; Huelva-López, L; Aguado-Correa, F; Bayo-Calero, J; Bayo-Lozano, E

    To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented. A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators. More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors. The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Identifying Facilitators and Barriers for Patient Safety in a Medicine Label Design System Using Patient Simulation and Interviews

    DEFF Research Database (Denmark)

    Dieckmann, Peter; Clemmensen, Marianne Hald; Sørensen, Trine Kart

    2016-01-01

    Objectives Medicine label design plays an important role in improving patient safety. This study aimed at identifying facilitators and barriers in a medicine label system to prevent medication errors in clinical use by health care professionals. Methods The study design is qualitative and explora...

  5. Facilitating Improved Writing among Students through Directed Peer Review

    Science.gov (United States)

    Crossman, Joanne M.; Kite, Stacey L.

    2012-01-01

    This study contributes to scant empirical investigation of peer critique of writing among heterogeneously grouped native and nonnative speakers of English, now commonplace in higher education. This mixed-methods study investigated the use of directed peer review to improve writing among graduate students, the majority of whom were nonnative…

  6. Improving Voluntary Environmental Management Programs: Facilitating Learning and Adaptation

    Science.gov (United States)

    Genskow, Kenneth D.; Wood, Danielle M.

    2011-05-01

    Environmental planners and managers face unique challenges understanding and documenting the effectiveness of programs that rely on voluntary actions by private landowners. Programs, such as those aimed at reducing nonpoint source pollution or improving habitat, intend to reach those goals by persuading landowners to adopt behaviors and management practices consistent with environmental restoration and protection. Our purpose with this paper is to identify barriers for improving voluntary environmental management programs and ways to overcome them. We first draw upon insights regarding data, learning, and adaptation from the adaptive management and performance management literatures, describing three key issues: overcoming information constraints, structural limitations, and organizational culture. Although these lessons are applicable to a variety of voluntary environmental management programs, we then present the issues in the context of on-going research for nonpoint source water quality pollution. We end the discussion by highlighting important elements for advancing voluntary program efforts.

  7. Requirements and standards facilitating quality improvement for reporting systems in gastrointestinal endoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement.

    Science.gov (United States)

    Bretthauer, Michael; Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D

    2016-03-01

    To develop standards for high quality in gastrointestinal (GI) endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all GI endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE's viewpoints on the requirements for high-quality endoscopy reporting systems in GI endoscopy. Recommendations 1 Endoscopy reporting systems must be electronic. 2 Endoscopy reporting systems should be integrated into hospitals' patient record systems. 3 Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources. 4 Endoscopy reporting systems shall restrict the use of free-text entry to a minimum, and be based mainly on structured data entry. 5 Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated. 6 Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically. 7 Endoscopy reporting systems shall facilitate the inclusion of information on histopathology of detected lesions, patient satisfaction, adverse events, and surveillance recommendations. 8 Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format. 9 Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees. 10 Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations.

  8. Facilitating involvement in Alcoholics Anonymous during out-patient treatment: a randomized clinical trial.

    Science.gov (United States)

    Walitzer, Kimberly S; Dermen, Kurt H; Barrick, Christopher

    2009-03-01

    This study evaluated two strategies to facilitate involvement in Alcoholics Anonymous (AA)--a 12-Step-based directive approach and a motivational enhancement approach--during skills-focused individual treatment. Randomized controlled trial with assessments at baseline, end of treatment and 3, 6, 9 and 12 months after treatment. PARTICIPANTS, SETTING AND INTERVENTION: A total of 169 alcoholic out-patients (57 women) assigned randomly to one of three conditions: a directive approach to facilitating AA, a motivational enhancement approach to facilitating AA or treatment as usual, with no special emphasis on AA. Self-report of AA meeting attendance and involvement, alcohol consumption (percentage of days abstinent, percentage of days heavy drinking) and negative alcohol consequences. Participants exposed to the 12-Step directive condition for facilitating AA involvement reported more AA meeting attendance, more evidence of active involvement in AA and a higher percentage of days abstinent relative to participants in the treatment-as-usual comparison group. Evidence also suggested that the effect of the directive strategy on abstinent days was mediated partially through AA involvement. The motivational enhancement approach to facilitating AA had no effect on outcome measures. These results suggest that treatment providers can use a 12-Step-based directive approach to effectively facilitate involvement in AA and thereby improve client outcome.

  9. Measurements of procalcitonin facilitate targeting of endotoxin adsorption treatment in febrile neutropenic patients suffering from shock.

    Science.gov (United States)

    Hara, Masaki; Tsuchiya, Ken; Nitta, Kosaku; Ando, Minoru

    2014-01-01

    Immediate initiation of hemoperfusion treatment with polymixin B immobilized fiber (PMX-DHP) is a potent strategy to improve hemodynamics in septic patients with critical circulatory failure. However, it is often difficult to accurately and rapidly differentiate between bacterial infections and non-infectious causes of shock in acutely critically-ill patients. Procalcitonin (PCT) measurements may assist in the early identification of bacterial infection/sepsis and determination of severity in such patients. We present two febrile neutropenic (FN) patients who developed severe shock after chemotherapy for hematological malignancies. PCT levels were markedly elevated in both patients (≥ 10 ng/ml), suggesting a high likelihood of bacterial infectious etiology as the cause of their shock, and thus they were promptly treated with PMX-DHP. Measurements of PCT may facilitate targeting of PMX-DHP treatment among FN patients suffering from shock, which may lead to better prognosis.

  10. Reporting systems in gastrointestinal endoscopy: Requirements and standards facilitating quality improvement: European Society of Gastrointestinal Endoscopy position statement.

    Science.gov (United States)

    Bretthauer, Michael; Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D

    2016-04-01

    To develop standards for high quality of gastrointestinal endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all gastrointestinal endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE's viewpoints on requirements for high-quality endoscopy reporting systems. The following recommendations are issued: Endoscopy reporting systems must be electronic.Endoscopy reporting systems should be integrated into hospital patient record systems.Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources.Endoscopy reporting systems shall restrict the use of free text entry to a minimum, and be based mainly on structured data entry.Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated.Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically.Endoscopy reporting systems shall enable the inclusion of information on histopathology of detected lesions; patient's satisfaction; adverse events; surveillance recommendations.Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format.Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees.Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations.

  11. Facilitating patients with disorders of consciousness to sit without trunk support: a qualitative study.

    Science.gov (United States)

    Miyata, Kumiko; Yoshimura, Sadako; Hayashi, Yuko

    2015-09-01

    This study aimed to clarify why and how clinical nurses facilitate sitting without trunk support among patients with disorders of consciousness. Recent attention has focused on encouraging patients with disorders of consciousness to sit without trunk support, but no reports describe this intervention among patients with poor awareness and physical disuse. Qualitative research design. We enrolled five clinical nurses with interventional experience in rehabilitating patients with disorders of consciousness to sit without trunk support. Participant observation and semi-structured interviews were used to collect data. The data were analysed by text-mining method. Three reasons for nursing in the sitting position were identified: to raise the patient's body to assess the recovery of activities of daily living, to adjust their circadian rhythm and encourage the will to sit, and to make it easier to breathe. Five practices were identified: moving the patient to the prone position to sit in safety and comfort, developing postural stability by improving the flexibility of the lower limbs, improving the flexibility of the hip joints, developing trunk balance and encouraging hand use for stability, and ensuring safety by terminating the sitting practice when symptoms of respiratory failure, heart failure, or excessive tiredness developed. The rationale for nursing patients with disorders of consciousness to sit without trunk support was to establish a foundation for independent living. This was achieved by preparing patient's disused body for activity by improving the flexibility of hip joint in the prone position. This represents a new intervention for patients with disorders of consciousness that could facilitate independent living. This study provides empirical and practical evidence from nurses who perform novel clinical interventions that specifically promote independent living. Further accumulation of quantitative clinical results and physiological verification are

  12. The 'patient's physician one-step removed': the evolving roles of medical tourism facilitators.

    Science.gov (United States)

    Snyder, Jeremy; Crooks, Valorie A; Adams, Krystyna; Kingsbury, Paul; Johnston, Rory

    2011-09-01

    Medical tourism involves patients travelling internationally to receive medical services. This practice raises a range of ethical issues, including potential harms to the patient's home and destination country and risks to the patient's own health. Medical tourists often engage the services of a facilitator who may book travel and accommodation and link the patient with a hospital abroad. Facilitators have the potential to exacerbate or mitigate the ethical concerns associated with medical tourism, but their roles are poorly understood. 12 facilitators were interviewed from 10 Canadian medical tourism companies. Three themes were identified: facilitators' roles towards the patient, health system and medical tourism industry. Facilitators' roles towards the patient were typically described in terms of advocacy and the provision of information, but limited by facilitators' legal liability. Facilitators felt they played a positive role in the lives of their patients and the Canadian health system and served as catalysts for reform, although they noted an adversarial relationship with some Canadian physicians. Many facilitators described personally visiting medical tourism sites and forming personal relationships with surgeons abroad, but noted the need for greater regulation of their industry. Facilitators play a substantial and evolving role in the practice of medical tourism and may be entering a period of professionalisation. Because of the key role of facilitators in determining the effects of medical tourism on patients and public health, this paper recommends a planned conversation between medical tourism stakeholders to define and shape facilitators' roles.

  13. Barriers and Facilitators for Being Physically Active in Patients with Ankylosing Spondylitis: A Cross-sectional Comparative Study.

    Science.gov (United States)

    Fongen, Camilla; Sveaas, Silje Halvorsen; Dagfinrud, Hanne

    2015-06-01

    The aims of the present study were to explore the barriers and facilitators for being physically active and the perceived health benefits of physical activity in a group of patients with ankylosing spondylitis (AS), and to compare the findings with those in population controls. A total of 148 patients and 133 controls were included in a cross-sectional study. Barriers, facilitators and perceived health benefits were registered in a structured interview. Patients were significantly more likely to report barriers to being physically active compared with controls (78% versus 58%; p ≤ 0.001). The barriers most frequently reported by patients were pain (48%), stiffness (36%), fatigue (30%) and disability (21%). A similar proportion of patients (62%) and controls (61%) reported that they had the potential to become more physically active (p = 0.12). Time and motivation were the most frequently reported facilitators in both groups. Patients also reported stable disease (15%) and individually adapted physical activity (8%) as facilitators. An equal proportion of patients (96%) and controls (96%) reported that physical activity had a positive effect on their health (p = 0.94). Improved fitness and increased vitality were the most frequently reported health benefits in both groups. Patients also reported greater disease stability (37%) and reduced pain (33%) as benefits. A larger proportion of patients than controls reported barriers to being physically active. In addition to regular barriers, facilitators and health benefits, patients reported that disease-related factors influenced their participation in physical activity. Copyright © 2014 John Wiley & Sons, Ltd.

  14. Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation

    Science.gov (United States)

    Harvey, Gillian; Lynch, Elizabeth

    2017-01-01

    Facilitating the implementation of continuous quality improvement (CQI) is a complex undertaking. Numerous contextual factors at a local, organizational, and health system level can influence the trajectory and ultimate success of an improvement program. Some of these contextual factors are amenable to modification, others less so. As part of planning and implementing healthcare improvement, it is important to assess and build an understanding of contextual factors that might present barriers to or enablers of implementation. On the basis of this initial diagnosis, it should then be possible to design and implement the improvement intervention in a way that is responsive to contextual barriers and enablers, often described as “tailoring” the implementation approach. Having individuals in the active role of facilitators is proposed as an effective way of delivering a context-sensitive, tailored approach to implementing CQI. This paper presents an overview of the facilitator role in implementing CQI. Drawing on empirical evidence from the use of facilitator roles in healthcare, the type of skills and knowledge required will be considered, along with the type of facilitation strategies that can be employed in the implementation process. Evidence from both case studies and systematic reviews of facilitation will be reviewed and key lessons for developing and studying the role in the future identified. PMID:28275594

  15. Framework for Patient Flow Improvement

    Directory of Open Access Journals (Sweden)

    S.V. Medina-León

    2014-07-01

    Full Text Available There has been much research where the flow of patients was improved, but most of this study is case-specific and only a few papers offer guidelines for patient flow analysis and improvement. In this study a general framework for the analysis and improvement of patient flow is presented, based on a literature review and on experience from a case study in a hospital in Mexico dealing with identifying improvement opportunities that reduced waiting times in the obstetrics/gynecology area of the emergency department. The framework involves an initial analysis using basic tools followed by the selection of a strategy based on system complexity; financial investment required and team participation. The alternative strategies considered were use of advanced analysis tools; use of kaizen events; or direct recommendations. The aim of the framework is to serve as guideline in patient flow improvement projects by helping select the most appropriate improvement path, resulting in project success.

  16. Facilitators and Threats to the Patient Dignity in Hospitalized Patients with Heart Diseases: A Qualitative Study.

    Science.gov (United States)

    Borhani, Fariba; Abbaszadeh, Abbas; Rabori, Roghayeh Mehdipour

    2016-01-01

    Patient's dignity is an important issue which is highlighted in nursing It is an issue that is highly dependent on context and culture. Heart disease is the most common disease in Iran and the world. Identification of facilitator and threatening patient dignity in heart patients is vital. This study aimed to explore facilitator and threatening patient dignity in hospitalized patients with heart disease. This qualitative content analysis study was performed in 2014 in Kerman, Iran. 20 patients admitted to coronary care units and 5 personnel were selected using purposeful sampling in semi-structured and in depth interviews. Researchers also used documentation and field notes until data saturation. Qualitative data analysis was done constantly and simultaneously with data collection. Three central themes emerged: a) Care context which includes human environment and physical environment, b) Holistic safe care including meeting the needs of patients both in the hospital and after discharge, c) Creating a sense of security and an effective relationship between patient and nurse, including a respectful relationship and account the family in health team. The results of this study showed that care context is important for patient dignity as well as physical environment and safe holistic care.

  17. Facilitators and Threats to the Patient Dignity in Hospitalized Patients with Heart Diseases: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Fariba Borhani

    2016-01-01

    Full Text Available Background: Patient’s dignity is an important issue which is highlighted in nursing It is an issue that is highly dependent on context and culture. Heart disease is the most common disease in Iran and the world. Identification of facilitator and threatening patient dignity in heart patients is vital. This study aimed to explore facilitator and threatening patient dignity in hospitalized patients with heart disease. Methods: This qualitative content analysis study was performed in 2014 in Kerman, Iran. 20 patients admitted to coronary care units and 5 personnel were selected using purposeful sampling in semi-structured and in depth interviews. Researchers also used documentation and field notes until data saturation. Qualitative data analysis was done constantly and simultaneously with data collection Results: Three central themes emerged: a Care context which includes human environment and physical environment, b Holistic safe care including meeting the needs of patients both in the hospital and after discharge, c Creating a sense of security and an effective relationship between patient and nurse, including a respectful relationship and account the family in health team. Conclusion: The results of this study showed that care context is important for patient dignity as well as physical environment and safe holistic care.

  18. Understanding barriers and facilitators to healthy eating and physical activity from patients either before and after knee arthroplasty.

    Science.gov (United States)

    Pellegrini, Christine A; Ledford, Gwendolyn; Chang, Rowland W; Cameron, Kenzie A

    2017-05-05

    We sought to identify patient-reported barriers and facilitators to healthy eating and physical activity among patients before or after knee arthroplasty. Twenty patients with knee osteoarthritis aged 40-79 years who had knee arthroplasty surgery scheduled or completed within 3 months were interviewed. Interview topics included perceived barriers and facilitators to healthy eating and activity before or after surgery. Interviews were coded and analyzed using constant comparative analysis. Interviews were completed with 11 pre-operative (67.1 ± 7.6 years, 45.5% female, BMI 31.2 ± 6.3) and nine post-operative patients (61.7 ± 11.7 years, 44.4% female, BMI 30.2 ± 4.7 kg/m(2)). The most commonly identified personal barriers to healthy eating identified were desire for high-fat/high-calorie foods, managing overconsumption and mood. Factors related to planning, portion control and motivation to improve health were identified as healthy eating facilitators. Identified personal barriers for activity included pain, physical limitations and lack of motivation, whereas facilitators included having motivation to improve knee symptoms/outcomes, personal commitment to activity and monitoring activity levels. Identifying specific eating and activity barriers and facilitators, such as mood and motivation to improve outcomes, provides critical insight from the patient perspective, which will aid in developing weight management programs during rehabilitation for knee arthroplasty patients. Implications for rehabilitation This study provides insight into the identified barriers and facilitators to healthy eating and physical activity in knee arthroplasty patients, both before and after surgery. Intrapersonal barriers that may hinder engagement in physical activity and rehabilitation include pain, physical limitations and lack of motivation; factors that may help to improve activity and the rehabilitation process include being motivated to improve knee outcomes

  19. Improving emergency department patient flow.

    Science.gov (United States)

    Jarvis, Paul Richard Edwin

    2016-06-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

  20. Perceived barriers and facilitators for general practitioner-patient communication in palliative care: a systematic review

    NARCIS (Netherlands)

    Slort, W.; Schweitzer, B.P.M.; Blankenstein, A.H.; Abarshi, E.A.; Riphagen, I.I.; Echteld, M.A.; Aaronson, N.K.; van der Horst, H.E.; Deliens, L.

    2011-01-01

    While effective general practitioner (GP)-patient communication is required for the provision of good palliative care, barriers and facilitators for this communication are largely unknown. We aimed to identify barriers and facilitators for GP-patient communication in palliative care. In a systematic

  1. Two different strategies to facilitate involvement in healthcare improvements: a Swedish county council initiative.

    Science.gov (United States)

    Andersson, Ann-Christine; Idvall, Ewa; Perseius, Kent-Inge; Elg, Mattias

    2014-09-01

    From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance. The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in health-care organizations. Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants' profession, position, gender, and the organizational administration of which they were a part, in relation to their participation. An improvement project in a County Council in Sweden. Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects. Two different types of improvement strategies, Designed Improvement Processes and Intrapreneurship Projects. How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations. Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside. Managers need to give prerequisites and incentives for staff who do not participate in improvements to do so. Comparisons of different types of improvement initiatives are an underused research strategy that yields interesting and thoughtful results.

  2. Teachers' Perspectives and Suggestions for Improving Teacher Education to Facilitate Student Learning

    Science.gov (United States)

    Linkenhoker, Dina L.

    2012-01-01

    The purpose of this transcendental phenomenological study is to give teachers a voice to express their self-efficacy beliefs, their opinions about the content and the effectiveness of their teacher preparation programs to facilitate student learning, and to hear their suggestions for improving teacher education to enable future educators to…

  3. Assessing and Improving Student Organizations: Resources for Facilitators CD-ROM. The Assessing and Improving Student Organization (AISO) Program

    Science.gov (United States)

    Nolfi, Tricia; Ruben, Brent D.

    2010-01-01

    This companion to the "Guide for Students" and "Student Workbook" includes the complete set of PowerPoint slides, a PDF of the Facilitator's Guide in PPT (PowerPoint) slide show format, and PDFs of all scoring sheets, handouts and project planning guides needed for the AISO (Assessing and Improving Student Organization) process. The Assessing and…

  4. Barriers and facilitators to palliative care of patients with chronic heart failure in Germany: a study protocol

    Directory of Open Access Journals (Sweden)

    Stefan Köberich

    2015-07-01

    Full Text Available Background. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. Design and Methods. Tripartite study. First part of this study evaluates health care providers’ (physicians and nurses perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. Expected Impact for Public Health. The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients.

  5. Collective learning, change and improvement in health care: trialling a facilitated learning initiative with general practice teams.

    Science.gov (United States)

    Bunniss, Suzanne; Gray, Francesca; Kelly, Diane

    2012-06-01

    Many patients, families, health care professionals and politicians desire for quality improvement within the UK National Health Service. One way to achieve this change is for health care teams to work and learn together more effectively. This research aimed to design and trial a facilitated learning programme with the aim of supporting general practice teams in fostering the characteristics of learning organizations. This is an action research study. Qualitative data were captured during and after the trial from 40 participants in two multi-professional general practice teams within different Scottish health boards. Data were gathered using observations, semi-structured interviews and written learning notes. Taking part in the LPP was a positive experience of learning together as a practice and enhanced communication within the team was a particular outcome. External facilitation helped provide focus and reduce inter-professional barriers. Teams found working in small, mixed role discussion groups particularly valuable in understanding each others' perspectives. The active learning style of the LPP could be daunting at times but teams valued the chance to identify their own quality improvement goals. Teams introduced a number of changes to improve the quality of care within their practice as a result of their participation. This trial of the learning practice programme shows that, with facilitation and the appropriate input of resources, general practice teams can successfully apply learning organization principles to produce quality improvement outcomes. The study also demonstrates the value of action research in researching iterative change over time. © 2011 Blackwell Publishing Ltd.

  6. Facilitating participatory steps for planning and implementing low-cost improvements in small workplaces.

    Science.gov (United States)

    Kogi, Kazutaka

    2008-07-01

    In this paper, practical means of facilitating participatory steps taken in workplace improvement programs in small workplaces were reviewed. The reviewed programs included those organized by partners of our Asian inter-country network for small enterprises, construction sites, home workplaces and agricultural farms. Trainers who commonly acted as facilitators were found to play multiple roles in helping managers, workers and farmers take initiative and achieve immediate improvements. The participatory steps were more successfully facilitated when the trainers supported (a) building on local good practice, (b) focusing on a range of basic ergonomics principles, and (c) stepwise progress through feedback of achievements. The use of action-oriented toolkits comprising low-cost action checklists and group work guides was commonly helpful. The locally adjusted nature of the toolkits seemed essential. Trainers could thus help people build local initiative, plan and implement low-cost ideas through serial group work steps and confirm benefits in a stepwise manner. The review of the results suggested that a local network of trainers trained in the use of locally adjusted toolkits was vital for facilitating effective improvements in different small workplaces.

  7. Interactive rhythmic cue facilitates gait relearning in patients with Parkinson's disease.

    Science.gov (United States)

    Uchitomi, Hirotaka; Ota, Leo; Ogawa, Ken-ichiro; Orimo, Satoshi; Miyake, Yoshihiro

    2013-01-01

    To develop a method for cooperative human gait training, we investigated whether interactive rhythmic cues could improve the gait performance of Parkinson's disease patients. The interactive rhythmic cues ware generated based on the mutual entrainment between the patient's gait rhythms and the cue rhythms input to the patient while the patient walked. Previously, we found that the dynamic characteristics of stride interval fluctuation in Parkinson's disease patients were improved to a healthy 1/f fluctuation level using interactive rhythmic cues and that this effect was maintained in the short term. However, two problems remained in our previous study. First, it was not clear whether the key factor underpinning the effect was the mutual entrainment between the gait rhythms and the cue rhythms or the rhythmic cue fluctuation itself. Second, it was not clear whether or not the gait restoration was maintained longitudinally and was relearned after repeating the cue-based gait training. Thus, the present study clarified these issues using 32 patients who participated in a four-day experimental program. The patients were assigned randomly to one of four experimental groups with the following rhythmic cues: (a) interactive rhythmic cue, (b) fixed tempo cue, (c) 1/f fluctuating tempo cue, and (d) no cue. It has been reported that the 1/f fluctuation of stride interval in healthy gait is absent in Parkinson's disease patients. Therefore, we used this dynamic characteristic as an evaluation index to analyze gait relearning in the four different conditions. We observed a significant effect in condition (a) that the gait fluctuation of the patients gradually returned to a healthy 1/f fluctuation level, whereas this did not occur in the other conditions. This result suggests that the mutual entrainment can facilitate gait relearning effectively. It is expected that interactive rhythmic cues will be widely applicable in the fields of rehabilitation and assistive technology.

  8. Reporting systems in gastrointestinal endoscopy: Requirements and standards facilitating quality improvement: European Society of Gastrointestinal Endoscopy position statement

    Science.gov (United States)

    Aabakken, Lars; Dekker, Evelien; Kaminski, Michal F; Rösch, Thomas; Hultcrantz, Rolf; Suchanek, Stepan; Jover, Rodrigo; Kuipers, Ernst J; Bisschops, Raf; Spada, Cristiano; Valori, Roland; Domagk, Dirk; Rees, Colin; Rutter, Matthew D

    2016-01-01

    To develop standards for high quality of gastrointestinal endoscopy, the European Society of Gastrointestinal Endoscopy (ESGE) has established the ESGE Quality Improvement Committee. A prerequisite for quality assurance and improvement for all gastrointestinal endoscopy procedures is state-of-the-art integrated digital reporting systems for standardized documentation of the procedures. The current paper describes the ESGE’s viewpoints on requirements for high-quality endoscopy reporting systems. The following recommendations are issued: Endoscopy reporting systems must be electronic.Endoscopy reporting systems should be integrated into hospital patient record systems.Endoscopy reporting systems should include patient identifiers to facilitate data linkage to other data sources.Endoscopy reporting systems shall restrict the use of free text entry to a minimum, and be based mainly on structured data entry.Separate entry of data for quality or research purposes is discouraged. Automatic data transfer for quality and research purposes must be facilitated.Double entry of data by the endoscopist or associate personnel is discouraged. Available data from outside sources (administrative or medical) must be made available automatically.Endoscopy reporting systems shall enable the inclusion of information on histopathology of detected lesions; patient’s satisfaction; adverse events; surveillance recommendations.Endoscopy reporting systems must facilitate easy data retrieval at any time in a universally compatible format.Endoscopy reporting systems must include data fields for key performance indicators as defined by quality improvement committees.Endoscopy reporting systems must facilitate changes in indicators and data entry fields as required by professional organizations. PMID:27087943

  9. Facilitating recruitment of patients with schizophrenia to a clinical trial

    DEFF Research Database (Denmark)

    Grønbech, Bettina Ellen

    People with severe mental illness, such as schizophrenia have higher rates of mortality especially due to cardiovascular disease. We have established a clinical trial named “Coronary artery disease and schizophrenia”. However, patients with schizophrenia have cognitive disturbances, which make re...... recruitment of patients challenging. The purpose of this study is to understand which type of recruitment strategy is needed in clinical trials....

  10. Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure.

    Directory of Open Access Journals (Sweden)

    Susan Browne

    Full Text Available BACKGROUND: Those with advanced heart failure (HF experience high levels of morbidity and mortality, similar to common cancers. However, there remains evidence of inequity of access to palliative care services compared to people with cancer. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care. METHODS: Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (n = 30, carers (n = 20, and professionals (n = 65. Data analysed using Normalisation Process Theory (NPT as the underpinning conceptual framework. FINDINGS: Uncertainty is ubiquitous in accounts from advanced HF patients and their caregivers. This uncertainty relates to understanding of the implications of their diagnosis, appropriate treatments, and when and how to seek effective help. Health professionals agree this is a major problem but feel they lack knowledge, opportunities, or adequate support to improve the situation. Fragmented care with lack of coordination and poor communication makes life difficult. Poor understanding of the condition extends to the wider circle of carers and means that requests for help may not be perceived as legitimate, and those with advanced HF are not prioritised for social and financial supports. Patient and caregiver accounts of emergency care are uniformly poor. Managing polypharmacy and enduring concomitant side effects is a major burden, and the potential for rationalisation exists. This study has potential limitations because it was undertaken within a single geographical location within the United Kingdom. CONCLUSIONS: Little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health care services that are poorly coordinated and offer fragmented care. There is evidence that these poor

  11. Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review.

    Science.gov (United States)

    Solomons, Nan M; Spross, Judith A

    2011-01-01

    The purpose of the present study is to examine the barriers and facilitators to evidence-based practice (EBP) using Shortell's framework for continuous quality improvement (CQI). EBP is typically undertaken to improve practice. Although there have been many studies focused on the barriers and facilitators to adopting EBP, these have not been tied explicitly to CQI frameworks. CINAHL, Academic Search Premier, Medline, Psych Info, ABI/Inform and LISTA databases were searched using the keywords: nurses, information literacy, access to information, sources of knowledge, decision making, research utilization, information seeking behaviour and nursing practice, evidence-based practice. Shortell's framework was used to organize the barriers and facilitators. Across the articles, the most common barriers were lack of time and lack of autonomy to change practice which falls within the strategic and cultural dimensions in Shortell's framework. Barriers and facilitators to EBP adoption occur at the individual and institutional levels. Solutions to the barriers need to be directed to the dimension where the barrier occurs, while recognizing that multidimensional approaches are essential to the success of overcoming these barriers. The findings of the present study can help nurses identify barriers and implement strategies to promote EBP as part of CQI. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  12. Improving the teaching skills of residents as tutors/facilitators and addressing the shortage of faculty facilitators for PBL modules.

    Science.gov (United States)

    Jafri, Wasim; Mumtaz, Khalid; Burdick, William P; Morahan, Page S; Freeman, Rosslynne; Zehra, Tabassum

    2007-10-08

    Residents play an important role in teaching of medical undergraduate students. Despite their importance in teaching undergraduates they are not involved in any formal training in teaching and leadership skills. We aimed to compare the teaching skills of residents with faculty in facilitating small group Problem Based Learning (PBL) sessions. This quasi experimental descriptive comparative research involved 5 postgraduate year 4 residents and five senior faculty members. The study was conducted with all phase III (Final year) students rotating in Gastroenterology. The residents and faculty members received brief training of one month in facilitation and core principles of adult education. Different aspects of teaching skills of residents and faculty were evaluated by students on a questionnaire (graded on Likert Scale from 1 to 10) assessing i) Knowledge Base-content Learning (KBL), ii) PBL, iii) Student Centered Learning (SCL) and iv) Group Skills (GS). There were 33 PBL teaching sessions in which 120 evaluation forms were filled; out of these 53% forms were filled for residents and 47% for faculty group. The faculty showed a statistically greater rating in "KBL" (faculty 8.37 Vs resident 7.94; p-value 0.02), "GS" (faculty 8.06 vs. residents 7.68; p-value 0.04). Differences in faculty and resident scores in "the PBL" and "SCL" were not significant. The overall score of faculty facilitators, however, was statistically significant for resident facilitators. (p = .05). 1) Residents are an effective supplement to faculty members for PBL; 2) Additional facilitators for PBL sessions can be identified in an institution by involvement of residents in teacher training workshops.

  13. Improving the teaching skills of residents as tutors/facilitators and addressing the shortage of faculty facilitators for PBL modules

    Directory of Open Access Journals (Sweden)

    Morahan Page S

    2007-10-01

    Full Text Available Abstract Background Residents play an important role in teaching of medical undergraduate students. Despite their importance in teaching undergraduates they are not involved in any formal training in teaching and leadership skills. We aimed to compare the teaching skills of residents with faculty in facilitating small group Problem Based Learning (PBL sessions. Methods This quasi experimental descriptive comparative research involved 5 postgraduate year 4 residents and five senior faculty members. The study was conducted with all phase III (Final year students rotating in Gastroenterology. The residents and faculty members received brief training of one month in facilitation and core principles of adult education. Different aspects of teaching skills of residents and faculty were evaluated by students on a questionnaire (graded on Likert Scale from 1 to 10 assessing i Knowledge Base-content Learning (KBL, ii PBL, iii Student Centered Learning (SCL and iv Group Skills (GS. Results There were 33 PBL teaching sessions in which 120 evaluation forms were filled; out of these 53% forms were filled for residents and 47% for faculty group. The faculty showed a statistically greater rating in "KBL" (faculty 8.37 Vs resident 7.94; p-value 0.02, "GS" (faculty 8.06 vs. residents 7.68; p-value 0.04. Differences in faculty and resident scores in "the PBL" and "SCL" were not significant. The overall score of faculty facilitators, however, was statistically significant for resident facilitators. (p = .05. Conclusion 1 Residents are an effective supplement to faculty members for PBL; 2 Additional facilitators for PBL sessions can be identified in an institution by involvement of residents in teacher training workshops.

  14. The Skills of Facilitator Nurses in Psycho-Social Group Intervention for Cancer Patients

    OpenAIRE

    Chujo, Masami; Okamura, Hitoshi

    2015-01-01

    Background The objective of this study was to provide cancer patients with a psychosocial group intervention consisting of 3 parts, i.e., education on how to cope with stress and solve problems, group discussions, and progressive muscle relaxation, and to investigate the intervention techniques of Japanese facilitators. Methods Group interventions for breast cancer patients performed by 3 facilitators were analyzed qualitatively and inductively using a phenomenological approach. Results The s...

  15. Bio-Intelligence: A Research Program Facilitating the Development of New Paradigms for Tomorrow's Patient Care

    Science.gov (United States)

    Phan, Sieu; Famili, Fazel; Liu, Ziying; Peña-Castillo, Lourdes

    The advancement of omics technologies in concert with the enabling information technology development has accelerated biological research to a new realm in a blazing speed and sophistication. The limited single gene assay to the high throughput microarray assay and the laborious manual count of base-pairs to the robotic assisted machinery in genome sequencing are two examples to name. Yet even more sophisticated, the recent development in literature mining and artificial intelligence has allowed researchers to construct complex gene networks unraveling many formidable biological puzzles. To harness these emerging technologies to their full potential to medical applications, the Bio-intelligence program at the Institute for Information Technology, National Research Council Canada, aims to develop and exploit artificial intelligence and bioinformatics technologies to facilitate the development of intelligent decision support tools and systems to improve patient care - for early detection, accurate diagnosis/prognosis of disease, and better personalized therapeutic management.

  16. Barriers, motivators, and facilitators of physical activity in dementia patients : A systematic review

    NARCIS (Netherlands)

    van Alphen, Helena J. M.; Hortobagyi, Tibor; van Heuvelen, Marieke J. G.

    2016-01-01

    Purpose: Physical activity (PA) has the potential to slow the progression of dementia patients' cognitive and physical decline. A better understanding of the factors that facilitate or hamper dementia patients' PA participation will increase the success rate of implementing PA in dementia patients'

  17. Barriers, motivators, and facilitators of physical activity in dementia patients : A systematic review

    NARCIS (Netherlands)

    van Alphen, Helena J. M.; Hortobagyi, Tibor; van Heuvelen, Marieke J. G.

    2016-01-01

    Purpose: Physical activity (PA) has the potential to slow the progression of dementia patients' cognitive and physical decline. A better understanding of the factors that facilitate or hamper dementia patients' PA participation will increase the success rate of implementing PA in dementia patients'

  18. Facilitators and barriers in pain management for trauma patients in the chain of emergency care.

    Science.gov (United States)

    Berben, Sivera A A; Meijs, Tineke H J M; van Grunsven, Pierre M; Schoonhoven, Lisette; van Achterberg, Theo

    2012-09-01

    The aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands. A qualitative approach was adopted with the use of the implementation Model of Change of Clinical Practice. The chain of emergency care concerned prehospital Emergency Medical Services (EMS) and Emergency Departments (EDs). We included two EMS ambulance services and three EDs and conducted five focus groups and 10 individual interviews. Stakeholders and managers of organisations were interviewed individually. Focus group participants were selected based on availability and general characteristics. Transcripts of the audio recordings and field notes were analysed in consecutive steps, based on thematic content analysis. Each step was independently performed by the researchers, and was discussed afterwards. We analysed differences and similarities supported by software for qualitative analysis MaxQDA. This study identified five concepts as facilitators and barriers in pain management for trauma patients in the chain of emergency care. We described the concepts of knowledge, attitude, professional communication, organisational aspects and patient input, illustrated with quotes from the interviews and focus group sessions. Furthermore, we identified whether the themes occurred in the chain of care. Knowledge deficits, attitude problems and patient input were similar for the EMS and ED settings, despite the different positions, backgrounds and educational levels of respondents. In the chain of care a lack of professional communication and organisational feedback occurred as new themes, and were specifically related to the organisational structure of the prehospital EMS and EDs. Identified organisational aspects stressed the importance of organisational embedding of improvement of pain management. However, change of clinical practice requires a comprehensive approach focused at all five concepts. We think a shift

  19. The utah beacon experience: integrating quality improvement, health information technology, and practice facilitation to improve diabetes outcomes in small health care facilities.

    Science.gov (United States)

    Tennison, Janet; Rajeev, Deepthi; Woolsey, Sarah; Black, Jeff; Oostema, Steven J; North, Christie

    2014-01-01

    The Utah Improving Care through Connectivity and Collaboration (IC3) Beacon community (2010-2013) was spearheaded by HealthInsight, a nonprofit, community-based organization. One of the main objectives of IC(3) was to improve health care provided to patients with diabetes in three Utah counties, collaborating with 21 independent smaller clinics and two large health care enterprises. This paper will focus on the use of health information technology (HIT) and practice facilitation to develop and implement new care processes to improve clinic workflow and ultimately improve patients' diabetes outcomes at 21 participating smaller, independent clinics. Early in the project, we learned that most of the 21 clinics did not have the resources needed to successfully implement quality improvement (QI) initiatives. IC(3) helped clinics effectively use data generated from their electronic health records (EHRs) to design and implement interventions to improve patients' diabetes outcomes. This close coupling of HIT, expert practice facilitation, and Learning Collaboratives was found to be especially valuable in clinics with limited resources. Through this process we learned that (1) an extensive readiness assessment improved clinic retention, (2) clinic champions were important for a successful collaboration, and (3) current EHR systems have limited functionality to assist in QI initiatives. In general, smaller, independent clinics lack knowledge and experience with QI and have limited HIT experience to improve patient care using electronic clinical data. Additionally, future projects like IC(3) Beacon will be instrumental in changing clinic culture so that QI is integrated into routine workflow. Our efforts led to significant changes in how practice staff optimized their EHRs to manage and improve diabetes care, while establishing the framework for sustainability. Some of the IC(3) Beacon practices are currently smoothly transitioning to new models of care such as Patient

  20. Orthogeriatric care: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Tarazona-Santabalbina FJ

    2016-06-01

    Full Text Available Francisco José Tarazona-Santabalbina,1,2 Ángel Belenguer-Varea,1,2 Eduardo Rovira,1,2 David Cuesta-Peredó1,21Geriatric Medicine Unit, Internal Medicine Department, Hospital Universitario de la Ribera, 2Medical School, Universidad Católica de Valencia San vicente Mártir, Valencia, SpainAbstract: Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. Keywords: hip fractures, geriatric assessment, orthogeriatric care, recovery of function, mortality

  1. The expression of glycerol facilitators from various yeast species improves growth on glycerol of Saccharomyces cerevisiae

    DEFF Research Database (Denmark)

    Klein, Mathias; Islam, Zia ul; Knudsen, Peter Boldsen;

    2016-01-01

    of predicted glycerol facilitators (Fps1 homologues) from superior glycerol-utilizing yeast species such as Pachysolen tannophilus, Komagataella pastoris, Yarrowia lipolytica and Cyberlindnera jadinii significantly improves the growth performance on glycerol of the previously selected glycerol-consuming S....... cerevisiae wild-type strain (CBS 6412-13A). The maximum specific growth rate increased from 0.13 up to 0.18 h−1 and a biomass yield coefficient of 0.56 gDW/gglycerol was observed. These results pave the way for exploiting the assets of glycerol in the production of fuels, chemicals and pharmaceuticals based...

  2. Attitude toward the out-patient cardiac rehabilitation program and facilitators for maintenance of exercise behavior.

    Science.gov (United States)

    Wong, Eliza M L; Zhong, Xue Bing; Sit, Janet W H; Chair, Sek Ying; Leung, Doris Y P; Leung, Carmen; Leung, K C

    2016-09-01

    This study examined the attitudes of Chinese patients with coronary heart disease (CHD) toward the outpatient cardiac rehabilitation program (OCRP), as well as their exercise behavior, intention, maintenance and related factors. A qualitative descriptive study design was used, and 22 CHD patients were recruited in Hong Kong in 2014. In-depth interviews and content analyses were conducted. The tripartite model of attitudes was adopted as research framework. Two themes were identified: (1) informant attitude (perception, affection, and practice) toward the OCRP and (2) Exercise Behavior - intention, maintenance and its related factors. Most informants showed positive perception and affection regarding the outpatient rehabilitation program, leading to regular practice of exercise in the program and at home. Peer, group dynamic, social support and Chinese culture influences on exercise behavior may serve as major facilitators to maintain exercise behavior. Positive attitude toward the OCRP enhanced the participation rate, whereas peer and social support from the family and workplace were useful to improve the maintenance of exercise behavior. Overall, this study provides insights into strategic planning for the OCRP and continual support for CHD patients in the community.

  3. Facilitators and barriers in pain management for trauma patients in the chain of emergency care.

    NARCIS (Netherlands)

    Berben, S.A.A.; Meijs, T.H.; Grunsven, P.M. van; Schoonhoven, L.; Achterberg, T. van

    2012-01-01

    INTRODUCTION: The aim of the study is to give insight into facilitators and barriers in pain management in trauma patients in the chain of emergency care in the Netherlands. PATIENTS AND METHODS: A qualitative approach was adopted with the use of the implementation Model of Change of Clinical

  4. Barriers, motivators, and facilitators of physical activity in dementia patients: A systematic review.

    Science.gov (United States)

    van Alphen, Helena J M; Hortobágyi, Tibor; van Heuvelen, Marieke J G

    2016-01-01

    Physical activity (PA) has the potential to slow the progression of dementia patients' cognitive and physical decline. A better understanding of the factors that facilitate or hamper dementia patients' PA participation will increase the success rate of implementing PA in dementia patients' daily care. We systematically screened the barriers, motivators, and facilitators of PA participation in dementia patients, complementing previous analyses of quantitative correlates of PA in community-dwelling dementia patients. Systematic searches yielded 78 potential studies of which seven met the eligibility criteria including 39 dementia patients and 36 caregivers (33 spouses and three daughters). We identified 35 barriers, 26 motivators, and 21 facilitators related to PA. We reduced these factors to six themes within the social-ecological model. Prominent barriers to PA were physical and mental limitations and difficulties with guidance and organization of PA by caregivers. Motivators included the motivation to maintain physical and mental health and participate in preferred PA options. Facilitators included strategies to avoid health problems, providing support and guidance for PA, and access to convenient and personalized PA options. The emerging picture suggests that dementia patients' PA participation will increase if service providers become familiar with the health benefits of PA, the characteristics of PA programs, methods of delivery, and the concepts of how such programs can be personalized to and synchronized with patients' individual needs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Facilitated Nurse Medication-Related Event Reporting to Improve Medication Management Quality and Safety in Intensive Care Units.

    Science.gov (United States)

    Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B

    Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.

  6. Key components of external facilitation in an acute stroke quality improvement collaborative in the Veterans Health Administration.

    Science.gov (United States)

    Bidassie, Balmatee; Williams, Linda S; Woodward-Hagg, Heather; Matthias, Marianne S; Damush, Teresa M

    2015-05-14

    Facilitation is a key component for successful implementation in several implementation frameworks; however, there is a paucity of research specifying this component. As part of a stroke quality improvement intervention in the Veterans Health Administration (VHA), facilitation plus data feedback was compared to data feedback alone in 11 VA medical facilities. The objective of this study was to elucidate upon the facilitation components of the stroke quality improvement. We conducted a secondary evaluation of external facilitation using semi-structured interviews. Five facilitators and two program directors were interviewed. Qualitative analysis was performed on transcribed interviews to gain an understanding of the role and activities of external facilitators during the on-site and telephone facilitation. Quantitative frequencies were calculated from the self-reported time spent in facilitation tasks by facilitators. The external facilitators saw their role as empowering the clinical teams to take ownership of the process changes at the clinical sites to improve their performance quality. To fulfill this role, they reported engaging in a number of core tasks during telephone and on-site visits including: assessing the context in which the teams were currently operating, guiding the clinical teams through their planned changes and use of process improvement tools, identifying resources and making referrals, holding teams accountable for plan implementation with on-site visits, and providing support and encouragement to the teams. Time spent in facilitation activities changed across time from guiding change (early) to supporting efforts made by the clinical teams (later). Facilitation activity transitioned to more monitoring, problem solving, and intentional work to hand over the clinical improvement process to the site teams with the coach's role being increasingly that of a more distant consultant. Overall, this study demonstrated that external facilitation is not

  7. Facilitating mental health research for patients, clinicians and researchers: a mixed-method study

    OpenAIRE

    Robotham, D; Waterman, S; Oduola, S; Papoulias, C; Craig, T.; Wykes, T.

    2016-01-01

    OBJECTIVES: Research registers using Consent for Contact (C4C) can facilitate recruitment into mental health research studies, allowing investigators to contact patients based on clinical records information. We investigated whether such a register was useful for mental health research, seeking the perspectives of patients and research investigators.SETTING AND DESIGN: In 2012, a C4C register was developed in a large secondary mental health provider within the UK; almost 9000 patients have jo...

  8. Interdisciplinary facilitation of the minimal participation of patients with severe brain injury in early rehabilitation

    DEFF Research Database (Denmark)

    Pallesen, Hanne; Buhl, Inge

    2016-01-01

    ABSTRACT Aim: The purpose of the study was to shed light on the participatory aspect of early rehabilitation, when contact, communication and interaction between the patients and the professionals is minimal, because of the patients’ severe brain injury and complex conditions. Methodology...... by a combination of the clinicians’ professional skills, their ability to create a rehabilitation environment in which patients can perform activities, the right framework for the meeting, and a suitable approach, to facilitate fruitful interaction with the patients....

  9. The effects of stair gait training using proprioceptive neuromuscular facilitation on stroke patients' dynamic balance ability.

    Science.gov (United States)

    Seo, KyoChul; Park, Seung Hwan; Park, KwangYong

    2015-05-01

    [Purpose] This study aims to examine stroke patients' changes in dynamic balance ability through stair gait training where in proprioceptive neuromuscular facilitation (PNF) was applied. [Subjects and Methods] In total 30 stroke patients participated in this experiment and were randomly and equally allocated to an experimental group and a control group. The experimental group received exercise treatment for 30 min and stair gait training where in PNF was applied for 30 min and the control group received exercise treatment for 30 min and ground gait training where in PNF was applied for 30 min. For the four weeks of the experiment, each group received training three times per week, for 30 min each time. Berg Balance Scale (BBS) values were measured and a time up and go (TUG) test and a functional reach test (FRT) were performed for a comparison before and after the experiment. [Results] According to the result of the stroke patients' balance performance through stair gait training, the BBS and FRT results significantly increased and the TUG test result significantly decreased in the experimental group. On the contrary, BBS and FRT results did not significantly increase and the TUG test result did not significantly decrease in the control group. According to the result of comparing differences between before and after training in each group, there was a significant change in the BBS result of the experimental group only. [Conclusions] In conclusion, the gait training group to which PNF was applied saw improvements in their balance ability, and a good result is expected when neurological disease patients receive stair gait training applying PNF.

  10. Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.

    Science.gov (United States)

    Awoonor-Williams, John Koku; Bailey, Patricia E; Yeji, Francis; Adongo, Ayire Emmanuel; Baffoe, Peter; Williams, Afua; Mercer, Sarah

    2015-10-01

    Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere.

  11. A degradable, bioactive, gelatinized alginate hydrogel to improve stem cell/growth factor delivery and facilitate healing after myocardial infarction.

    Science.gov (United States)

    Della Rocca, Domenico G; Willenberg, Bradley J; Ferreira, Leonardo F; Wate, Prateek S; Petersen, John W; Handberg, Eileen M; Zheng, Tong; Steindler, Dennis A; Terada, Naohiro; Batich, Christopher D; Byrne, Barry J; Pepine, Carl J

    2012-11-01

    Despite remarkable effectiveness of reperfusion and drug therapies to reduce morbidity and mortality following myocardial infarction (MI), many patients have debilitating symptoms and impaired left ventricular (LV) function highlighting the need for improved post-MI therapies. A promising concept currently under investigation is intramyocardial injection of high-water content, polymeric biomaterial gels (e.g., hydrogels) to modulate myocardial scar formation and LV adverse remodeling. We propose a degradable, bioactive hydrogel that forms a unique microstructure of continuous, parallel capillary-like channels (Capgel). We hypothesize that the innovative architecture and composition of Capgel can serve as a platform for endogenous cell recruitment and drug/cell delivery, therefore facilitating myocardial repair after MI.

  12. Nursing the patient with complex communication needs: time as a barrier and a facilitator to successful communication in hospital.

    Science.gov (United States)

    Hemsley, Bronwyn; Balandin, Susan; Worrall, Linda

    2012-01-01

    Effective nurse-patient communication is an essential aspect of health care. Time to communicate, however, is limited and subject to workload demands. Little is known about how nurses manage this 'lack of time' when caring for patients with developmental disability and complex communication needs, who typically communicate at a slow rate. The aim of this study was to investigate nurses' expressed concepts of 'time' in stories about communicating with patients with developmental disability and complex communication needs in hospital. In 2009, 15 hospital nurses from a range of wards in two metropolitan hospitals participated in interviews about barriers to and strategies for successful communication with patients with developmental disability and complex communication needs in hospital. The data were analysed using narrative inquiry methodology and the stories verified with the participants. Nurses identified 'time' as a barrier and a facilitator to successful communication. Time as a barrier was related thematically to avoiding direct communication and preferring that family or paid carers communicated on behalf of the patient. Time as a facilitator was related to valuing communication, investing extra time, and to applying a range of adaptive communication strategies to establish successful communication. Time is perceived by nurses as both an enemy and friend for improving communication. Nurses who perceive that communication takes too long may avoid communication and miss opportunities to improve communication through increased familiarity with the person's communication methods. Those who take time to communicate narrate applying a range of strategies to achieve success in basic needs communication. © 2011 Blackwell Publishing Ltd.

  13. Evaluation of attention training and metacognitive facilitation to improve reading comprehension in aphasia.

    Science.gov (United States)

    Lee, Jaime B; Moore Sohlberg, McKay

    2013-05-01

    This pilot study investigated the impact of direct attention training combined with metacognitive facilitation on reading comprehension in individuals with aphasia. A single-subject, multiple baseline design was employed across 4 participants to evaluate potential changes in reading comprehension resulting from an 8-week intervention using Attention Process Training-3 (APT-3). The primary outcome measure was a maze reading task. Pre- and posttesting included attention and reading comprehension measures. Visual inspection of graphed performance data across conditions was used as the primary method of analysis. Treatment effect sizes were calculated for changes in reading comprehension probes from baseline to maintenance phases. Two of the study's 4 participants demonstrated improvements in maze reading, with corresponding effect sizes that were small in magnitude according to benchmarks for aphasia treatment research. All 4 participants made improvements on select standardized measures of attention. Interventions that include a metacognitive component with direct attention training may elicit improvements in participants' attention and allocation of resources. Maze passage reading is a repeated measure that appears sensitive to treatment-related changes in reading comprehension. Issues for future research related to measurement, candidacy, and clinical delivery are discussed.

  14. Developing a performance data suite to facilitate lean improvement in a chemotherapy day unit.

    Science.gov (United States)

    Lingaratnam, Senthil; Murray, Danielle; Carle, Amber; Kirsa, Sue W; Paterson, Rebecca; Rischin, Danny

    2013-07-01

    A multidisciplinary team from the Peter MacCallum Cancer Centre in Melbourne, Australia, developed a performance data suite to support a service improvement project based on lean manufacturing principles in its 19-chair chemotherapy day unit (CDU) and cytosuite chemotherapy production facility. The aims of the project were to reduce patient wait time and improve equity of access to the CDU. A project team consisting of a pharmacist and CDU nurse supported the management team for 10 months in engaging staff and customers to identify waste in processes, analyze root causes, eliminate non-value-adding steps, reduce variation, and level workloads to improve quality and flow. Process mapping, staff and patient tracking and opinion surveys, medical record audits, and interrogation of electronic treatment records were undertaken. This project delivered a 38% reduction in median wait time on the day (from 32 to 20 minutes; P lean improvement methodology provided a robust framework for improved understanding and management of complex system constraints within a CDU, resulting in improved access to treatment and reduced waiting times on the day.

  15. Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

    Science.gov (United States)

    Croome, Natasha; Ahluwalia, Monisha; Hughes, Lyndsay D.; Abas, Melanie

    2017-01-01

    Objective: The aim of this study was to identify the range and frequency of patient-reported barriers and facilitators to antiretroviral treatment (ART) adherence in sub-Saharan Africa (SSA). Design: Studies from 2005 to 2016 were identified by searching 10 electronic databases and through additional hand and web-searching. Methods: Inclusion criteria were HIV-positive adults taking ART based in any SSA country, qualitative study or quantitative survey and included at least one patient-reported barrier or facilitator to ART adherence. Exclusion criteria were only including data from treatment-naive patients initiating ART, only single-dose treatment, participants residing outside of SSA and reviews. Results: After screening 11 283 records, 154 studies (161 papers) were included in this review. Forty-three barriers and 30 facilitators were reported across 24 SSA countries. The most frequently identified barriers across studies were forgetting (n = 76), lack of access to adequate food (n = 72), stigma and discrimination (n = 68), side effects (n = 67) and being outside the house or travelling (n = 60). The most frequently identified facilitators across studies were social support (n = 60), reminders (n = 55), feeling better or healthier after taking ART (n = 35), disclosing their HIV status (n = 26) and having a good relationship with a health provider (n = 22). Conclusion: This review addresses the gap in knowledge by collating all the patient-reported barriers and facilitators to ART adherence in SSA. Current barriers measures need to be adapted or new tools developed to include the wide variety of factors identified. The factors that have the greatest impact need to be isolated so interventions are developed that reduce the barriers and enhance the facilitators. PMID:28121707

  16. Short-term effects of physiotherapy combining repetitive facilitation exercises and orthotic treatment in chronic post-stroke patients

    Science.gov (United States)

    Tomioka, Kazutoshi; Matsumoto, Shuji; Ikeda, Keiko; Uema, Tomohiro; Sameshima, Jun-ichi; Sakashita, Yuji; Kaji, Tomokazu; Shimodozono, Megumi

    2017-01-01

    [Purpose] This study investigated the short-term effects of a combination therapy consisting of repetitive facilitative exercises and orthotic treatment. [Subjects and Methods] The subjects were chronic post-stroke patients (n=27; 24 males and 3 females; 59.3 ± 12.4 years old; duration after onset: 35.7 ± 28.9 months) with limited mobility and motor function. Each subject received combination therapy consisting of repetitive facilitative exercises for the hemiplegic lower limb and gait training with an ankle-foot orthosis for 4 weeks. The Fugl-Meyer assessment of the lower extremity, the Stroke Impairment Assessment Set as a measure of motor performance, the Timed Up & Go test, and the 10-m walk test as a measure of functional ambulation were evaluated before and after the combination therapy intervention. [Results] The findings of the Fugl-Meyer assessment, Stroke Impairment Assessment Set, Timed Up & Go test, and 10-m walk test significantly improved after the intervention. Moreover, the results of the 10-m walk test at a fast speed reached the minimal detectible change threshold (0.13 m/s). [Conclusion] Short-term physiotherapy combining repetitive facilitative exercises and orthotic treatment may be more effective than the conventional neurofacilitation therapy, to improve the lower-limb motor performance and functional ambulation of chronic post-stroke patients. PMID:28265141

  17. The facilitators and barriers associated with implementation of a patient-centered medical home in VHA.

    Science.gov (United States)

    Helfrich, Christian D; Sylling, Philip W; Gale, Randall C; Mohr, David C; Stockdale, Susan E; Joos, Sandra; Brown, Elizabeth J; Grembowski, David; Asch, Steven M; Fihn, Stephan D; Nelson, Karin M; Meredith, Lisa S

    2016-02-24

    The patient-centered medical home (PCMH) is a team-based, comprehensive model of primary care. When effectively implemented, PCMH is associated with higher patient satisfaction, lower staff burnout, and lower hospitalization for ambulatory care-sensitive conditions. However, less is known about what factors contribute to (or hinder) PCMH implementation. We explored the associations of specific facilitators and barriers reported by primary care employees with a previously validated, clinic-level measure of PCMH implementation, the Patient Aligned Care Team Implementation Progress Index (Pi(2)). We used a 2012 survey of primary care employees in the Veterans Health Administration to perform cross-sectional, respondent-level multinomial regressions. The dependent variable was the Pi(2) categorized as high implementation (top decile, 54 clinics, 235 respondents), medium implementation (middle eight deciles, 547 clinics, 4537 respondents), and low implementation (lowest decile, 42 clinics, 297 respondents) among primary care clinics. The independent variables were ordinal survey items rating 19 barriers to patient-centered care and 10 facilitators of PCMH implementation. For facilitators, we explored clinic Pi(2) score decile both as a function of respondent-reported availability of facilitators and of rating of facilitator helpfulness. The availability of five facilitators was associated with higher odds of a respondent's clinic's Pi(2) scores being in the highest versus lowest decile: teamlet huddles (OR = 3.91), measurement tools (OR = 3.47), regular team meetings (OR = 2.88), information systems (OR = 2.42), and disease registries (OR = 2.01). The helpfulness of four facilitators was associated with higher odds of a respondent's clinic's Pi(2) scores being in the highest versus lowest decile. Six barriers were associated with significantly higher odds of a respondent's clinic's Pi(2) scores being in the lowest versus highest decile, with the

  18. Practice improvement, part II: update on patient communication technologies.

    Science.gov (United States)

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support.

  19. Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence

    Directory of Open Access Journals (Sweden)

    Qingyan Ma

    2016-10-01

    Full Text Available Introduction: Qualitative research on antiretroviral therapy (ART adherence interventions can provide a deeper understanding of intervention facilitators and barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking. Methods: We searched 19 databases to identify studies presenting primary qualitative data on the experiences, attitudes and acceptability of interventions to improve ART adherence among PLHIV and treatment providers. We used thematic synthesis to synthesize qualitative evidence and the CERQual (Confidence in the Evidence from Reviews of Qualitative Research approach to assess the confidence of review findings. Results: Of 2982 references identified, a total of 31 studies from 17 countries were included. Twelve studies were conducted in high-income countries, 13 in middle-income countries and six in low-income countries. Study populations focused on adults living with HIV (21 studies, n=1025, children living with HIV (two studies, n=46, adolescents living with HIV (four studies, n=70 and pregnant women living with HIV (one study, n=79. Twenty-three studies examined PLHIV perspectives and 13 studies examined healthcare provider perspectives. We identified six themes related to types of interventions, including task shifting, education, mobile phone text messaging, directly observed therapy, medical professional outreach and complex interventions. We also identified five cross-cutting themes, including strengthening social relationships, ensuring confidentiality, empowerment of PLHIV, compensation and integrating religious beliefs into interventions. Our qualitative evidence suggests that strengthening PLHIV social relationships, PLHIV empowerment and developing culturally appropriate interventions may facilitate adherence interventions. Our study indicates that potential barriers are inadequate training and compensation for lay

  20. How outpatient palliative care teleconsultation facilitates empathic patient-professional relationships: a qualitative study.

    Directory of Open Access Journals (Sweden)

    Jelle van Gurp

    Full Text Available The problems and needs of advanced cancer patients and proxies normally increase as the disease progresses. Home-based advanced cancer patients and their proxies benefit from collaborations between primary care physicians and hospital-based palliative care specialists when confronted with complex problems in the last phase of life. Telemedicine might facilitate direct, patient-centered communication between patients and proxies, primary care physicians, and specialist palliative care teams (SPCTs. This study focuses on the impact of teleconsultation technologies on the relationships between home-based palliative care patients and hospital-based palliative care specialists.This work consists of a qualitative study among patients, family members, and caregivers that utilizes long-term direct observations, semi-structured interviews, and open interviews following the observations.The analysis of the empirical data resulted in three key concepts that describe the impact of teleconsultation on the patient-professional relationship in palliative homecare: transcending the institutional walls of home and hospital; transparency of teleconsultation technology; and technologized, intimate patient-professional relationships. Teleconsultation offers (1 condensed encounters between home-based palliative care patients and distant professionals, (2 a unique insight into the patients' daily lives for palliative care specialists, and (3 long-term interaction that results in trustful relationships and experiences of intimacy and relief.Teleconsultation fits the practice of home-based palliative care. Teleconsultation can, if well applied, facilitate computer-mediated but empathic patient-palliative care specialist relationships, which enable professional care attuned to the patient's context as well as patient involvement. This article proposes a teleconsultation implementation guide for optimal use of teleconsultation in daily palliative care practice.

  1. Facilitating the improved management of waste in South Africa through a national waste information system.

    Science.gov (United States)

    Godfrey, Linda

    2008-01-01

    Developing a waste information system (WIS) for a country is more than just about collecting routine data on waste; it is about facilitating the improved management of waste by providing timely, reliable information to the relevant role-players. It is a means of supporting the waste governance challenges facing South Africa - challenges ranging from strategic waste management issues at national government to basic operational challenges at local government. The paper addresses two hypotheses. The first is that the identified needs of government can provide a platform from which to design a national WIS framework for a developing country such as South Africa, and the second is that the needs for waste information reflect greater, currently unfulfilled challenges in the sustainable management of waste. Through a participatory needs analysis process, it is shown that waste information is needed by the three spheres of government, to support amongst others, informed planning and decision-making, compliance monitoring and enforcement, community participation through public access to information, human, infrastructure and financial resource management and policy development. These needs for waste information correspond closely with key waste management challenges currently facing the country. A shift in governments approach to waste, in line with national and international policy, is evident from identified current and future waste information needs. However, the need for information on landfilling remains entrenched within government, possibly due to the poor compliance of landfill sites in South Africa and the problems around the illegal disposal of both general and hazardous waste.

  2. Chitosan improves anti-biofilm efficacy of gentamicin through facilitating antibiotic penetration.

    Science.gov (United States)

    Mu, Haibo; Guo, Fan; Niu, Hong; Liu, Qianjin; Wang, Shunchun; Duan, Jinyou

    2014-12-03

    Antibiotic overuse is one of the major drivers in the generation of antibiotic resistant "super bugs" that can potentially cause serious effects on health. In this study, we reported that the polycationic polysaccharide, chitosan could improve the efficacy of a given antibiotic (gentamicin) to combat bacterial biofilms, the universal lifestyle of microbes in the world. Short- or long-term treatment with the mixture of chitosan and gentamicin resulted in the dispersal of Listeria monocytogenes (L. monocytogenes) biofilms. In this combination, chitosan with a moderate molecular mass (~13 kDa) and high N-deacetylation degree (~88% DD) elicited an optimal anti-biofilm and bactericidal activity. Mechanistic insights indicated that chitosan facilitated the entry of gentamicin into the architecture of L. monocytogenes biofilms. Finally, we showed that this combination was also effective in the eradication of biofilms built by two other Listeria species, Listeria welshimeri and Listeria innocua. Thus, our findings pointed out that chitosan supplementation might overcome the resistance of Listeria biofilms to gentamicin, which might be helpful in prevention of gentamicin overuse in case of combating Listeria biofilms when this specific antibiotic was recommended.

  3. Chitosan Improves Anti-Biofilm Efficacy of Gentamicin through Facilitating Antibiotic Penetration

    Directory of Open Access Journals (Sweden)

    Haibo Mu

    2014-12-01

    Full Text Available Antibiotic overuse is one of the major drivers in the generation of antibiotic resistant “super bugs” that can potentially cause serious effects on health. In this study, we reported that the polycationic polysaccharide, chitosan could improve the efficacy of a given antibiotic (gentamicin to combat bacterial biofilms, the universal lifestyle of microbes in the world. Short- or long-term treatment with the mixture of chitosan and gentamicin resulted in the dispersal of Listeria monocytogenes (L. monocytogenes biofilms. In this combination, chitosan with a moderate molecular mass (~13 kDa and high N-deacetylation degree (~88% DD elicited an optimal anti-biofilm and bactericidal activity. Mechanistic insights indicated that chitosan facilitated the entry of gentamicin into the architecture of L. monocytogenes biofilms. Finally, we showed that this combination was also effective in the eradication of biofilms built by two other Listeria species, Listeria welshimeri and Listeria innocua. Thus, our findings pointed out that chitosan supplementation might overcome the resistance of Listeria biofilms to gentamicin, which might be helpful in prevention of gentamicin overuse in case of combating Listeria biofilms when this specific antibiotic was recommended.

  4. Development of the EMAP tool facilitating existential communication between general practitioners and cancer patients

    DEFF Research Database (Denmark)

    Assing Hvidt, Elisabeth; Hansen, Dorte Gilså; Ammentorp, Jette

    2017-01-01

    BACKGROUND: General practice recognizes the existential dimension as an integral part of multidimensional patient care alongside the physical, psychological and social dimensions. However, general practitioners (GPs) report substantial barriers related to communication with patients about...... existential concerns. OBJECTIVES: To describe the development of the EMAP tool facilitating communication about existential problems and resources between GPs and patients with cancer. METHODS: A mixed-methods design was chosen comprising a literature search, focus group interviews with GPs and patients (n...... dimension. The tool utilized the acronym and mnemonic EMAP (existential communication in general practice) indicating the intention of the tool: to provide a map of possible existential problems and resources that the GP and the patient can discuss to find points of reorientation in the patient's situation...

  5. The facilitating role of chemotherapy in the palliative phase of cancer: qualitative interviews with advanced cancer patients.

    Directory of Open Access Journals (Sweden)

    Hilde M Buiting

    Full Text Available OBJECTIVE: To explore the extent to which patients have a directing role in decisions about chemotherapy in the palliative phase of cancer and (want to anticipate on the last stage of life. DESIGN: Qualitative interview study. METHODS: In depth-interviews with 15 patients with advanced colorectal or breast cancer at the medical oncology department in a Dutch teaching hospital; interviews were analysed following the principles of thematic content-analysis. RESULTS: All patients reported to know that the chemotherapy they received was with palliative intent. Most of them did not express the wish for information about (other treatment options and put great trust in their physicians' treatment advice. The more patients were aware of the severity of their disease, the more they seemed to 'live their life' in the present and enjoy things besides having cancer. Such living in the present seemed to be facilitated by the use of chemotherapy. Patients often considered the 'chemotherapy-free period' more stressful than periods when receiving chemotherapy despite their generally improved physical condition. Chemotherapy (regardless of side-effects seemed to shift patients' attention away from the approaching last stage of life. Interestingly, although patients often discussed advance care planning, they were reluctant to bring on end-of-life issues that bothered them at that specific moment. Expressing real interest in people 'as a person' was considered an important element of appropriate care. CONCLUSIONS: Fearing their approaching death, patients deliberately focus on living in the present. Active (chemotherapy treatment facilitates this focus, regardless of the perceived side-effects. However, if anxiety for what lies ahead is the underlying reason for treatment, efforts should be made in assisting patients to find other ways to cope with this fear. Simultaneously, such an approach may reduce the use of burdensome and sometimes costly treatment in the

  6. Home Automated Telemanagement (HAT System to Facilitate Self-Care of Patients with Chronic Diseases

    Directory of Open Access Journals (Sweden)

    Joseph Finkelstein

    2003-06-01

    Full Text Available Successful patient self-management requires a multidisciplinary approach that includes regular patient assessment, disease-specific education, control of medication adherence, implementation of health behavior change models and social support. Existing systems for computer-assisted disease management do not provide this multidisciplinary patient support and do not address treatment compliance issues. We developed the Home Automated Telemanagement (HAT system for patients with different chronic health conditions to facilitate their self-care. The HAT system consists of a home unit, HAT server, and clinician units. Patients at home use a palmtop or a laptop connected with a disease monitor on a regular basis. Each HAT session consists of self-testing, feedback, and educational components. The self-reported symptom data and objective results obtained from disease-specific sensors are automatically sent from patient homes to the HAT server in the hospital. Any web-enabled device can serve as a clinician unit to review patient results. The HAT system monitors self-testing results and patient compliance. The HAT system has been implemented and tested in patients receiving anticoagulation therapy, patients with asthma, COPD and other health conditions. Evaluation results indicated high level of acceptance of the HAT system by the patients and that the system has a positive impact on main clinical outcomes and patient satisfaction with medical care.

  7. Improving oral hygiene for patients.

    Science.gov (United States)

    Bonetti, Debbie; Hampson, Victoria; Queen, Kerry; Kirk, Donna; Clarkson, Jan; Young, Linda

    2015-01-13

    Systematic reviews and patient safety initiatives recommend that oral hygiene should be part of routine patient care. However, evidence suggests it is often neglected in hospitals and care homes. Research recommends encouraging beliefs that support oral hygiene, and teaching nurses appropriate skills, as necessary prerequisites to implementing best practice in hospital wards. This article describes a pilot study of an educational workshop on oral hygiene. Results from the pilot study suggest that this workshop is a feasible intervention for a service-wide trial. The literature suggests that other interventions are required to complement this approach if nurses are to make oral hygiene a priority in daily patient care.

  8. Facilitating access to voluntary and community services for patients with psychosocial problems: a before-after evaluation

    Directory of Open Access Journals (Sweden)

    Leibowitz Judy

    2008-05-01

    Full Text Available Abstract Background Patients with psychosocial problems may benefit from a variety of community, educational, recreational and voluntary sector resources, but GPs often under-refer to these through lack of knowledge and time. This study evaluated the acceptability and effectiveness of graduate primary care mental health workers (GPCMHWs facilitating access to voluntary and community sector services for patients with psychosocial problems. Methods Patients with psychosocial problems from 13 general practices in London were referred to a GPCMHW Community Link scheme providing information and support to access voluntary and community resources. Patient satisfaction, mental health and social outcomes, and use of primary care resources, were evaluated. Results 108 patients consented to take part in the study. At three-month follow-up, 63 (58% had made contact with a community service identified as suitable for their needs. Most were satisfied with the help provided by the GPCMHW in identifying and supporting access to a suitable service. There was a reduction in the number of patients with a probable mental health problem on the GHQ-12 from 83% to 52% (difference 31% (95% CI, 17% – 44%. Social adjustment improved and frequencies of primary care consultations and of prescription of psychotropic medications were reduced. Conclusion Graduates with limited training in mental health and no prior knowledge of local community resources can help patients with psychosocial problems access voluntary and community services, and patients value such a scheme. There was some evidence of effectiveness in reducing psychosocial and mental health problems.

  9. The Holistic, Interactive and Persuasive Model to Facilitate Self-care of Patients with Diabetes

    Science.gov (United States)

    Vargas-Lombard, Miguel; Jipsion, Armando; Vejarano, Rafael; Camargo, Ismael; Álvarez, Humberto; Mora, Elena Villalba; Menasalva Ruíz, Ernestina

    The patient, in his multiple facets of citizen and user of services of health, needs to acquire during, and later in his majority of age, favorable conditions of health to accentuate his quality of life and it is the responsibility of the health organizations to initiate the process of support for that patient during the process of mature life. The provision of services of health and the relation doctor-patient are undergoing important changes in the entire world, forced to a large extent by the indefensibility of the system itself. Nevertheless decision making requires previous information and, what more the necessity itself of being informed requires having a “culture” of health that generates pro activity and the capacity of searching for instruments that facilitate the awareness of the suffering and the self-care of the same. Therefore it is necessary to put into effect a ICT model (hiPAPD) that has the objective of causing Interaction, Motivation and Persuasion towards the surroundings of the diabetic Patient facilitating his self-care. As a result the patient himself individually manages his services through devices and AmI Systems (Ambient Intelligent).

  10. Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program.

    Science.gov (United States)

    Tappen, Ruth M; Wolf, David G; Rahemi, Zahra; Engstrom, Gabriella; Rojido, Carolina; Shutes, Jill M; Ouslander, Joseph G

    Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.

  11. Assessing tobacco use by cancer patients and facilitating cessation: an American Association for Cancer Research policy statement.

    Science.gov (United States)

    Toll, Benjamin A; Brandon, Thomas H; Gritz, Ellen R; Warren, Graham W; Herbst, Roy S

    2013-04-15

    When diagnosed with cancer, patients can immediately make a meaningful positive impact on their health by stopping their tobacco use. Scientific evidence clearly shows that tobacco use in patients with cancer leads to poorer outcomes. The specific biological processes driving tobacco consumption's interference in cancer therapy are the subject of continuing research, but the evidence is clear that tobacco use in patients with cancer leads to decreased treatment efficacy and safety, decreased survival, decreased quality of life, increased treatment-related toxicity, and increased risk of cancer recurrence and second primary tumors. Data suggest that tobacco cessation can improve outcomes and survival in patients with cancer, yet full execution of evidence-based cessation interventions is infrequent in oncology settings. Therefore, both improved provision of cessation assistance to all patients with cancer who use tobacco or have recently quit and further study of the deleterious effects of tobacco use and benefits of tobacco cessation on cancer progression and treatment are needed and recommended by the American Association for Cancer Research. Progress on both fronts begins with universal assessment and documentation of tobacco use as a standard of quality cancer care regardless of treatment setting and will be further facilitated through the development of reliable, valid, and standard measures of tobacco use, incorporation of evidence-based procedures into quality and accreditation procedures, and the development of appropriate training, clinical infrastructure, and incentives for delivery of tobacco cessation interventions.

  12. Effects of proprioceptive neuromuscular facilitation stretching and deep-breathing exercises on upper extremity lymphedema in stroke patients

    Science.gov (United States)

    Hwang, Woon Taek; Jeong, Yeon-Jae; Kim, Seong-Yeol; Jeong, Yeon-Gyu

    2016-01-01

    [Purpose] The purpose of this study was to determine the effects of deep-breathing and proprioceptive neuromuscular facilitation stretching exercises on upper limb lymphedema in stroke patients. [Subjects and Methods] The study consisted of 10 patients with lymphedema that had occurred after stroke. Neurodevelopmental treatment was applied in the same manner as that used for the existing treatment. The subjects performed deep-breathing and stretching exercises three times per week for 4 weeks (12 sessions total). Body water volume in the upper limbs was measured before and after exercise by using an InBody S10 analyzer. [Results] Performance of deep-breathing and stretching exercises significantly reduced body water volume in both the affected and unaffected arms. The extracellular-to-total cellular fluid volume ratio in the affected arm improved to 0.379 after exercise, although this change was not significant. [Conclusion] The results of the present study show that deep-breathing and proprioceptive neuromuscular facilitation stretching exercises reduce upper extremity lymphedema in stroke patients. PMID:28174433

  13. Effects of proprioceptive neuromuscular facilitation stretching and deep-breathing exercises on upper extremity lymphedema in stroke patients.

    Science.gov (United States)

    Hwang, Woon Taek; Jeong, Yeon-Jae; Kim, Seong-Yeol; Jeong, Yeon-Gyu

    2016-12-01

    [Purpose] The purpose of this study was to determine the effects of deep-breathing and proprioceptive neuromuscular facilitation stretching exercises on upper limb lymphedema in stroke patients. [Subjects and Methods] The study consisted of 10 patients with lymphedema that had occurred after stroke. Neurodevelopmental treatment was applied in the same manner as that used for the existing treatment. The subjects performed deep-breathing and stretching exercises three times per week for 4 weeks (12 sessions total). Body water volume in the upper limbs was measured before and after exercise by using an InBody S10 analyzer. [Results] Performance of deep-breathing and stretching exercises significantly reduced body water volume in both the affected and unaffected arms. The extracellular-to-total cellular fluid volume ratio in the affected arm improved to 0.379 after exercise, although this change was not significant. [Conclusion] The results of the present study show that deep-breathing and proprioceptive neuromuscular facilitation stretching exercises reduce upper extremity lymphedema in stroke patients.

  14. Improving patient flow in the emergency department.

    Science.gov (United States)

    Jensen, Kirk; Crane, Jody

    2008-11-01

    To improve patient flow in the ED, hospitals should: Establish a measure of patient demand by hour, and design a system to handle it. Appropriately capacitate triage processes and systems. Use a system for patient segmentation and establish distinct processes for different patient segments. Consider using team triage, and examine current triage protocols. Devise a method of tracking patients and results. Field a willing staff with a burning platform.

  15. Patient participation during oncological encounters: barriers and facilitators experienced by elderly cancer patients.

    NARCIS (Netherlands)

    Noordman, J.; Driesenaar, J.A.; Henselmans, I.; Heijmans, M.; Verboom, J.; Dulmen, S. van

    2017-01-01

    Objective: To enhance patient participation during (oncological) encounters, this study aims to gain insight into communication barriers and supportive interventions experienced by elderly patients with cancer. Method: A mixed method design, including both quantitative (secondary survey data

  16. Participatory design facilitates Person Centred Nursing in service improvement with older people: a secondary directed content analysis.

    Science.gov (United States)

    Wolstenholme, Daniel; Ross, Helen; Cobb, Mark; Bowen, Simon

    2017-05-01

    To explore, using the example of a project working with older people in an outpatient setting in a large UK NHS Teaching hospital, how the constructs of Person Centred Nursing are reflected in interviews from participants in a Co-design led service improvement project. Person Centred Care and Person Centred Nursing are recognised terms in healthcare. Co-design (sometimes called participatory design) is an approach that seeks to involve all stakeholders in a creative process to deliver the best result, be this a product, technology or in this case a service. Co-design practice shares some of the underpinning philosophy of Person Centred Nursing and potentially has methods to aid in Person Centred Nursing implementation. The research design was a qualitative secondary Directed analysis. Seven interview transcripts from nurses and older people who had participated in a Co-design led improvement project in a large teaching hospital were transcribed and analysed. Two researchers analysed the transcripts for codes derived from McCormack & McCance's Person Centred Nursing Framework. The four most expressed codes were as follows: from the pre-requisites: knowing self; from care processes, engagement, working with patient's beliefs and values and shared Decision-making; and from Expected outcomes, involvement in care. This study describes the Co-design theory and practice that the participants responded to in the interviews and look at how the co-design activity facilitated elements of the Person Centred Nursing framework. This study adds to the rich literature about using emancipatory and transformational approaches to Person Centred Nursing development, and is the first study exploring explicitly the potential contribution of Co-design to this area. Methods from Co-design allow older people to contribute as equals in a practice development project, co-design methods can facilitate nursing staff to engage meaningfully with older participants and develop a shared

  17. Bone Reduction to Facilitate Immediate Implant Placement and Loading Using CAD/CAM Surgical Guides for Patients With Terminal Dentition.

    Science.gov (United States)

    Alzoubi, Fawaz; Massoomi, Nima; Nattestad, Anders

    2016-10-01

    The aim of this study is to present a method, using 3 computer-aided design/computer-aided manufacturing (CAD/CAM) surgical guides, to accurately obtain the desired bone reduction followed by immediate implant placements and loading for patients diagnosed with terminal dentition. Patients who had bone reduction, implants placed, and immediate loading using Anatomage Invivo 5 CAD/CAM surgical guides between the period 2013 and 2015 were evaluated retrospectively. Patients diagnosed with terminal dentition and treated using the "3-guide technique" were identified. Pre- and postsurgical images were superimposed to evaluate deviations of the bone reduction and deviations at the crest, apex, and angle of implants placed. Twenty-six implants placed in 5 patients were included in this study. The overall deviation means measured for bone reduction was 1.98 mm. The overall deviation means measured for implant placement at the crest, apex, and angle were 1.43 mm, 1.90 mm, and 4.14°, respectively. The CAD/CAM surgical guide fabrication is an emerging tool that may facilitate the surgical process and aid in safe and predictable execution of bone reduction and immediate implant placement. Using 3 CAD/CAM surgical guides, a method is presented to obtain the desired bone reduction followed by immediate implant placement and loading for patients diagnosed with terminal dentition. This method may improve guide stability for patients with terminal dentition undergoing complete implant-supported treatment by taking advantage of the teeth to be extracted.

  18. Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse

    Directory of Open Access Journals (Sweden)

    Surjya Prasad Upadhyay

    2011-01-01

    Full Text Available Many patients are admitted to the intensive care unit (ICU for acute intoxication, serious complication of overdose, or withdrawal symptoms of illicit drugs. An acute withdrawal of drugs with addiction potential is associated with a sympathetic overactivity leading to marked psychomimetic disturbances. Acute intoxication or withdrawal of such drugs is often associated with life-threatening complications which require ICU admission and necessitate prolonged sedative analgesic medications, weaning from which is often complicated by withdrawal and other psychomimetic symptoms. Dexmedetomidine, an alpha-2 (α2 agonist, has been used successfully to facilitate withdrawal and detoxification of various drugs and also to control delirium in ICU patients. Herein, we report a case of a chronic opioid abuse (heroin patient admitted with acute overdose complications leading to a prolonged ICU course requiring sedative-analgesic medication; the drug withdrawal-related symptoms further complicated the weaning process. Dexmedetomidine infusion was successfully used as a sedative-analgesic to control the withdrawal-related psychomimetic symptoms and to facilitate smooth detoxification and weaning from opioid and other sedatives.

  19. A Teacher Training Model for Improving Social Facilitation in the Inclusive Program

    Science.gov (United States)

    Robinson, Suzanne; Myck-Wayne, Janice

    2016-01-01

    The twofold purpose of this article is to highlight the importance of fostering social competence within inclusive preschool programs and to describe a model for training teachers in research-based social facilitation strategies so as to promote social interaction between children with and without disabilities. This model was developed to address…

  20. A Breakthrough for Josh: How Use of an iPad Facilitated Reading Improvement

    Science.gov (United States)

    McClanahan, Barbara; Williams, Kristen; Kennedy, Ed; Tate, Susan

    2012-01-01

    As part of a diagnosis and tutoring project in an elementary education reading course, a pre-service teacher was encouraged to use an iPad as the vehicle for intervention strategies with a fifth grade struggling reader with Attention Deficit Hyperactivity Disorder. The device not only helped the student focus attention, it facilitated his becoming…

  1. Can we Improve Patient Safety?

    Directory of Open Access Journals (Sweden)

    Martin Thomas Corbally

    2014-09-01

    Full Text Available Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out (WHO,errors, especially wrong site surgery, continue. Most such errors are due to lapses in communication where decision makers fail to consult or confirm operative findings but worryingly where parental concerns over the planned procedure are ignored or not followed through. The WHO surgical pause / Time Out aims to capture these errors and prevent them but the combination of human error and complex hospital environments can overwhelm even robust safety structures and simple common sense. Parents are the ultimate repository of information on their child's condition and planned surgery but are traditionally excluded from the process of Surgical pause and Time Out perhaps to avoid additional stress. In addition surgeons, like pilots, are subject to the phenomenon of plan continue fail with potentially disastrous outcomes.

  2. Barriers to and facilitators of coping with spinal cord injury for Iranian patients: a qualitative study.

    Science.gov (United States)

    Babamohamadi, Hassan; Negarandeh, Reza; Dehghan-Nayeri, Nahid

    2011-06-01

    The purpose of the present study was to explore the perspectives and experiences of Iranian patients regarding barriers and facilitators to their ability to cope with spinal cord injury (SCI). A qualitative design, based on the content analysis approach, was used to collect and analyze the experiences of 18 patients with spinal cord injury in two centers in Tehran, Iran. After using purposeful sampling for selection of the participants, semi-structured interviews were held for data collection. Lack of "knowledge", "financial resources", "employment opportunities", "suitable facilities and accessibility" as well as "societal acceptance and support" emerged as barriers; and having "self-confidence", "religious beliefs", "support networks" and "positive thinking" emerged as facilitators in coping with spinal cord injury. Participants believed that with these hindering factors in place, adapting to their new condition had been difficult, therefore they can only manage to adapt partially to their situation. Additional multidisciplinary endeavors are needed to help this group cope adequately and further research is required to influence policy making and legislation processes efficiently. © 2011 Blackwell Publishing Asia Pty Ltd.

  3. Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services.

    Science.gov (United States)

    Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Wu, Amina; Lam, Annie

    2016-12-01

    The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons' access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to find relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to find that they relied on out-of-date resources and inefficient search strategies to find CSSs. Our findings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs.

  4. Perceived Barriers to and Facilitators of Patient-to-Provider E-Mail in the Management of Diabetes Care.

    Science.gov (United States)

    Popeski, Naomi; McKeen, Caitlin; Khokhar, Bushra; Edwards, Alun; Ghali, William A; Sargious, Peter; White, Debbie; Hebert, Marilynne; Rabi, Doreen M

    2015-12-01

    1) to describe current utilization of e-mail in the clinical care of patients with diabetes; and 2) to identify barriers to and facilitators of the adoption of e-mail in diabetes care. Participants included diabetes care providers, including 9 physicians and 7 allied health professionals (AHPs). Participation involved, first, completing a self-administered survey to evaluate the use of e-mail within diabetes-related clinical practice. Second, focus group discussions were conducted with diabetes care providers using semistructured interviews to collect data about their perceptions of using e-mail to exchange information with patients diagnosed with diabetes. Patients' perspectives on the use of e-communication with their care providers was also proposed on the basis of the discussions. Significant differences were found between physicians and AHPs concerning questions that were related to the use of e-mail and the amount of time spent using e-mail to communicate to patients. There was perceived function and value to the use of e-mail among AHPs, while few physicians used e-mail routinely and were uncertain about its potential in improving care. Five themes, including barriers, benefits, risks, safeguards and compensation, were developed from the focus group interviews. Currently, most of the physicians surveyed do not e-mail patients directly; however, AHPs frequently use e-mail in diabetes care and find this tool valuable. Variation in practices regarding clinical e-mail across care disciplines suggest that appropriate policy with guidelines for e-mail and e-communication within the health care system may improve uptake of clinical e-mail and perhaps, by extension, improve efficiency and access in diabetes care. Copyright © 2015. Published by Elsevier Inc.

  5. Performance improvement with patient service partners.

    Science.gov (United States)

    Burns, J P

    1998-01-01

    Once the decision is made to use a patient-focused care delivery system, a variety of methods can be used to successfully design the model. The author describes the process used by a multilevel, multidisciplinary team at a community hospital to design and implement a Service Partner role that would meet and exceed customer expectations. Demonstrated performance improvements included increased patient satisfaction, productive labor dollar savings, and improvements in the work environment for staff members.

  6. Effect of baclofen combined with neural facilitation technique on the reduction of muscular spasm in patients with spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    to Rood technique (slight joint extrusion, slow and persistent stretch, etc.), Brunnstrom technique (non-symmetric cervical reflex: head turning to one side promoting contralateral flexuosity in both upper and lower extremities) and Bobath technique (reflective inhibition, such as reducing supine position; increasing lateral recumbent position, rolling in bed and posture transfer; controlling key sites; 6 weeks in total).MAIN OUTCOME MEASURES: At 6 weeks after treatment, modified Ashworth grading method and Barthel Index were used to detect extensor muscular tension in two lower extremities and activities of daily living (ADL) of patients in both groups.RESULTS: ① Grade of muscular tension in two lower extremities: At 6 weeks after treatment, muscular tension in the treatment group was classified into grade Ⅰ (n =12), gradeⅡ (n =2) and grade Ⅲ(n =0),which was markedly improved as compared with that in the control group [grade Ⅰ (n =6), grade Ⅱ (n =4) and grade Ⅲ (n =4)]. In addition, there was significant difference between the two groups (P < 0.05). ② ADL ability: Barthel Index of patients with complete and incomplete spinal cord injury in the treatment group was higher than that in the control group at 6 weeks after treatment, and there was significant difference between them (P < 0.05).CONCLUSION: Baclofen combining with neural facilitation technique can not only remarkably relieve muscular tension of upper motor neuronal paralysis after spinal cord injury, but also obviously accelerate recoveries of motor functional and ADL ability.

  7. Experiences of patients with hypertension at primary health care in facilitating own lifestyle change of regular physical exercise

    Directory of Open Access Journals (Sweden)

    Nomasonto B.D. Magobe

    2017-02-01

    Full Text Available Background: Regular physical exercise is one of the lifestyle modification general measures to control the blood pressure (BP of patients with hypertension. Globally, hypertension is considered a non-communicable disease (NCD, as well as a chronic condition of lifestyle, that contributes to the mortality rate caused by complications of cardiovascular burden of diseases. In South Africa, NCDs account for nearly 40% of adult deaths, with a high prevalence among black people in urban areas such as Soweto.The first step in treating hypertension is lifestyle modification, referred to in this study as health-promoting lifestyle change measures. Despite the positive benefits of regular physical exercise in controlling hypertension, in 2014, only 10% of men and 18% of women with hypertension had their BP controlled to a level that would eliminate the risk of cardiovascular disease (CVD complications.Objectives: The aim of this article is to present the experiences of patients with hypertension regarding the facilitation of their own health-promoting lifestyle change measure of regular physical exercise.Method: A qualitative, exploratory, descriptive and contextual research design was used. The accessible population of patients with hypertension at three primary health care (PHC clinics in Soweto was targeted and purposefully sampled. Focus group and individual interviews were conducted to collect data till data saturation occurred. Tesch’s open-coding method of data analysis was used.Results and conclusions: Findings show that participants experienced poor self-care due to poor self-efficacy, demonstrated by not engaging in regular physical exercise, which in turn, resulted in uncontrolled BP and cardiovascular complications from hypertension. More should be done to educate, motivate and empower patients with the necessary knowledge, skills and the values in facilitating their own regular physical exercise in order to improve their own quality of

  8. Effect of eye movements and proprioceptive neuromuscular facilitation on balance and head alignment in stroke patients with neglect syndrome.

    Science.gov (United States)

    Park, Si-Eun; Min, Kyung-Ok; Lee, Sang-Bin; Choi, Wan-Suk; Kim, Soon-Hee

    2016-01-01

    [Purpose] The purpose of this study was to assess the effect of eye movements and proprioceptive neuromuscular facilitation (PNF) on patients with neglect syndrome. [Subjects and Methods] The subjects were randomly allocated to 2 groups: the eye movements (EM) group; and the PNF with eye movements (PEM) group. The program was conducted five times each week for 6 weeks. Balance (both static and dynamic) and head alignment (craniovertebral angle and cranial rotation angle) were measured before and after testing. [Results] In measurements of static balance, the EM group showed significant improvement in sway length and sway area when examined in the eyes-open condition, but not when examined in the eyes-closed condition. The PEM group showed significant improvement when examined under both conditions. In the assessment of dynamic balance, both groups showed significant improvement in measurements of sway areas. With respect to head alignment, there were no significant differences pre- and post-testing in either the craniovertebral angle or the cranial rotation angle in the EM group, but the PEM group showed significant differences in both measurements. [Conclusion] These results suggest that in stroke patients with neglect syndrome, PNF with eye movements, rather than eye movements alone, has a greater positive effect on balance and head alignment.

  9. A Programmed Training Technique That Uses Reinforcement to Facilitate Acquisition and Retention in Brain-Damaged Patients

    Science.gov (United States)

    Dolan, Michael P.; Norton, James C.

    1977-01-01

    Hospitalized brain-damaged patients were Ss in a study designed to evaluate the effectiveness of a treatment technique used with contingent reinforcement to facilitate acquisition and retention of environmentally relevant information. (Editor)

  10. Improving Patient Satisfaction with Waiting Time

    Science.gov (United States)

    Eilers, Gayleen M.

    2004-01-01

    Waiting times are a significant component of patient satisfaction. A patient satisfaction survey performed in the author's health center showed that students rated waiting time lowest of the listed categories--A ratings of 58% overall, 63% for scheduled appointments, and 41% for the walk-in clinic. The center used a quality improvement process and…

  11. Primary care physicians' perspectives on facilitating older patients' access to community support services: Qualitative case study.

    Science.gov (United States)

    Ploeg, Jenny; Denton, Margaret; Hutchison, Brian; McAiney, Carrie; Moore, Ainsley; Brazil, Kevin; Tindale, Joseph; Lam, Annie

    2017-01-01

    To understand how family physicians facilitate older patients' access to community support services (CSSs) and to identify similarities and differences across primary health care (PHC) models. Qualitative, multiple-case study design using semistructured interviews. Four models of PHC delivery, specifically 2 family health teams (FHTs), 4 non-FHTs family health organizations, 4 fee-for-service practices, and 2 community health centres in urban Ontario. Purposeful sampling of 23 family physicians in solo and small and large group practices within the 4 models of PHC. A multiple-case study approach was used. Semistructured interviews were conducted and data were analyzed using within- and cross-case analysis. Case study tactics to ensure study rigour included memos and an audit trail, investigator triangulation, and the use of multiple, rather than single, case studies. Three main themes were identified: consulting and communicating with the health care team to create linkages; linking patients and families to CSSs; and relying on out-of-date resources and ineffective search strategies for information on CSSs. All participants worked with their team members; however, those in FHTs and community health centres generally had a broader range of health care providers available to assist them. Physicians relied on home-care case managers to help make linkages to CSSs. Physicians recommended the development of an easily searchable, online database containing available CSSs. This study shows the importance of interprofessional teamwork in primary care settings to facilitate linkages of older patients to CSSs. The study also provides insight into the strategies physicians use to link older persons to CSSs and their recommendations for change. This understanding can be used to develop resources and approaches to better support physicians in making appropriate linkages to CSSs. Copyright© the College of Family Physicians of Canada.

  12. Barriers and facilitators to reaching a diagnosis of PNES from the patients' perspective: Preliminary findings.

    Science.gov (United States)

    Pretorius, Chrisma

    2016-05-01

    This qualitative study aimed at examining the subjective experiences of patients during the complicated and often prolonged diagnostic process of psychogenic non-epileptic seizures (PNES). Thematic analyses were used to explore the semi-structured interviews that were conducted with ten individuals who have been diagnosed with PNES. Six main themes, namely inexpert healthcare providers, limited medical insurance and loss of independence were identified as barriers, while social support, comprehensive medical insurance and knowledgeable healthcare providers were identified as facilitators through the process of thematic analysis. The patients' perspectives revealed that an earlier diagnosis of PNES is essential to address the loss of independence and limit inappropriate and potentially harmful treatment as well as the costly burden of this condition on both the patient and the healthcare system. It was evident in this study that healthcare providers play an essential role in the subjective experiences of these individuals during the diagnostic process. The implementation of continuous education programmes for healthcare providers in particular could contribute positively to the diagnostic process of PNES for patients. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  13. Development of an Automated Bone Mineral Density Software Application: Facilitation Radiologic Reporting and Improvement of Accuracy.

    Science.gov (United States)

    Tsai, I-Ta; Tsai, Meng-Yuan; Wu, Ming-Ting; Chen, Clement Kuen-Huang

    2016-06-01

    The conventional method of bone mineral density (BMD) report production by dictation and transcription is time consuming and prone to error. We developed an automated BMD reporting system based on the raw data from a dual energy X-ray absorptiometry (DXA) scanner for facilitating the report generation. The automated BMD reporting system, a web application, digests the DXA's raw data and automatically generates preliminary reports. In Jan. 2014, 500 examinations were randomized into an automatic group (AG) and a manual group (MG), and the speed of report generation was compared. For evaluation of the accuracy and analysis of errors, 5120 examinations during Jan. 2013 and Dec. 2013 were enrolled retrospectively, and the context of automatically generated reports (AR) was compared with the formal manual reports (MR). The average time spent for report generation in AG and in MG was 264 and 1452 s, respectively (p Z scores in AR is 100 %. The overall accuracy of AR and MR is 98.8 and 93.7 %, respectively (p < 0.001). The mis-categorization rate in AR and MR is 0.039 and 0.273 %, respectively (p = 0.0013). Errors occurred in AR and can be grouped into key-in errors by technicians and need for additional judgements. We constructed an efficient and reliable automated BMD reporting system. It facilitates current clinical service and potentially prevents human errors from technicians, transcriptionists, and radiologists.

  14. Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members

    Directory of Open Access Journals (Sweden)

    Flynn SJ

    2013-08-01

    practice in Baltimore, Maryland. We conducted four separate 90-minute focus groups among patients with controlled (one group and uncontrolled (one group hypertension, as well as their family members (two groups. Trained moderators used open-ended questions to assess participants’ perceptions regarding patient, family, clinic, and community-level factors influencing patients’ effective hypertension self-management. Results: Patient participants identified several facilitators (including family members’ support and positive relationships with doctors and barriers (including competing health priorities, lack of knowledge about hypertension, and poor access to community resources that influence their hypertension self-management. Family members also identified several facilitators (including their participation in patients’ doctor’s visits and discussions with patients’ doctors outside of visits and barriers (including their own limited health knowledge and patients’ lack of motivation to sustain hypertension self-management behaviors that affect their efforts to support patients’ hypertension self-management. Conclusion: African American patients with hypertension and their family members reported numerous patient, family, clinic, and community-level facilitators and barriers to patients’ hypertension self-management. Patients’ and their family members’ views may help guide efforts to tailor behavioral interventions designed to improve hypertension self-management behaviors and hypertension control in minority populations. Keywords: hypertension, patient perspective, qualitative research, health disparities

  15. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review

    Directory of Open Access Journals (Sweden)

    Mark Elkins

    2015-07-01

    Full Text Available Question: Does inspiratory muscle training improve inspiratory muscle strength in adults receiving mechanical ventilation? Does it improve the duration or success of weaning? Does it affect length of stay, reintubation, tracheostomy, survival, or the need for post-extubation non-invasive ventilation? Is it tolerable and does it cause adverse events? Design: Systematic review of randomised trials. Participants: Adults receiving mechanical ventilation. Intervention: Inspiratory muscle training versus sham or no inspiratory muscle training. Outcome measures: Data were extracted regarding: inspiratory muscle strength and endurance; the rapid shallow breathing index; weaning success and duration; duration of mechanical ventilation; reintubation; tracheostomy; length of stay; use of non-invasive ventilation after extubation; survival; readmission; tolerability and adverse events. Results: Ten studies involving 394 participants were included. Heterogeneity within some meta-analyses was high. Random-effects meta-analyses showed that the training significantly improved maximal inspiratory pressure (MD 7 cmH2O, 95% CI 5 to 9, the rapid shallow breathing index (MD 15 breaths/min/l, 95% CI 8 to 23 and weaning success (RR 1.34, 95% CI 1.02 to 1.76. Although only assessed in individual studies, significant benefits were also reported for the time spent on non-invasive ventilation after weaning (MD 16 hours, 95% CI 13 to 18, length of stay in the intensive care unit (MD 4.5 days, 95% CI 3.6 to 5.4 and length of stay in hospital (MD 4.4 days, 95% CI 3.4 to 5.5. Weaning duration decreased in the subgroup of patients with known weaning difficulty. The other outcomes weren’t significantly affected or weren’t measured. Conclusion: Inspiratory muscle training for selected patients in the intensive care unit facilitates weaning, with potential reductions in length of stay and the duration of non-invasive ventilatory support after extubation. The heterogeneity

  16. Improving patient education for patients with low literacy skills.

    Science.gov (United States)

    Mayeaux, E J; Murphy, P W; Arnold, C; Davis, T C; Jackson, R H; Sentell, T

    1996-01-01

    Patients who misunderstand their diagnosis and treatment plans usually exhibit poor compliance. The 90 million adult Americans with low literacy skills struggle to understand such essential health information as discharge instructions, consent forms, oral instructions and drug labels. The Joint Commission on Accreditation of Health Organizations (JCAHO) now requires that instructions be given on a level understandable to the patient. Most physicians tend to give too much information on too high a level for many patients to understand. Physicians who speak in simpler language, repeat their instructions and demonstrate key points, while avoiding too many directives, enhance their patients' understanding. Combining easy-to-read written patient education materials with oral instructions has been shown to greatly enhance patient understanding. To be effective with patients whose literacy skills are low, patient education materials should be short and simple, contain culturally sensitive graphics and encourage desired behavior. Compliance with therapy also may be improved by including family members in the patient education process.

  17. Can sensory attention focused exercise facilitate the utilization of proprioception for improved balance control in PD?

    Science.gov (United States)

    Lefaivre, Shannon C; Almeida, Quincy J

    2015-02-01

    Impaired sensory processing in Parkinson's disease (PD) has been argued to contribute to balance deficits. Exercises aimed at improving sensory feedback and body awareness have the potential to ameliorate balance deficits in PD. Recently, PD SAFEx™, a sensory and attention focused rehabilitation program, has been shown to improve motor deficits in PD, although balance control has never been evaluated. The objective of this study was to measure the effects of PD SAFEx™ on balance control in PD. Twenty-one participants with mild to moderate idiopathic PD completed 12 weeks of PD SAFEx™ training (three times/week) in a group setting. Prior to training, participants completed a pre-assessment evaluating balance in accordance with an objective, computerized test of balance (modified clinical test of sensory integration and balance (m-CTSIB) and postural stability testing (PST)) protocols. The m-CTSIB was our primary outcome measure, which allowed assessment of balance in both eyes open and closed conditions, thus enabling evaluation of specific sensory contributions to balance improvement. At post-test, a significant interaction between time of assessment and vision condition (p=.014) demonstrated that all participants significantly improved balance control, specifically when eyes were closed. Balance control did not change from pre to post with eyes open. These results provide evidence that PD SAFEx™ is effective at improving the ability to utilize proprioceptive information, resulting in improved balance control in the absence of vision. Enhancing the ability to utilize proprioception for individuals with PD is an important intermediary to improving balance deficits.

  18. Caring for LGBTQ patients: Methods for improving physician cultural competence.

    Science.gov (United States)

    Klein, Elizabeth W; Nakhai, Maliheh

    2016-05-01

    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment. © The Author(s) 2016.

  19. Use of RE-AIM to develop a multi-media facilitation tool for the patient-centered medical home

    Directory of Open Access Journals (Sweden)

    Glasgow Russell E

    2011-10-01

    Full Text Available Abstract Background Much has been written about how the medical home model can enhance patient-centeredness, care continuity, and follow-up, but few comprehensive aids or resources exist to help practices accomplish these aims. The complexity of primary care can overwhelm those concerned with quality improvement. Methods The RE-AIM planning and evaluation model was used to develop a multimedia, multiple-health behavior tool with psychosocial assessment and feedback features to facilitate and guide patient-centered communication, care, and follow-up related to prevention and self-management of the most common adult chronic illnesses seen in primary care. Results The Connection to Health Patient Self-Management System, a web-based patient assessment and support resource, was developed using the RE-AIM factors of reach (e.g., allowing input and output via choice of different modalities, effectiveness (e.g., using evidence-based intervention strategies, adoption (e.g., assistance in integrating the system into practice workflows and permitting customization of the website and feedback materials by practice teams, implementation (e.g., identifying and targeting actionable priority behavioral and psychosocial issues for patients and teams, and maintenance/sustainability (e.g., integration with current National Committee for Quality Assurance recommendations and clinical pathways of care. Connection to Health can work on a variety of input and output platforms, and assesses and provides feedback on multiple health behaviors and multiple chronic conditions frequently managed in adult primary care. As such, it should help to make patient-healthcare team encounters more informed and patient-centered. Formative research with clinicians indicated that the program addressed a number of practical concerns and they appreciated the flexibility and how the Connection to Health program could be customized to their office. Conclusions This primary care practice

  20. Improved injection needles facilitate germline transformation of the buckeye butterfly Junonia coenia.

    Science.gov (United States)

    Beaudette, Kahlia; Hughes, Tia M; Marcus, Jeffrey M

    2014-01-01

    Germline transformation with transposon vectors is an important tool for insect genetics, but progress in developing transformation protocols for butterflies has been limited by high post-injection ova mortality. Here we present an improved glass injection needle design for injecting butterfly ova that increases survival in three Nymphalid butterfly species. Using the needles to genetically transform the common buckeye butterfly Junonia coenia, the hatch rate for injected Junonia ova was 21.7%, the transformation rate was 3%, and the overall experimental efficiency was 0.327%, a substantial improvement over previous results in other butterfly species. Improved needle design and a higher efficiency of transformation should permit the deployment of transposon-based genetic tools in a broad range of less fecund lepidopteran species.

  1. A model for the facilitation of effective management of aggression experienced by Psychiatric Nurses from patients in a psychiatric institution

    Directory of Open Access Journals (Sweden)

    Emmanuel Bimenyimana

    2016-02-01

    Full Text Available Background: ‘The time I was hit nobody helped me. They (psychiatric nurses just said: “you do not have to worry, you are not bleeding … in time you will see more”’. The core of the nursing profession is caring for those in need. However, when the psychiatric nurse (PN is overwhelmed by aggression from the person cared for, the ideal of rendering quality patient care is compromised. There has to be a way to assist the PNs to manage aggression effectively in order to render quality patient care and improve PNs mental health.Objectives: The purpose of this article is to describe the process that was followed in developing, describing and evaluating a model that could be used as a framework of reference to facilitate the effective management of aggression as an integral part of the mental health of PNs.Methods: A theory-generative, qualitative, exploratory, descriptive and contextual study design was used to develop the model. The central concept was derived from the Masters’ research ‘The lived experience of aggression and violence by PNs in a Gauteng psychiatric institution’. The process entailed the identification of the central concept, the definition of the central concept and other essential criteria and the classification of the central and related concepts. The conceptual framework was then described and evaluated.Results: The central concept was identified and the ‘facilitation of effective self-management of aggression’ was described and evaluated.Conclusion: The conceptual framework may be able to assist PNs in managing aggression effectively, taking control of workplace environment.

  2. Data Mining to Facilitate Effective User Navigation and Improve Structure of a Website

    Directory of Open Access Journals (Sweden)

    Shweta Mohod,

    2014-08-01

    Full Text Available Now a days for a company it is very important to have active presence on web to become successful in electronic market. This requirement is fulfilled by an interactive website of a company. Website can be used to sell goods, maintain customer relationships, promotion of goods. By looking at the customer's response towards website we can decide campaign for future products and services. So for this website should be interactive and must be used by user by the way designer wants to. So, it is very important to study navigational behavior of a customer. By analyzing the web logs which records the navigational activity of the customer we can get several sequential patterns which helps us to study whether user is pursuing site's goal or not. Sequences are analyzed with WUM (Web Utilization Miner which gives g-sequence (Generalized Sequence and aggregate tree as an output. On the basis of the structure that is given by WUM, conclusions are studied and it is decided whether site structure needs improvement; The improvements suggested should be minimum but at the same time site should satisfy business goal. A mathematical programming model is used which suggest minimum improvements to site. Improvements which tends to change structure of site are avoided as it may be confusing for old site user.

  3. A Qualitative Study Exploring Facilitators for Improved Health Behaviors and Health Behavior Programs: Mental Health Service Users’ Perspectives

    Directory of Open Access Journals (Sweden)

    Candida Graham

    2014-01-01

    Full Text Available Objective. Mental health service users experience high rates of cardiometabolic disorders and have a 20–25% shorter life expectancy than the general population from such disorders. Clinician-led health behavior programs have shown moderate improvements, for mental health service users, in managing aspects of cardiometabolic disorders. This study sought to potentially enhance health initiatives by exploring (1 facilitators that help mental health service users engage in better health behaviors and (2 the types of health programs mental health service users want to develop. Methods. A qualitative study utilizing focus groups was conducted with 37 mental health service users attending a psychosocial rehabilitation center, in Northern British Columbia, Canada. Results. Four major facilitator themes were identified: (1 factors of empowerment, self-value, and personal growth; (2 the need for social support; (3 pragmatic aspects of motivation and planning; and (4 access. Participants believed that engaging with programs of physical activity, nutrition, creativity, and illness support would motivate them to live more healthily. Conclusions and Implications for Practice. Being able to contribute to health behavior programs, feeling valued and able to experience personal growth are vital factors to engage mental health service users in health programs. Clinicians and health care policy makers need to account for these considerations to improve success of health improvement initiatives for this population.

  4. Improving Video Game Development: Facilitating Heterogeneous Team Collaboration through Flexible Software Processes

    Science.gov (United States)

    Musil, Juergen; Schweda, Angelika; Winkler, Dietmar; Biffl, Stefan

    Based on our observations of Austrian video game software development (VGSD) practices we identified a lack of systematic processes/method support and inefficient collaboration between various involved disciplines, i.e. engineers and artists. VGSD includes heterogeneous disciplines, e.g. creative arts, game/content design, and software. Nevertheless, improving team collaboration and process support is an ongoing challenge to enable a comprehensive view on game development projects. Lessons learned from software engineering practices can help game developers to increase game development processes within a heterogeneous environment. Based on a state of the practice survey in the Austrian games industry, this paper presents (a) first results with focus on process/method support and (b) suggests a candidate flexible process approach based on Scrum to improve VGSD and team collaboration. Results showed (a) a trend to highly flexible software processes involving various disciplines and (b) identified the suggested flexible process approach as feasible and useful for project application.

  5. Zero-tension lysimeters: An improved design to monitor colloid-facilitated contaminant transport in the vadose zone

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, M.L.; Scharf, R.L.; Shang, C.

    1995-04-24

    There is increasing evidence that mobile colloids facilitate the long-distance transport of contaminants. The mobility of fine particles and macromolecules has been linked to the movement of actinides, organic contaminants, and heavy metals through soil. Direct evidence for colloid mobility includes the presence of humic materials in deep aquifers as well as coatings of accumulated clay, organic matter, or sesquioxides on particle or aggregate surfaces in subsoil horizons of many soils. The potential for colloid-facilitated transport of contaminants from hazardous-waste sites requires adequate monitoring before, during, and after in-situ remediation treatments. Zero-tension lysimeters (ZTLs) are especially appropriate for sampling water as it moves through saturated soil, although some unsaturated flow events may be sampled as well. Because no ceramic barrier or fiberglass wick is involved to maintain tension on the water (as is the case with other lysimeters), particles suspended in the water as well as dissolved species may be sampled with ZTLs. In this report, a ZTL design is proposed that is more suitable for monitoring colloid-facilitated contaminant migration. The improved design consists of a cylinder made of polycarbonate or polytetrafluoroethylene (PTFE) that is placed below undisturbed soil material. In many soils, a hydraulically powered tube may be used to extract an undisturbed core of soil before placement of the lysimeter. In those cases, the design has significant advantages over conventional designs with respect to simplicity and speed of installation. Therefore, it will allow colloid-facilitated transport of contaminants to be monitored at more locations at a given site.

  6. How can neuroimaging facilitate the diagnosis and stratification of patients with psychosis?

    Science.gov (United States)

    Kempton, Matthew J; McGuire, Philip

    2015-05-01

    Early diagnosis and treatment of patients with psychosis are associated with improved outcome in terms of future functioning, symptoms and treatment response. Identifying neuroimaging biomarkers for illness onset and treatment response would lead to immediate clinical benefits. In this review we discuss if neuroimaging may be utilised to diagnose patients with psychosis, predict those who will develop the illness in those at high risk, and stratify patients. State-of-the-art developments in the field are critically examined including multicentre studies, longitudinal designs, multimodal imaging and machine learning as well as some of the challenges in utilising future neuroimaging biomarkers in clinical trials. As many of these developments are already being applied in neuroimaging studies of Alzheimer's disease, we discuss what lessons have been learned from this field and how they may be applied to research in psychosis. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

  7. Regional anesthesia for the trauma patient: improving patient outcomes.

    Science.gov (United States)

    Gadsden, Jeff; Warlick, Alicia

    2015-01-01

    Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile.

  8. An online module series to prepare pharmacists to facilitate student engagement in patient-centered care delivery: development and evaluation

    Directory of Open Access Journals (Sweden)

    Kassam R

    2012-06-01

    Full Text Available Rosemin Kassam,1 Mona Kwong,1 John B Collins21Faculty of Pharmaceutical Sciences, 2Department of Educational Studies, University of British Columbia, Vancouver, CanadaIntroduction: Accreditation bodies across North America have adopted revised standards that place increased emphasis on experiential education and preceptors to promote and demonstrate patient-centered, pharmaceutical care practices to students. Since such practices are still evolving, challenges exist in recruiting skilled preceptors who are prepared to provide such opportunities. An online educational module series titled "A Guide to Pharmaceutical Care" (The Guide was developed and evaluated to facilitate this transition. The objectives of this paper are: (1 to describe the development of the modules; and (2 to present the evaluation results from its pilot testing.Methods: The Guide was developed as an online, self-directed training program. It begins by providing an overview of patient care (PC philosophy and practice, and then discusses the tools that facilitate PC. It also provides a range of tips to support students as they provide PC during their experiential learning. Pharmacists participating in the pilot study were recruited using purposive and snowball sampling techniques. A pre–post quantitative survey with additional open-ended questions was used to evaluate the modules.Results: The modules incorporated a variety of teaching strategies: self-reflection exercises, quizzes to review important concepts, quick tips, flash cards, and video clips to illustrate more in-depth learning. Thirty-two pharmacists completed the pre–post assessment and reported significant increases in their confidence because of this training. The most influenced outcome was "Application of techniques to facilitate learning opportunities that enable pharmacy students to practice pharmaceutical care competencies." They also indicated that the training clarified necessary changes in their

  9. Developing a monitoring method facilitating continual improvements in the sorting of waste at recycling centres.

    Science.gov (United States)

    Krook, Joakim; Eklund, Mats

    2010-01-01

    Beneficial use of waste relies on efficient systems for collection and separation. In Sweden, a bring system involving recycling centres for collection of bulky, electr(on)ic and hazardous waste has been introduced. A significant share of this waste is incorrectly sorted, causing downstream environmental implications. At present, however, there is a lack of affordable and accurate monitoring methods for providing the recycling centres with the necessary facts for improving the sorting of waste. The aim of this study was therefore to evaluate the usability of a simplified and potentially more suitable waste monitoring method for recycling centres. This method is based on standardised observations where the occurrence of incorrect sorting is monitored by taking digital pictures of the waste which then are analysed according to certain guidelines. The results show that the developed monitoring method could offer a resource-efficient and useful tool for proactive quality work at recycling centres, involving continuous efforts in developing and evaluating measures for improved sorting of waste. More research is however needed in order to determine to what extent the obtained results from the monitoring method are reliable.

  10. Social networks improve leaderless group navigation by facilitating long-distance communication

    Directory of Open Access Journals (Sweden)

    Nikolai W. F. BODE, A. Jamie WOOD, Daniel W. FRANKS

    2012-04-01

    Full Text Available Group navigation is of great importance for many animals, such as migrating flocks of birds or shoals of fish. One theory states that group membership can improve navigational accuracy compared to limited or less accurate individual navigational ability in groups without leaders (“Many-wrongs principle”. Here, we simulate leaderless group navigation that includes social connections as preferential interactions between individuals. Our results suggest that underlying social networks can reduce navigational errors of groups and increase group cohesion. We use network summary statistics, in particular network motifs, to study which characteristics of networks lead to these improvements. It is networks in which preferences between individuals are not clustered, but spread evenly across the group that are advantageous in group navigation by effectively enhancing long-distance information exchange within groups. We suggest that our work predicts a base-line for the type of social structure we might expect to find in group-living animals that navigate without leaders [Current Zoology 58 (2: 329-341, 2012].

  11. Social networks improve leaderless group navigation by facilitating long-distance communication

    Institute of Scientific and Technical Information of China (English)

    Nikolai W.F.BODE; A.Jamie WOOD; Daniel W.FRANKS

    2012-01-01

    Group navigation is of great importance for many animals,such as migrating flocks of birds or shoals of fish.One theory states that group membership can improve navigational accuracy compared to limited or less accurate individual navigational ability in groups without leaders ("Many-wrongs principle").Here,we simulate leaderless group navigation that includes social connectious as preferential interactions between individuals.Our results suggest that underlying social networks can reduce navigational errors of groups and increase group cohesion.We use network summary statistics,in particular network motifs,to study which characteristics of networks lead to these improvements.It is networks in which preferences between individuals are not clustered,but spread evenly across the group that are advantageous in group navigation by effectively enhancing long-distance information exchange within groups.We suggest that our work predicts a base-line for the type of social structure we might expect to find in group-living animals that navigate without leaders [Current Zoology 58 (2):329-341,2012].

  12. Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change.

    Science.gov (United States)

    McAlearney, Ann Scheck; Terris, Darcey; Hardacre, Jeanne; Spurgeon, Peter; Brown, Claire; Baumgart, Andre; Nyström, Monica E

    2014-01-01

    We sought to improve our understanding of how health care quality improvement (QI) methods and innovations could be efficiently and effectively translated between settings to reduce persistent gaps in health care quality both within and across countries. We aimed to examine whether we could identify a core set of organizational cultural attributes, independent of context and setting, which might be associated with success in implementing and sustaining QI systems in health care organizations. We convened an international group of investigators to explore the issues of organizational culture and QI in different health care contexts and settings. This group met in person 3 times and held a series of conference calls to discuss emerging ideas over 2 years. Investigators also conducted pilot studies in their home countries to examine the applicability of our conceptual model. We suggest that organizational coherence may be a critical element of QI efforts in health care organizations and propose that there are 3 key components of organizational coherence: (1) people, (2) processes, and (3) perspectives. Our work suggests that the concept of organizational coherence embraces both culture and context and can thus help guide both researchers and practitioners in efforts to enhance health care QI efforts, regardless of organizational type, location, or context.

  13. From crossbreeding to biotechnology-facilitated improvement of banana and plantain.

    Science.gov (United States)

    Ortiz, Rodomiro; Swennen, Rony

    2014-01-01

    The annual harvest of banana and plantain (Musa spp.) is approximately 145 million tons worldwide. About 85% of this global production comes from small plots and kitchen or backyard gardens from the developing world, and only 15% goes to the export trade. Musa acuminata and Musa balbisiana are the ancestors of several hundreds of parthenocarpic Musa diploid and polyploid cultivars, which show multiple origins through inter- and intra-specific hybridizations from these two wild diploid species. Generating hybrids combining host plant resistance to pathogens and pests, short growth cycles and height, high fruit yield, parthenocarpy, and desired quality from the cultivars remains a challenge for Musa crossbreeding, which started about one century ago in Trinidad. The success of Musa crossbreeding depends on the production of true hybrid seeds in a crop known for its high levels of female sterility, particularly among polyploid cultivars. All banana export cultivars grown today are, however, selections from somatic mutants of the group Cavendish and have a very narrow genetic base, while smallholders in sub-Saharan Africa, tropical Asia and Latin America use some bred-hybrids (mostly cooking types). Musa improvement goals need to shift to address emerging threats because of the changing climate. Innovative cell and molecular biology tools have the potential to enhance the pace and efficiency of genetic improvement in Musa. Micro-propagation has been successful for high throughput of clean planting materials while in vitro seed germination assists in obtaining seedlings after inter-specific and across ploidy hybridization. Flow cytometry protocols are used for checking ploidy among genebank accessions and breeding materials. DNA markers, the genetic maps based on them, and the recent sequencing of the banana genome offer means for gaining more insights in the genetics of the crops and to identifying genes that could lead to accelerating Musa betterment. Likewise, DNA

  14. Improved Radiation Dosimetry/Risk Estimates to Facilitate Environmental Management of Plutonium-Contaminated Sites

    Energy Technology Data Exchange (ETDEWEB)

    Scott, Bobby R.; Tokarskaya, Zoya B.; Zhuntova, Galina V.; Osovets, Sergey V.; Syrchikov, Victor A., Belyaeva, Zinaida D.

    2007-12-14

    This report summarizes 4 years of research achievements in this Office of Science (BER), U.S. Department of Energy (DOE) project. The research described was conducted by scientists and supporting staff at Lovelace Respiratory Research Institute (LRRI)/Lovelace Biomedical and Environmental Research Institute (LBERI) and the Southern Urals Biophysics Institute (SUBI). All project objectives and goals were achieved. A major focus was on obtaining improved cancer risk estimates for exposure via inhalation to plutonium (Pu) isotopes in the workplace (DOE radiation workers) and environment (public exposures to Pu-contaminated soil). A major finding was that low doses and dose rates of gamma rays can significantly suppress cancer induction by alpha radiation from inhaled Pu isotopes. The suppression relates to stimulation of the body's natural defenses, including immunity against cancer cells and selective apoptosis which removes precancerous and other aberrant cells.

  15. Barriers and facilitators of adherence to antiretroviral drug therapy and retention in care among adult HIV-positive patients: a qualitative study from Ethiopia.

    Directory of Open Access Journals (Sweden)

    Woldesellassie M Bezabhe

    Full Text Available BACKGROUND: Antiretroviral therapy (ART has been life saving for hundreds of thousands of Ethiopians. With increased availability of ART in recent years, achievement of optimal adherence and patient retention are becoming the greatest challenges in the management of HIV/AIDS in Ethiopia. However, few studies have explored factors influencing medication adherence to ART and retention in follow-up care among adult Ethiopian HIV-positive patients, especially in the Amhara region of the country, where almost one-third of the country's ART is prescribed. The aim of this qualitative study was to collect such data from patients and healthcare providers in the Amhara region of Ethiopia. METHODS: Semi-structured interviews were conducted with 24 patients, of whom 11 had been lost to follow-up and were non-persistent with ART. In addition, focus group discussions were performed with 15 ART nurses and 19 case managers. All interviews and focus groups were audio-recorded, transcribed, and coded for themes and patterns in Amharic using a grounded theory approach. The emergent concepts and categories were translated into English. RESULTS: Economic constraints, perceived stigma and discrimination, fasting, holy water, medication side effects, and dissatisfaction with healthcare services were major reasons for patients being non-adherent and lost to follow-up. Disclosure of HIV status, social support, use of reminder aids, responsibility for raising children, improved health on ART, and receiving education and counseling emerged as facilitators of adherence to ART. CONCLUSIONS: Improving adherence and retention requires integration of enhanced treatment access with improved job and food security. Healthcare providers need to be supported to better equip patients to cope with the issues associated with ART. Development of social policies and cooperation between various agencies are required to facilitate optimal adherence to ART, patient retention, and improved

  16. Sintered cadmium telluride nanocrystal photovoltaics: Improving chemistry to facilitate roll-to-roll fabrication

    Science.gov (United States)

    Kurley, James Matthew, III

    Recent interest in clean, renewable energy has increased importance on cost-effective and materials efficient deposition methods. Solution-processed solar cells utilizing cadmium telluride nanocrystal inks offer a viable method for reducing cost, increasing materials effectiveness, and decreasing the need for fossil fuels in the near future. Initial work focused on developing a useful platform for testing new chemistries for solubilizing and depositing nanocrystal inks. Layer-by-layer deposition using a combination of spincoating, cadmium chloride treatment, and annealing created a photovoltaic-grade CdTe absorber layer. In conjunction with layer-by-layer deposition, a device architecture of ITO/CdTe/ZnO/Al was utilized to create power conversion efficiencies of over 12% with the help of current/light soaking. Detailed exploration of device geometry, capacitance measurements, and intensity- and temperature-dependent testing determined the ITO/CdTe interface required additional scrutiny. This initial investigation sparked three new. avenues of research: create an Ohmic contact to CdTe, remove the cadmium chloride bath treatment, and create a roll-to-roll friendly process. Improved contact between ITO and CdTe was achieved by using a variety of materials already proven to create Ohmic contact to CdTe. While most of these materials were previously employed using standard approaches, solution-processed analogs were explored. The cadmium chloride bath treatment proved inconsistent, wasteful, and difficult to utilize quickly. It was removed by using trichlorocadmate-capped nanocrystals to combine the semiconductor with the required grain growth agent. To establish roll-to-roll friendly process, the deposition method was improved, heating source changed, and cadmium chloride bath step was removed. Spraycoating or doctor-blading the trichlorocadmate-capped nanocrystals followed by annealing with an IR lamp established a process that can deposit CdTe in a high throughput

  17. Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.

    Science.gov (United States)

    van Bruinessen, Inge Renske; van Weel-Baumgarten, Evelyn M; Gouw, Hans; Zijlstra, Josée M; Albada, Akke; van Dulmen, Sandra

    2013-12-01

    This study aims to gain insight into patient-perceived communication barriers and facilitators at different stages after the diagnosis of malignant lymphoma. We have detected patterns to explain when these factors influence communication predominantly. A qualitative approach was applied, derived from the context mapping framework. A total of 28 patients completed a set of assignments about their experiences with provider-patient communication during medical consultations. Subsequently, these patients and nine companions shared their experiences during a semistructured (group) interview, which was recorded on audiotape. The audiotapes and assignments were analysed with MAXQDA software. From the patients' viewpoint, communicating effectively appears to depend on their own attributes (e.g. emotions), the health care professionals' attributes (e.g. attitude) and external factors (e.g. time pressure). Three patient communication states were identified: (i) overwhelmed, passive; (ii) pro-active, self-motivated; and (iii) proficient, empowered. Patients seem to behave differently in the three communication states. This study lists patient-perceived communication barriers and facilitators and identifies three different communication states, which indicate when certain barriers and facilitators are encountered. These findings may support health care professionals to tailor the provision of support and information and remove communication barriers accordingly. Additionally, they provide input for interventions to support patients in effective communication. Copyright © 2013 John Wiley & Sons, Ltd.

  18. Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'

    Directory of Open Access Journals (Sweden)

    Amorin-Woods Lyndon G

    2012-03-01

    Full Text Available Abstract Background A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. Discussion This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Summary Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

  19. Clinical decision-making to facilitate appropriate patient management in chiropractic practice: 'the 3-questions model'.

    Science.gov (United States)

    Amorin-Woods, Lyndon G; Parkin-Smith, Gregory F

    2012-03-14

    A definitive diagnosis in chiropractic clinical practice is frequently elusive, yet decisions around management are still necessary. Often, a clinical impression is made after the exclusion of serious illness or injury, and care provided within the context of diagnostic uncertainty. Rather than focussing on labelling the condition, the clinician may choose to develop a defendable management plan since the response to treatment often clarifies the diagnosis. This paper explores the concept and elements of defensive problem-solving practice, with a view to developing a model of agile, pragmatic decision-making amenable to real-world application. A theoretical framework that reflects the elements of this approach will be offered in order to validate the potential of a so called '3-Questions Model'; Clinical decision-making is considered to be a key characteristic of any modern healthcare practitioner. It is, thus, prudent for chiropractors to re-visit the concept of defensible practice with a view to facilitate capable clinical decision-making and competent patient examination skills. In turn, the perception of competence and trustworthiness of chiropractors within the wider healthcare community helps integration of chiropractic services into broader healthcare settings.

  20. Specialist nurses' perceptions of inviting patients to participate in clinical research studies: a qualitative descriptive study of barriers and facilitators.

    Science.gov (United States)

    French, Caroline; Stavropoulou, Charitini

    2016-08-11

    Increasing the number of patients participating in research studies is a current priority in the National Health Service (NHS) in the United Kingdom. The role of specialist nurses in inviting patients to participate is important, yet little is known about their experiences of doing so. The aim of this study was to explore the perceptions of barriers and facilitators held by specialist nurses with experience of inviting adult NHS patients to a wide variety of research studies. A cross-sectional qualitative descriptive study was conducted between March and July 2015. Participants were 12 specialist nurses representing 7 different clinical specialties and 7 different NHS Trusts. We collected data using individual semi-structured interviews, and analysed transcripts using the Framework method to inductively gain a descriptive overview of barriers and facilitators. Barriers and facilitators were complex and interdependent. Perceptions varied among individuals, however barriers and facilitators centred on five main themes: i) assessing patient suitability, ii) teamwork, iii) valuing research, iv) the invitation process and v) understanding the study. Facilitators to inviting patients to participate in research often stemmed from specialist nurses' attitudes, skills and experience. Positive research cultures, effective teamwork and strong relationships between research and clinical teams at the local clinical team level were similarly important. Barriers were reported when specialist nurses felt they were providing patients with insufficient information during the invitation process, and when specialist nurses felt they did not understand studies to their satisfaction. Our study offers several new insights regarding the role of specialist nurses in recruiting patients for research. It shows that strong local research culture and teamwork overcome some wider organisational and workload barriers reported in previous studies. In addition, and in contrast to common practice

  1. Integrating patient satisfaction into performance measurement to meet improvement challenges.

    Science.gov (United States)

    Smith, J E; Fisher, D L; Endorf-Olson, J J

    2000-05-01

    A Value Compass has been proposed to guide health care data collection. The "compass corners" represent the four types of data needed to meet health care customer expectations: appropriate clinical outcomes, improved functional status, patient satisfaction, and appropriate costs. Collection of all four types of data is necessary to select processes in need of improvement, guide improvement teams, and monitor the success of improvement efforts. INTEGRATED DATA AT BRYANLGH: BryanLGH Medical Center in Lincoln, Nebraska, has adopted multiple performance measurement systems to collect clinical outcome, financial, and patient satisfaction data into integrated databases. Data integration allows quality professionals at BryanLGH to identify quality issues from multiple perspectives and track the interrelated effects of improvement efforts. A CASE EXAMPLE: Data from the fourth quarter of 1997 indicated the need to improve processes related to cesarean section (C-section) deliveries. An interdisciplinary team was formed, which focused on educating nurses, physicians, and the community about labor support measures. Physicians were given their own rates of C-section deliveries. The C-section rate decreased from 27% to 19%, but per-case cost increased. PickerPLUS+ results indicated that BryanLGH obstetric patients reported fewer problems with receiving information than the Picker norm, but they reported more problems with the involvement of family members and friends. The data collected so far have indicated a decrease in the C-section rate and a need to continue to work on cost and psychosocial issues. A complete analysis of results was facilitated by integrated performance management systems. Successes have been easily tracked over time, and the need for further work on related processes has been clearly identified.

  2. How does sport psychology actually improve athletic performance? A framework to facilitate athletes' and coaches' understanding.

    Science.gov (United States)

    Gee, Chris J

    2010-09-01

    The popularity of sport psychology, both as an academic discipline and an applied practice, has grown substantially over the past two decades. Few within the realm of competitive athletics would argue with the importance of being mentally prepared prior to an athletic competition as well as the need to maintain that particular mindset during a competitive contest. Nevertheless, recent research has shown that many athletes, coaches, and sporting administrators are still quite reluctant to seek out the services of a qualified sport psychologist, even if they believe it could help. One of the primary reasons for this hesitation appears to be a lack of understanding about the process and the mechanisms by which these mental skills affect performance. Unlike the "harder sciences" of sport physiology and biochemistry where athletes can see the tangible results in themselves or other athletes (e.g., he or she lifted weights, developed larger muscles, and is now stronger/faster as a result), the unfamiliar and often esoteric nature of sport psychology appears to be impeding a large number of athletes from soliciting these important services. As such, the purpose of this article is to provide the reader with a simple framework depicting how mental skills training translates into improved within-competition performance. This framework is intended to help bridge the general "understanding gap" that is currently being reported by a large number of athletes and coaches, while also helping sport psychology practitioners sell their valuable services to individual athletes and teams.

  3. Electrotactile feedback improves performance and facilitates learning in the routine grasping task

    Directory of Open Access Journals (Sweden)

    Milica Isaković

    2016-06-01

    Full Text Available Aim of this study was to investigate the feasibility of electrotactile feedback in closed loop training of force control during the routine grasping task. The feedback was provided using an array electrode and a simple six-level spatial coding, and the experiment was conducted in three amputee subjects. The psychometric tests confirmed that the subjects could perceive and interpret the electrotactile feedback with a high success rate. The subjects performed the routine grasping task comprising 4 blocks of 60 grasping trials. In each trial, the subjects employed feedforward control to close the hand and produce the desired grasping force (four levels. First (baseline and the last (validation session were performed in open loop, while the second and the third session (training included electrotactile feedback. The obtained results confirmed that using the feedback improved the accuracy and precision of the force control. In addition, the subjects performed significantly better in the validation vs. baseline session, therefore suggesting that electrotactile feedback can be used for learning and training of myoelectric control.

  4. Nurses' perceptions of facilitating genuineness in a nurse–patient relationship

    Directory of Open Access Journals (Sweden)

    Anna Elizabeth Van den Heever

    2015-06-01

    Results: When groups were compared, statistically significant differences were identified in nurses' perceptions of facilitating genuineness with respect to age, years' experience as a nurse and qualifications. It is recommended that nurses' awareness of genuineness and its facilitation should involve learning through socialisation and self-awareness.

  5. Facilitators and barriers to exercise adherence in patients with osteopenia and osteoporosis: a systematic review.

    Science.gov (United States)

    Rodrigues, I B; Armstrong, J J; Adachi, J D; MacDermid, J C

    2017-03-01

    The aim of this study was to categorize the facilitators and barriers of exercise and identify methods to promote exercise adherence in the osteoporosis population. Despite the fair methodological quality of included randomized controlled trials (RCTs), less than 75 % identified facilitators and barriers to exercise. Methods to promote and measure exercise adherence were poorly reported.

  6. [Proprioceptive neuromuscular facilitation method of therapeutic rehabilitation in the treatment of patients with Parkinson disease].

    Science.gov (United States)

    Mirek, Elzbieta; Chwała, Wiesław; Longawa, Krystyna; Rudzińska, Monika; Adamkiewicz, Paweł; Szczudlik, Andrzej

    2003-01-01

    Planning and verification of progress of efficacious physiotherapeutic effect on Parkinson's disease depends notably on the right identification of areas and scope of dysfunction of motoric systems. Biomechanical evaluation of motoric organ disability made by means of three-dimensional motion analysis using the "Vicon" system can make it considerably easier. A sample of three patients (two women and one man of average age of sixty-four) with idiopathic parkinsonism has been examined for the purpose of this evaluation. Based upon results of the three-dimensional motion analysis of these patients, dominant individual movement disorders were determined and individual therapeutic rehabilitation using the PNF method was planned. Within therapy, using the PNF method, they applied special techniques using motor patterns for the pelvis, upper and lower limbs in order to improve movement through an approach of assessed parameters to the biomechanical standard. After three weeks of therapy, specific characteristics of gait were examined again. On the basis of research results before therapy, it was found that these patients had none or limited scope of plantar flexion of feet, excessive dorsal flexion of feet, lengthened duration of stance phase, considerable excessive external rotation of shanks and excessive anteversion of the pelvis during gait cycle. Also big differences in values for spatiotemporal parameters (such as walking speed and frequency, stride length and time of single limb support) between the patients and healthy people were observed. After therapy, there has not been a marked variability in the scope of angular changes to the above-mentioned dysfunction. Only proportions between the duration of stance phase and swing phase have improved noticeably, so that they have directly resulted in better rhythm of gait. They have considerably approached the standards of frequency and speed (p = 0.05). However, stride length and duration of single limb support has not

  7. Creating effective leadership for improving patient safety.

    Science.gov (United States)

    Mohr, Julie J; Abelson, Herbert T; Barach, Paul

    2002-01-01

    Leadership has emerged as a key theme in the rapidly growing movement to improve patient safety. Leading an organization that is committed to providing safer care requires overcoming the common traps in thinking about error, such as blaming individuals, ignoring the underlying systems factors, and blaming the bureaucracy of the organization. Leaders must address the system issues that are at work within their organizations to allow individual and organizational learning to occur.

  8. Improving medication adherence in patients with hypertension

    DEFF Research Database (Denmark)

    Hedegaard, Ulla; Kjeldsen, Lene Juel; Pottegård, Anton

    2015-01-01

    BACKGROUND: and Purpose: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve...... medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention. METHODS: Patients (N=532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review......, tailored adherence counselling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at one-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months...

  9. [Improving patient safety through voluntary peer review].

    Science.gov (United States)

    Kluge, S; Bause, H

    2015-01-01

    The intensive care unit (ICU) is one area of the hospital in which processes and communication are of primary importance. Errors in intensive care units can lead to serious adverse events with significant consequences for patients. Therefore quality and risk-management are important measures when treating critically ill patients. A pragmatic approach to support quality and safety in intensive care is peer review. This approach has gained significant acceptance over the past years. It consists of mutual visits by colleagues who conduct standardised peer reviews. These reviews focus on the systematic evaluation of the quality of an ICU's structure, its processes and outcome. Together with different associations, the State Chambers of Physicians and the German Medical Association have developed peer review as a standardized tool for quality improvement. The common goal of all stakeholders is the continuous and sustainable improvement in intensive care with peer reviews significantly increasing and improving communication between professions and disciplines. Peer reviews secure the sustainability of planned change processes and consequently lead the way to an improved culture of quality and safety.

  10. Benefits of pharmacological facilitation with glycoprotein IIb-IIIa inhibitors in diabetic patients undergoing primary angioplasty for STEMI. A subanalysis of the EGYPT cooperation.

    Science.gov (United States)

    De Luca, Giuseppe; Michael Gibson, C; Bellandi, Francesco; Murphy, Sabina; Maioli, Mauro; Noc, Marko; Zeymer, Uwe; Dudek, Dariusz; Arntz, Hans-Richard; Zorman, Simona; Gabriel, H Mesquita; Emre, Ayse; Cutlip, Donald; Rakowski, Tomasz; Gyongyosi, Mariann; Huber, Kurt; Van't Hof, Arnoud W J

    2009-10-01

    The Early Glycoprotein IIb-IIIa inhibitors in Primary angioplasty (EGYPT) cooperation aimed at evaluating, by pooling individual patient's data of randomized trials, the benefits of pharmacological facilitation with Gp IIb-IIIa inhibitors among STEMI patients undergoing primary angioplasty. In the current study we analyze the benefits of early Gp IIb-IIIa inhibitors in diabetic patients. The literature was scanned by formal searches of electronic databases (MEDLINE, EMBASE) from January 1990 to October 2007. We examined all randomized trials on facilitation by early administration of Gp IIb-IIIa inhibitors in STEMI. No language restrictions were enforced. Individual patients' data were obtained from 11 out of 13 trials, including 1,662 patients. Diabetes was present in 281 (16.9%). Early Gp IIb-IIIa inhibitors were associated with improved preprocedural TIMI 3 flow (26.0% vs. 13.1%, P = 0.006), postprocedural TIMI 3 flow (90.1% vs. 75.0%, P = 0.18), MBG 3 (40.8% vs. 30.4%, P = 0.004), and less distal embolization (11.6% vs. 20.8%, P = 0.05). However, early Gp IIb-IIIa inhibitors did not significantly reduce mortality (8.3% vs. 9.5%, P = 0.64). This meta-analysis shows that pharmacological facilitation with early administration of Gp IIb-IIIa inhibitors in STEMI patients with diabetes undergoing primary angioplasty, is associated with significant benefits in terms of preprocedural and postprocedural TIMI flow, improved myocardial perfusion, without significant benefits in mortality.

  11. Defining systems expertise: effective simulation at the organizational level--implications for patient safety, disaster surge capacity, and facilitating the systems interface.

    Science.gov (United States)

    Kaji, Amy H; Bair, Aaron; Okuda, Yasuharu; Kobayashi, Leo; Khare, Rahul; Vozenilek, John

    2008-11-01

    The Institute of Medicine's report "To Err is Human" identified simulation as a means to enhance safety in the medical field, just as flight simulation is used to improve the aviation industry. Yet, while there is evidence that simulation may improve task performance, there is little evidence that simulation actually improves patient outcome. Similarly, simulation is currently used to model teamwork-communication skills for disaster management and critical events, but little research or evidence exists to show that simulation improves disaster response or facilitates intersystem or interagency communication. Simulation ranges from the use of standardized patient encounters to robot-mannequins to computerized virtual environments. As such, the field of simulation covers a broad range of interactions, from patient-physician encounters to that of the interfaces between larger systems and agencies. As part of the 2008 Academic Emergency Medicine Consensus Conference on the Science of Simulation, our group sought to identify key research questions that would inform our understanding of simulation's impact at the organizational level. We combined an online discussion group of emergency physicians, an extensive review of the literature, and a "public hearing" of the questions at the Consensus Conference to establish recommendations. The authors identified the following six research questions: 1) what objective methods and measures may be used to demonstrate that simulator training actually improves patient safety? 2) How can we effectively feedback information from error reporting systems into simulation training and thereby improve patient safety? 3) How can simulator training be used to identify disaster risk and improve disaster response? 4) How can simulation be used to assess and enhance hospital surge capacity? 5) What methods and outcome measures should be used to demonstrate that teamwork simulation training improves disaster response? and 6) How can the interface

  12. Improving adherence and outcomes in diabetic patients

    Directory of Open Access Journals (Sweden)

    Joshi R

    2017-02-01

    Full Text Available Renu Joshi, Disha Joshi, Pramil Cheriyath Department of Endocrinology, Pinnacle Health Hospitals, Harrisburg, PA, USA Objective: Nonadherence in diabetes is a problem leading to wasted resources and preventable deaths each year. Remedies for diminishing nonadherence are many but marginally effective, and outcomes remain suboptimal. Aim: The aim of this study was to test a new iOS “app”, PatientPartner. Derived from complexity theory, this novel technology has been extensively used in other fields; this is the first trial in a patient population. Methods: Physicians referred patients who were “severely non-adherent” with HbA1c levels >8. After consent and random assignment (n=107, subjects in the intervention group were immersed in the 12-min PatientPartner game, which assesses and trains subjects on parameters of thinking that are critical for good decision making in health care: information management, stress coping, and health strategies. The control group did not play PatientPartner. All subjects were called each week for 3 weeks and self-reported on their medication adherence, diet, and exercise. Baseline and 3-month post-intervention HbA1c levels were recorded for the intervention group.Results: Although the control group showed no difference on any measures at 3 weeks, the intervention group reported significant mean percentage improvements on all measures: medication adherence (57%, standard deviation [SD] 18%–96%, SD 9, diet (50%, SD 33%–75%, SD 28, and exercise (29%, SD 31%–43%, SD 33. At 3 months, the mean HbA1c levels in the intervention group were significantly lower (9.6 than baseline (10.7. Conclusion: Many programs to improve adherence have been proved to be expensive and marginally effective. Therefore, improvements from the single use of a 12-min-long “app” are noteworthy. This is the first ever randomized, controlled trial to demonstrate that an “app” can impact the gold standard biological marker, HbA1c

  13. Flow Experience During Attentional Training Improves Cognitive Functions in Patients with Traumatic Brain Injury: An Exploratory Case Study

    Directory of Open Access Journals (Sweden)

    Kazuki Yoshida

    2014-12-01

    Conclusion: The results for Patient A suggested that the flow task was more effective than general OT for improving attention deficits. Moreover, the results for Patient B suggested that the flow task was more effective than the control task. Attention training inducing flow experience may thus facilitate improvement of attention.

  14. Benefits, Facilitators, Barriers, and Strategies to Improve Pesticide Protective Behaviors: Insights from Farmworkers in North Carolina Tobacco Fields.

    Science.gov (United States)

    Walton, AnnMarie Lee; LePrevost, Catherine E; Linnan, Laura; Sanchez-Birkhead, Ana; Mooney, Kathi

    2017-06-23

    Pesticide exposure is associated with deleterious health effects. Prior studies suggest Latino farmworkers perceive little control over their occupational health. Using the Health Belief Model as a theoretical guide, we explored the perceptions of Latino farmworkers working in tobacco in North Carolina (n = 72) about benefits and facilitators of pesticide protective behaviors as well as barriers, and strategies to overcome barriers to their use. Interviews were conducted with participants at farmworker housing during non-work time. Qualitative data were analyzed using ATLAS.ti. Farmworkers recognized pesticide protective behaviors as helping them to not get sick and stay healthy. Farmworkers perceived work experience as facilitating protective behaviors. Wetness in the field was the most commonly cited barrier to protective behavior use. To overcome this barrier, farmworkers suggested use of water-resistant outerwear, as well as packing a change of clothes for mid-day, with space and time to change provided by employers. Examination of the efficacy and feasibility of farmworkers' suggestions for addressing barriers is warranted. Training and behavior modeling by experienced peers may improve behavior adoption and perceived control.

  15. Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis

    NARCIS (Netherlands)

    Bruinessen, I.R. van; Weel-Baumgarten, E.M. van; Gouw, H.; Zijlstra, J.M.; Albada, A.; Dulmen, S. van

    2013-01-01

    OBJECTIVE: This study aims to gain insight into patient-perceived communication barriers and facilitators at different stages after the diagnosis of malignant lymphoma. We have detected patterns to explain when these factors influence communication predominantly. METHOD: A qualitative approach was

  16. Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.

    NARCIS (Netherlands)

    Bruinessen, I.R. van; Weel, E.M. van; Gouw, H.; Zijlstra, J.M.; Albada, A.; Dulmen, S. van

    2013-01-01

    Objective: This study aims to gain insight into patient-perceived communication barriers and facilitators at different stages after the diagnosis of malignant lymphoma. We have detected patterns to explain when these factors influence communication predominantly. Method: A qualitative approach was

  17. Barriers and facilitators to effective communication experienced by patients with malignant lymphoma at all stages after diagnosis.

    NARCIS (Netherlands)

    Bruinessen, I.R. van; Weel, E.M. van; Gouw, H.; Zijlstra, J.M.; Albada, A.; Dulmen, S. van

    2013-01-01

    Objective: This study aims to gain insight into patient-perceived communication barriers and facilitators at different stages after the diagnosis of malignant lymphoma. We have detected patterns to explain when these factors influence communication predominantly. Method: A qualitative approach was a

  18. Development of a web-based pharmaceutical care plan to facilitate collaboration between healthcare providers and patients

    NARCIS (Netherlands)

    Geurts, Marlies M E; Ivens, Martijn; van Gelder, Egbert; de Gier, Johan J

    2013-01-01

    BACKGROUND: In medication therapy management there is a need for a tool to document medication reviews and pharmaceutical care plans (PCPs) as well as facilitate collaboration and sharing of patient data between different healthcare providers. Currently, pharmacists and general practitioners (GPs)

  19. Afferent facilitation of corticomotor responses is increased by IgGs of patients with NMDA-receptor antibodies.

    Science.gov (United States)

    Manto, Mario; Dalmau, Josep; Didelot, Adrien; Rogemond, Véronique; Honnorat, Jérôme

    2011-01-01

    A severe subacute encephalitis associated with auto-antibodies to the NMDA receptor (NMDA-R) has been reported in humans. These antibodies are directed to NR1/NR2 heteromers of the NMDA receptor. We studied the effects of patients' cerebrospinal fluid (CSF) injected in rFr2 (the prefrontal area) on the afferent facilitation in a conditioning paradigm for corticomotor responses. The afferent facilitation was assessed in forelimbs and hindlimbs of rats, before and after application of trains of high-frequency stimulation (HFS) which are known to modulate the excitability of M1. Before HFS, patients' CSF did not modify afferent facilitation. After HFS, the amplitudes of corticomotor responses before conditioning were significantly larger in forelimbs and hindlimbs. There was an increase of the afferent facilitation in forelimbs. The same effect was observed after injection of purified IgGs from patients' sera. Our results highlight that IgGs of patients with NMDA-R antibodies induce a state of corticomotor hyperexcitability following application of HFS over the prefrontal area.

  20. Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people

    National Research Council Canada - National Science Library

    Nyström, Monica Elisabeth; Strehlenert, Helena; Hansson, Johan; Hasson, Henna

    2014-01-01

    .... The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill...

  1. Facilitating improved road safety based on increased knowledge about driving behaviour and profiling sub-groups of drivers

    DEFF Research Database (Denmark)

    Martinussen, Laila Marianne

    with underlying mechanisms of lack of focus, emotional stress, recklessness and confusion, and hence it is highly important to further explore means to making drivers become more focused or attentive when driving, and to deal with emotional responses in traffic like impatience and frustration (Article 1). 2......The aim of the Ph.D. study presented in this thesis was to facilitate improved road safety through increased understanding of methods used to measure driving behaviour, and through increased knowledge about driving behaviour in sub-groups of drivers. More specifically, the usefulness of the Driver...... Behaviour Questionnaire (DBQ) within a Danish context was explored, sub-groups of drivers differing in their potential danger in traffic were identified, and the relationship between implicit attitudes towards safe and risky driving and self-reported driving behaviour was explored. The methods applied were...

  2. Light-emitting conjugated polymers with microporous network architecture: interweaving scaffold promotes electronic conjugation, facilitates exciton migration, and improves luminescence.

    Science.gov (United States)

    Xu, Yanhong; Chen, Long; Guo, Zhaoqi; Nagai, Atsushi; Jiang, Donglin

    2011-11-09

    Herein we report a strategy for the design of highly luminescent conjugated polymers by restricting rotation of the polymer building blocks through a microporous network architecture. We demonstrate this concept using tetraphenylethene (TPE) as a building block to construct a light-emitting conjugated microporous polymer. The interlocked network successfully restricted the rotation of the phenyl units, which are the major cause of fluorescence deactivation in TPE, thus providing intrinsic luminescence activity for the polymers. We show positive "CMP effects" that the network promotes π-conjugation, facilitates exciton migration, and improves luminescence activity. Although the monomer and linear polymer analogue in solvents are nonemissive, the network polymers are highly luminescent in various solvents and the solid state. Because emission losses due to rotation are ubiquitous among small chromophores, this strategy can be generalized for the de novo design of light-emitting materials by integrating the chromophores into an interlocked network architecture.

  3. Effects of trunk stability exercise using proprioceptive neuromuscular facilitation with changes in chair height on the gait of patients who had a stroke.

    Science.gov (United States)

    Park, Si-Eun; Moon, Sang-Hyun

    2016-07-01

    [Purpose] The purpose of this study was to identify the effects of trunk stability exercise using proprioceptive neuromuscular facilitation with changes in chair heights on the gait of stroke patients. [Subjects and Methods] The subjects of this study were 11 stroke patients. The intervention method was trunk stability exercise using proprioceptive neuromuscular facilitation with different chair heights (50, 60, and 70 cm). These exercises were performed 5 times per week for 6 weeks. Gait velocity, cadence, stride length, gait cycle, and stance phase duration were used to measure gait function. [Results] Significant changes in gait velocity, cadence, and stride length were observed on the affected side. However, no significant changes in gait cycle and stance phase were observed on the affected side. [Conclusion] These results indicate that trunk stability exercise using proprioceptive neuromuscular facilitation with change in chair heights were effective in improving gait velocity, cadence, and stride length on the affected side. However, in this study, no significant changes were observed in gait cycle and stance phase on the affected side. Therefore, various interventions for stroke patients should be investigated in further studies.

  4. Efficacy of proprioceptive neuromuscular facilitation techniques versus traditional prosthetic training for improving ambulatory function in transtibial amputees

    Directory of Open Access Journals (Sweden)

    Pallavi Sahay, MPT

    2014-06-01

    Full Text Available The objective of this randomized controlled trial was to evaluate the efficacy of proprioceptive neuromuscular facilitation (PNF techniques in comparison to traditional prosthetic training (TPT in improving ambulatory function in transtibial amputees. Thirty study participants (19 men and 11 women with unilateral transtibial amputation participated in the study. They were randomly allocated to either the traditional training group (i.e., TPT (n = 15 or the PNF training group (n = 15. The treatment in the TPT group consisted of weight-bearing, weight-shifting, balance, and gait exercises for 30 minutes daily for 10 treatment sessions. In the PNF group, the same activities were performed by employing PNF principles and techniques. The outcome measures were gait parameters (e.g., stride width, step length, and stride length and the Locomotor Capabilities Index (LCI. The between-group comparisons at the end of the trial showed that the PNF group showed significant improvement in gait parameters and in the LCI, compared to the TPT group (p < 0.05. The results of the study suggested that prosthetic training based on proprioceptive feedback is more effective than the traditional prosthetic programme in improving ambulatory function.

  5. Massively parallel DNA sequencing facilitates diagnosis of patients with Usher syndrome type 1.

    Directory of Open Access Journals (Sweden)

    Hidekane Yoshimura

    Full Text Available Usher syndrome is an autosomal recessive disorder manifesting hearing loss, retinitis pigmentosa and vestibular dysfunction, and having three clinical subtypes. Usher syndrome type 1 is the most severe subtype due to its profound hearing loss, lack of vestibular responses, and retinitis pigmentosa that appears in prepuberty. Six of the corresponding genes have been identified, making early diagnosis through DNA testing possible, with many immediate and several long-term advantages for patients and their families. However, the conventional genetic techniques, such as direct sequence analysis, are both time-consuming and expensive. Targeted exon sequencing of selected genes using the massively parallel DNA sequencing technology will potentially enable us to systematically tackle previously intractable monogenic disorders and improve molecular diagnosis. Using this technique combined with direct sequence analysis, we screened 17 unrelated Usher syndrome type 1 patients and detected probable pathogenic variants in the 16 of them (94.1% who carried at least one mutation. Seven patients had the MYO7A mutation (41.2%, which is the most common type in Japanese. Most of the mutations were detected by only the massively parallel DNA sequencing. We report here four patients, who had probable pathogenic mutations in two different Usher syndrome type 1 genes, and one case of MYO7A/PCDH15 digenic inheritance. This is the first report of Usher syndrome mutation analysis using massively parallel DNA sequencing and the frequency of Usher syndrome type 1 genes in Japanese. Mutation screening using this technique has the power to quickly identify mutations of many causative genes while maintaining cost-benefit performance. In addition, the simultaneous mutation analysis of large numbers of genes is useful for detecting mutations in different genes that are possibly disease modifiers or of digenic inheritance.

  6. Barriers and facilitators to antiretroviral therapy adherence among patients with HIV in Bissau, Guinea-Bissau: a qualitative study

    DEFF Research Database (Denmark)

    Rasmussen, Dlama; da Silva Te, David; Rodkjær, Lotte Ørneborg;

    2013-01-01

    Adherence is a decisive factor in achieving a successful response to antiretroviral therapy (ART) for HIV infection. No previous studies have been conducted regarding HIV treatment adherence in Guinea-Bissau. In this study we assessed barriers and facilitators to patient ART adherence. Semi......-structured interviews were conducted with 20 adult, HIV infected individuals receiving ART at a HIV treatment centre in Bissau, Guinea-Bissau. The grounded theory method was used to gather and analyse data. Results indicated that HIV-related knowledge was a determining factor for optimal adherence. The facilitators...

  7. Alveolar bone thickness and root length changes in the treatment of skeletal Class Ⅲ patients facilitated by improved corticotomy: a cone-beam CT analysis%术前正畸中改良骨皮质切开术对牙槽骨及牙根影响的锥形束CT观察

    Institute of Scientific and Technical Information of China (English)

    吴佳琪; 江久汇; 徐莉; 梁成; 李翠英; 徐筱

    2015-01-01

    Objective To evaluate the alveolar bone thickness and root length changes of anterior teeth with cone-beam computed tomography(CBCT).Methods CBCT scans were taken for 12 skeletal Class Ⅲ patients who accepted the improved corticotomy(IC) procedures during pre-surgical orthodontics.The CBCT data in T1(the maxillary dental arch was aligned and leveled) and T2(extraction space closure) were superimposed and the alveolar bone thickness at root apex level and root length measurements were done.Results From T1 to T2,the buccal alveolar bone thickness for the upper lateral incisors increased from (1.89±0.83) to (2.47± 1.02) mm (P<0.05),and for central incisors and for canines from (2.32±0.71) to (2.68 ± 1.48) mm and from (2.28 ± 1.08) to (2.41 ± 1.40) mm,respectively.According to Sharpe Grading System,the root resorption grade for 69 teeth of 72 was located in Grade 1,two teeth in Grade 2,one tooth in Grade 3.Conclusions The improved corticotomy had the potential to increase the buccal alveolar bone thickness and the root resorption in most teeth was in Grade 1 according to Sharpe grading system.%目的 探讨在骨性Ⅲ类错(牙合)正畸-正颌联合治疗的术前正畸中改良骨皮质切开术(improved corticotomy,IC)对牙根周围牙槽骨厚度和牙根长度的影响.方法将接受IC的12例骨性Ⅲ类错(牙合)正畸-正颌联合治疗患者的72颗牙齿纳入研究,采用锥形束CT结构重叠法,测量上颌牙列排齐整平后(T1)和上颌牙列间隙关闭后(T2)锥形束CT上颌前牙根尖水平的唇侧、腭侧牙槽骨厚度和总厚度以及牙根长度,采用配对t检验比较两个时间点的差异;按照Sharpe分级,判断牙根吸收程度.结果上颌中切牙、侧切牙和尖牙根尖水平的唇侧牙槽骨厚度分别由T1的(2.32±0.71)、(1.89±0.83)和(2.28±1.08) mm增加到T2的(2.68±1.48)、(2.47±1.02)和(2.41±1.40) mm,其中侧切牙唇侧牙槽骨厚度两时间点差异有统计学意义(P<0.05).

  8. Health innovation for patient safety improvement

    Directory of Open Access Journals (Sweden)

    Renukha Sellappans

    2013-01-01

    Full Text Available Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE, a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of “health smart cards” that carry vital patient medical information in the form of a “credit card” or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

  9. Specialist nurses’ perceptions of inviting patients to participate in clinical research studies: a qualitative descriptive study of barriers and facilitators

    Directory of Open Access Journals (Sweden)

    Caroline French

    2016-08-01

    Full Text Available Abstract Background Increasing the number of patients participating in research studies is a current priority in the National Health Service (NHS in the United Kingdom. The role of specialist nurses in inviting patients to participate is important, yet little is known about their experiences of doing so. The aim of this study was to explore the perceptions of barriers and facilitators held by specialist nurses with experience of inviting adult NHS patients to a wide variety of research studies. Methods A cross-sectional qualitative descriptive study was conducted between March and July 2015. Participants were 12 specialist nurses representing 7 different clinical specialties and 7 different NHS Trusts. We collected data using individual semi-structured interviews, and analysed transcripts using the Framework method to inductively gain a descriptive overview of barriers and facilitators. Results Barriers and facilitators were complex and interdependent. Perceptions varied among individuals, however barriers and facilitators centred on five main themes: i assessing patient suitability, ii teamwork, iii valuing research, iv the invitation process and v understanding the study. Facilitators to inviting patients to participate in research often stemmed from specialist nurses’ attitudes, skills and experience. Positive research cultures, effective teamwork and strong relationships between research and clinical teams at the local clinical team level were similarly important. Barriers were reported when specialist nurses felt they were providing patients with insufficient information during the invitation process, and when specialist nurses felt they did not understand studies to their satisfaction. Conclusion Our study offers several new insights regarding the role of specialist nurses in recruiting patients for research. It shows that strong local research culture and teamwork overcome some wider organisational and workload barriers reported in

  10. Efficacy of Cancer Care Communication Between Clinicians and Latino Patients in a Rural US-Mexico Border Region: a Qualitative Study of Barriers and Facilitators to Better Communication.

    Science.gov (United States)

    Ko, Eunjeong; Zúñiga, María Luisa; Peacher, Diana; Palomino, Helen; Watson, Mercedes

    2016-08-25

    Quality of clinician-patient cancer communication is vital to cancer care and survivorship. Racial/ethnic minority patients in rural regions may have unique characteristics including cultural beliefs, language barriers, and low health literacy which require effective cross-cultural cancer communication. Despite the growing US population of racial/ethnic minorities and widespread emphasis on culturally appropriate health communication, little is known about challenges and facilitators of cancer communication among underserved rural Latino cancer patients in the US-Mexico border region. This study conducted secondary data analysis of interview data collected from 22 individual cancer patients living on the US side of the US-Mexico border. Thematic analysis was conducted to explore a priori questions regarding patient experiences with cancer care communication with their providers. Emerging themes included lack of language concordance, patient perspectives on clarity and accuracy of information provided, patient perceptions on provider sensitivity in giving cancer diagnosis, and improving the clinical interpersonal relationship. Practice guidelines are suggested and discussed. These findings illuminate the importance of advancing improvement of cancer communication between clinicians and Spanish language-dominant Latinos.

  11. Functional dysphonia: strategies to improve patient outcomes

    Science.gov (United States)

    Behlau, Mara; Madazio, Glaucya; Oliveira, Gisele

    2015-01-01

    Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for

  12. Effects of primary PCI and facilitated PCI on myocardial viability and ventricular systolic synchrony in acute myocardial infarction patients

    Institute of Scientific and Technical Information of China (English)

    谷新顺; 傅向华; 马宁

    2003-01-01

    Effects of primary PCI and facilitated PCI on myocardial viability and ventricular systolic synchrony in acute myocardial infarction patients!石家庄050000$河北医科大学第二医院@谷新顺 !石家庄050000$河北医科大学第二医院@傅向华 !石家庄050000$河北医科大学第二医院@马宁

  13. Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey

    Directory of Open Access Journals (Sweden)

    Cha-Nam Shin

    2017-01-01

    Conclusions: The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h. Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier, public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.

  14. Wikis to facilitate patient participation in developing information leaflets: first experiences

    NARCIS (Netherlands)

    Belt, T.H. van de; Faber, M.J.; Knijnenburg, J.M.; Duijnhoven, N.T.L. van; Nelen, W.L.D.M.; Kremer, J.A.M.

    2014-01-01

    OBJECTIVE: Although patients have gained a wealth of experienced based knowledge they are usually not involved in the development of patient information. We sought to determine the technical feasibility of wikis in generating dynamic patient information leaflets with participation from patients and

  15. Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome

    DEFF Research Database (Denmark)

    Storgaard, Filip Holst; Pedersen, Christina Gravgaard; Jensen, Majbritt Lykke

    Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome.......Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome....

  16. Early Palliative Care Improves Patients' Quality of Life

    Science.gov (United States)

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end-of-life ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also leads to ...

  17. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators.

    Directory of Open Access Journals (Sweden)

    Edward J Mills

    2006-11-01

    Full Text Available BACKGROUND: Adherence to highly active antiretroviral therapy (HAART medication is the greatest patient-enabled predictor of treatment success and mortality for those who have access to drugs. We systematically reviewed the literature to determine patient-reported barriers and facilitators to adhering to antiretroviral therapy. METHODS AND FINDINGS: We examined both developed and developing nations. We searched the following databases: AMED (inception to June 2005, Campbell Collaboration (inception to June 2005, CinAhl (inception to June 2005, Cochrane Library (inception to June 2005, Embase (inception to June 2005, ERIC (inception to June 2005, MedLine (inception to June 2005, and NHS EED (inception to June 2005. We retrieved studies conducted in both developed and developing nation settings that examined barriers and facilitators addressing adherence. Both qualitative and quantitative studies were included. We independently, in duplicate, extracted data reported in qualitative studies addressing adherence. We then examined all quantitative studies addressing barriers and facilitators noted from the qualitative studies. In order to place the findings of the qualitative studies in a generalizable context, we meta-analyzed the surveys to determine a best estimate of the overall prevalence of issues. We included 37 qualitative studies and 47 studies using a quantitative methodology (surveys. Seventy-two studies (35 qualitative were conducted in developed nations, while the remaining 12 (two qualitative were conducted in developing nations. Important barriers reported in both economic settings included fear of disclosure, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that are too complicated, number of pills required, decreased quality of life, work and family responsibilities, falling asleep, and access to medication. Important facilitators reported by patients in developed nation settings included having a sense of

  18. Qualitative meta-synthesis of barriers and facilitators that influence the implementation of community pharmacy services: perspectives of patients, nurses and general medical practitioners.

    Science.gov (United States)

    Hossain, Lutfun N; Fernandez-Llimos, Fernando; Luckett, Tim; Moullin, Joanna C; Durks, Desire; Franco-Trigo, Lucia; Benrimoj, Shalom I; Sabater-Hernández, Daniel

    2017-09-05

    The integration of community pharmacy services (CPSs) into primary care practice can be enhanced by assessing (and further addressing) the elements that enable (ie, facilitators) or hinder (ie, barriers) the implementation of such CPSs. These elements have been widely researched from the perspective of pharmacists but not from the perspectives of other stakeholders who can interact with and influence the implementation of CPSs. The aim of this study was to synthesise the literature on patients', general practitioners' (GPs) and nurses' perspectives of CPSs to identify barriers and facilitators to their implementation in Australia. A meta-synthesis of qualitative studies was performed. A systematic search in PubMed, Scopus and Informit was conducted to identify studies that explored patients', GPs' or nurses' views about CPSs in Australia. Thematic synthesis was performed to identify elements influencing CPS implementation, which were further classified using an ecological approach. Twenty-nine articles were included in the review, addressing 63 elements influencing CPS implementation. Elements were identified as a barrier, facilitator or both and were related to four ecological levels: individual patient (n=14), interpersonal (n=24), organisational (n=16) and community and healthcare system (n=9). It was found that patients, nurses and GPs identified elements reported in previous pharmacist-informed studies, such as pharmacist's training/education or financial remuneration, but also new elements, such as patients' capability to follow service's procedures, the relationships between GP and pharmacy professional bodies or the availability of multidisciplinary training/education. Patients, GPs and nurses can describe a large number of elements influencing CPS implementation. These elements can be combined with previous findings in pharmacists-informed studies to produce a comprehensive framework to assess barriers and facilitators to CPS implementation. This framework

  19. Available Tools to Facilitate Early Patient Access to Medicines in the EU and the USA: Analysis of Conditional Approvals and the Implications for Personalized Medicine.

    Science.gov (United States)

    Leyens, Lada; Richer, Étienne; Melien, Øyvind; Ballensiefen, Wolfgang; Brand, Angela

    2015-01-01

    Scientific knowledge and our understanding of the human body and diseases have limited any possible treatment tailoring to each patient. The technological advances enabling the integration of various data sets (e.g. '-omics', microbiome, epigenetics and environmental exposure) have facilitated a greater understanding of the human body, the molecular basis of disease and all the factors influencing disease onset, progression and response to treatment, thereby ushering in the era of personalized medicine. We evaluate the regulatory approaches available to facilitate early patient access to efficacious and safe compounds in the EU and the USA in order to make more informed recommendations in the future as to the gaps in regulations for early patient access. An in-depth analysis of conditional approvals (EU) and accelerated approvals (USA) is performed based on the publicly available information (European public assessment reports and a summary review of products approved under both programmes). The types of product, indications, time to approval and type of evidence submitted were analysed. Between 2007 and early 2015, 17 products were conditionally approved in the EU and 25 in the USA, most of them in the area of oncology and based on evidence from phase II clinical trial data. Early approval of promising products based on data from early phases of development is already possible in the EU and the USA. Some of the improvements could entail implementing a rolling assessment of evidence in Europe and extending the scope of early dialogues.

  20. Editorial: Advances in healthcare provider and patient training to improve the quality and safety of patient care

    Directory of Open Access Journals (Sweden)

    Elizabeth M. Borycki

    2015-09-01

    Full Text Available This special issue of the Knowledge Management & E-Learning: An International Journal is dedicated to describing “Advances in Healthcare Provider and Patient Training to Improve the Quality and Safety of Patient Care.” Patient safety is an important and fundamental requirement of ensuring the quality of patient care. Training and education has been identified as a key to improving healthcare provider patient safety competencies especially when working with new technologies such as electronic health records and mobile health applications. Such technologies can be harnessed to improve patient safety; however, if not used properly they can negatively impact on patient safety. In this issue we focus on advances in training that can improve patient safety and the optimal use of new technologies in healthcare. For example, use of clinical simulations and online computer based training can be employed both to facilitate learning about new clinical discoveries as well as to integrate technology into day to day healthcare practices. In this issue we are publishing papers that describe advances in healthcare provider and patient training to improve patient safety as it relates to the use of educational technologies, health information technology and on-line health resources. In addition, in the special issue we describe new approaches to training and patient safety including, online communities, clinical simulations, on-the-job training, computer based training and health information systems that educate about and support safer patient care in real-time (i.e. when health professionals are providing care to patients. These educational and technological initiatives can be aimed at health professionals (i.e. students and those who are currently working in the field. The outcomes of this work are significant as they lead to safer care for patients and their family members. The issue has both theoretical and applied papers that describe advances in patient

  1. The use of a policy dialogue to facilitate evidence-informed policy development for improved access to care: the case of the Winnipeg Central Intake Service (WCIS).

    Science.gov (United States)

    Damani, Zaheed; MacKean, Gail; Bohm, Eric; DeMone, Brie; Wright, Brock; Noseworthy, Tom; Holroyd-Leduc, Jayna; Marshall, Deborah A

    2016-10-18

    Policy dialogues are critical for developing responsive, effective, sustainable, evidence-informed policy. Our multidisciplinary team, including researchers, physicians and senior decision-makers, comprehensively evaluated The Winnipeg Central Intake Service, a single-entry model in Winnipeg, Manitoba, to improve patient access to hip/knee replacement surgery. We used the evaluation findings to develop five evidence-informed policy directions to help improve access to scheduled clinical services across Manitoba. Using guiding principles of public participation processes, we hosted a policy roundtable meeting to engage stakeholders and use their input to refine the policy directions. Here, we report on the use and input of a policy roundtable meeting and its role in contributing to the development of evidence-informed policy. Our evidence-informed policy directions focused on formal measurement/monitoring of quality, central intake as a preferred model for service delivery, provincial scope, transparent processes/performance indicators, and patient choice of provider. We held a policy roundtable meeting and used outcomes of facilitated discussions to refine these directions. Individuals from our team and six stakeholder groups across Manitoba participated (n = 44), including patients, family physicians, orthopaedic surgeons, surgical office assistants, Winnipeg Central Intake team, and administrators/managers. We developed evaluation forms to assess the meeting process, and collected decision-maker partners' perspectives on the value of the policy roundtable meeting and use of policy directions to improve access to scheduled clinical services after the meeting, and again 15 months later. We analyzed roundtable and evaluation data using thematic analysis to identify key themes. Four key findings emerged. First, participants supported all policy directions, with revisions and key implementation considerations identified. Second, participants felt the policy roundtable

  2. How outpatient palliative care teleconsultation facilitates empathic patient-professional relationships: a qualitative study

    NARCIS (Netherlands)

    Gurp, J.L. van; Selm, M. van; Vissers, K.; Leeuwen, E. van; Hasselaar, J.G.J.

    2015-01-01

    OBJECTIVE: The problems and needs of advanced cancer patients and proxies normally increase as the disease progresses. Home-based advanced cancer patients and their proxies benefit from collaborations between primary care physicians and hospital-based palliative care specialists when confronted with

  3. How outpatient palliative care teleconsultation facilitates empathic patient-professional relationships: a qualitative study

    NARCIS (Netherlands)

    van Gurp, J.; van Selm, M.; Vissers, K.; van Leeuwen, E.; Hasselaar, J.

    2015-01-01

    Objective The problems and needs of advanced cancer patients and proxies normally increase as the disease progresses. Home-based advanced cancer patients and their proxies benefit from collaborations between primary care physicians and hospital-based palliative care specialists when confronted with

  4. Development of a Video Tape Teaching Module To Facilitate the Patient's Understanding of Chemotherapy.

    Science.gov (United States)

    Vernot, Gertrude W.

    A practicum project was conducted to develop a method to enhance the knowledge base of targeted adult cancer patients entering into a treatment plan that included chemotherapy. The educational component necessary for informed consent by the patient had not been consistent; therefore, a videotape was developed containing general information common…

  5. Facilitating care of patients with HIV infection by hospital and primary care teams.

    Science.gov (United States)

    Smits, A; Mansfield, S; Singh, S

    1990-01-01

    To complement the role of primary care teams working with patients with HIV disease and AIDS within greater London and to ease the load on the special hospital units a home support team was developed. It comprises six specialist nurses, a general practitioner trained medical officer, and a receptionist and is funded from regional and district sources and charities. A nurse is available for out of hours and emergency weekend calls, with support from the patient's general practitioner or the attached medical officer. During the first 18 months 249 patients were seen; the mean duration of care was five months. Nearly a third (18/50, 30%) of patients who were terminally ill died at home. The team's activities included practical nursing care, emotional support for carers and patients, and advice and guidance to primary care teams. Problems in providing care in patients' homes included issues relating to confidentiality and 24 hour cover. With the increasing incidence of HIV infection the home support team may be a useful model for care of large numbers of patients with symptomatic HIV disease, especially in large urban areas. PMID:2106936

  6. The Diabetes Literacy and Numeracy Education Toolkit (DLNET): materials to facilitate diabetes education and management in patients with low literacy and numeracy skills.

    Science.gov (United States)

    Wolff, Kathleen; Cavanaugh, Kerri; Malone, Robb; Hawk, Victoria; Gregory, Becky Pratt; Davis, Dianne; Wallston, Kenneth; Rothman, Russell L

    2009-01-01

    Diabetes self-management education is an important component of comprehensive diabetes care. Patients with low health literacy and numeracy may have difficulty translating information from traditional diabetes educational programs and materials into effective self-care. To address this potential barrier to successful diabetes teaching and counseling, the authors developed the Diabetes Literacy and Numeracy Education Toolkit (DLNET). The DLNET is composed of 24 interactive modules covering standard diabetes care topics that can be customized to individual patient needs and used by all members of the multidisciplinary diabetes care team. The material's content and formatting aims to improve the ease of use for diabetes patients with low literacy and numeracy by adhering to a lower text reading level, using illustrations for key concepts, and color-coding and other accommodations to guide patients through instructions for self-care. Individual sections of the DLNET may be provided to patients for initial teaching, as well as for reinforcement. Although designed for lower literacy and numeracy skills, the DLNET provides unique materials to facilitate diabetes education for all patients.

  7. Endobronchial cryotherapy facilitates end-stage treatment options in patients with bronchial stenosis: A case series

    Directory of Open Access Journals (Sweden)

    Gerard J Fitzmaurice

    2014-01-01

    Full Text Available In keeping with international trends, lung cancer incidence and mortality are increasing among the Irish population with many patients presenting with advanced disease that excludes the potential for curative management. Consequently palliative treatment options for this patient group are being increasingly explored with various degrees of success. Endobronchial stenosis represents a particularly challenging area of management among these patients and a number of techniques have been described without the identification of a single gold standard. We report our experience of the first time use of endobronchial cryotherapy in Ireland with reference to a case series, including an example of its use in the management of benign disease, in order to support patients with borderline lung function and enable definitive palliative treatment.

  8. Endobronchial cryotherapy facilitates end-stage treatment options in patients with bronchial stenosis: A case series

    Science.gov (United States)

    Fitzmaurice, Gerard J.; Redmond, Karen C.; Fitzpatrick, David A.; Bartosik, Waldemar

    2014-01-01

    In keeping with international trends, lung cancer incidence and mortality are increasing among the Irish population with many patients presenting with advanced disease that excludes the potential for curative management. Consequently palliative treatment options for this patient group are being increasingly explored with various degrees of success. Endobronchial stenosis represents a particularly challenging area of management among these patients and a number of techniques have been described without the identification of a single gold standard. We report our experience of the first time use of endobronchial cryotherapy in Ireland with reference to a case series, including an example of its use in the management of benign disease, in order to support patients with borderline lung function and enable definitive palliative treatment. PMID:24791176

  9. Endobronchial cryotherapy facilitates end-stage treatment options in patients with bronchial stenosis: A case series.

    LENUS (Irish Health Repository)

    Fitzmaurice, Gerard J

    2014-04-01

    In keeping with international trends, lung cancer incidence and mortality are increasing among the Irish population with many patients presenting with advanced disease that excludes the potential for curative management. Consequently palliative treatment options for this patient group are being increasingly explored with various degrees of success. Endobronchial stenosis represents a particularly challenging area of management among these patients and a number of techniques have been described without the identification of a single gold standard. We report our experience of the first time use of endobronchial cryotherapy in Ireland with reference to a case series, including an example of its use in the management of benign disease, in order to support patients with borderline lung function and enable definitive palliative treatment.

  10. Intra-procedural continuous dialysis to facilitate interventional catheterization in pediatric patients with severe renal failure.

    Science.gov (United States)

    Opina, Angeline D; Qureshi, Athar M; Brewer, Eileen; Elenberg, Ewa; Swartz, Sarah; Michael, Mini; Justino, Henri

    2017-07-12

    Interventional catheterization procedures may be needed for patients with severe renal failure who are dependent on dialysis. To avoid the risk of fluid overload and electrolyte derangement during complex procedures in this oliguric/anuric patient population, we performed intra-procedural dialysis, either continuous renal replacement therapy (CRRT) or continous cycling peritoneal dialysis (CCPD). We performed a retrospective review of a cohort of pediatric patients, ages 0-18 years, with dialysis-dependent renal failure who received CRRT or CCPD during catheterization procedures from January 2013 to March 2016. Eight patients underwent a total of nine interventional catheterization procedures while receiving intra-procedural dialysis. Median age was 4.5 years (range 8 months to 17 years) and weight, 11.6 kg (11.2-62.6 kg). Six patients had end-stage renal disease (ESRD) and two patients had acute kidney injury (AKI), one due to hepatorenal syndrome and one due to multifactorial causes associated with congenital heart disease. The most common reason for catheterization was occlusive venous thrombosis requiring recanalization. CRRT was used during five cases and CCPD during four cases. Median procedure time was 337 min (95-651 min) and median contrast dose 4.2 mL kg(-1) (1.2-8.2 mL kg(-1) ). Euvolemia was maintained based on pre- and post-catheterizations weights, and no significant electrolyte abnormalities occurred based on lab monitoring during and post-procedure. Intra-procedural dialysis using CRRT or CCPD enables even small pediatric patients with severe renal failure to undergo long and complex interventional catheterizations by reducing the risk of fluid overload and electrolyte abnormalities. Collaboration between nephrology, cardiology, and dialysis teams is necessary for successful management of this challenging patient population. © 2017 Wiley Periodicals, Inc.

  11. Barriers and facilitators influencing self-management among COPD patients: a mixed methods exploration in primary and affiliated specialist care

    Directory of Open Access Journals (Sweden)

    Hillebregt CF

    2016-12-01

    Full Text Available Chantal F Hillebregt,1 Auke J Vlonk,1 Marc A Bruijnzeels,1 Onno CP van Schayck,2 Niels H Chavannes3 1Jan van Es Institute (JVEI, Netherlands Expert Center Integrated Primary Care, Almere, 2Department of General Practice, School for Public Health and Primary Care (CAPHRI, Maastricht University Medical Center, Maastricht, 3Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands Abstract: Self-management is becoming increasingly important in COPD health care although it remains difficult to embed self-management into routine clinical care. The implementation of self-management is understood as a complex interaction at the level of patient, health care provider (HCP, and health system. Nonetheless there is still a poor understanding of the barriers and effective facilitators. Comprehension of these determinants can have significant implications in optimizing self-management implementation and give further directions for the development of self-management interventions. Data were collected among COPD patients (N=46 and their HCPs (N=11 in three general practices and their collaborating affiliated hospitals. Mixed methods exploration of the data was conducted and collected by interviews, video-recorded consultations (N=50, and questionnaires on consultation skills. Influencing determinants were monitored by 1 interaction and communication between the patient and HCP, 2 visible and invisible competencies of both the patient and the HCP, and 3 degree of embedding self-management into the health care system. Video observations showed little emphasis on effective behavioral change and follow-up of given lifestyle advice during consultation. A strong presence of COPD assessment and monitoring negatively affects the patient-centered communication. Both patients and HCPs experience difficulties in defining personalized goals. The satisfaction of both patients and HCPs concerning patient centeredness during

  12. Detection of impaired IgG antibody formation facilitates the decision on early immunoglobulin replacement in hypogammaglobulinemic patients

    Directory of Open Access Journals (Sweden)

    Hermann Maximilian Wolf

    2015-02-01

    Full Text Available Hypogammaglobulinemia (serum IgG lower than 2SD below the age-matched mean and clinical symptoms such as increased susceptibility to infection, autoimmune manifestations, granulomatous disease, unexplained polyclonal lymphoproliferation are considered to be diagnostic hallmarks in patients with common variable immunodeficiency (CVID, the most frequent clinically severe primary immunodeficiency syndrome. In the present study we investigated patients with hypogammaglobulinemia and no clinical or immunological signs of defective cell-mediated immunity and differentiated two groups on the basis of their IgG antibody formation capacity against a variety of different antigens (bacterial toxins, polysaccharide antigens, viral antigens. Patients with hypogammaglobulinemia and intact antibody production (HIAP displayed no or only mild susceptibility to infections, while CVID patients showed marked susceptibility to bacterial infections that normalized following initiation of IVIG or SCIG replacement therapy. There was a substantial overlap in IgG serum levels between the asymptomatic HIAP group and the CVID patients examined before immunoglobulin treatment. HIAP patients showed normal levels of switched B memory cells (CD19+CD27+IgD-, while both decreased and normal levels of switched B memory cells could be found in CVID patients. IgG antibody response to a primary antigen, tick borne encephalitis virus (TBEV, was defective in CVID patients, thus confirming their substantial defect in IgG antibody production. Defective IgG antibody production against multiple antigens could also be demonstrated in an adult patient with recurrent infections but normal IgG levels. To facilitate early treatment before recurrent infections may lead to organ damage the antibody formation capacity should be examined in hypogammaglobulinemic patients and the decision to treat should be based on the finding of impaired IgG antibody production.

  13. Development of a web-based pharmaceutical care plan to facilitate collaboration between healthcare providers and patients

    Directory of Open Access Journals (Sweden)

    Marlies ME Geurts

    2014-02-01

    Full Text Available Background To facilitate collaboration between different healthcare providers and to exchange patient data we developed a paper-based tool, which also enabled to plan interventions and follow-up activities: the PCP. Interviews with participating healthcare providers concluded the PCP was a very useful tool to collect and share patient data. A disadvantage was the time spent to collect all information. We therefore developed our PCP into a web-based tool: the web-based PCP (W-PCP.Objectives Development of a W-PCP to (1 provide healthcare providers with information from pharmacist- and GP computer systems and (2 facilitate collaboration between healthcare providers and patients.Method The W-PCP was used in three research lines, two in primary care and one in a hospital setting. Outcomes measures were defined as satisfaction about efficiency and effectiveness during data sharing and documentation in providing care and conducting medication reviews using the W-PCP.First experiences concerning the use of W-PCP in a primary care setting were collected by a questionnaire and interviews with pharmacists and GPs using the W-PCP.Results A questionnaire was sent to 38 healthcare providers. 17 healthcare providers returned the questionnaire. The use of W-PCP resulted in positive experiences from participating healthcare providers. On the basis of experiences and requirements collected, the application will be further developed.Conclusions The W-PCP application can potentially support successful collaboration between different healthcare providers and patients, which is important for medication therapy management. With this application, a successful collaboration between different healthcare providers and patients could be achieved.

  14. Interprofessional Collaborative Practice to Improve Patient Outcomes: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Jennifer Styron

    2014-06-01

    Full Text Available This project focused on a pilot project implemented during the 2013-2014 academic year. The overall purpose was to facilitate interprofessional collaborative practice innovations through the development of leadership, core competencies, and the use of technology, especially among nurses. Nursing, medicine, and physician assistant students were educated on the IOM competencies for interprofessional teams and the core competencies identified by the Interprofessional Education Collaborative Expert Panel [1] to develop knowledge, skills, and attitudes needed to practice in the collaborative practice environments. The project addressed four goals: Develop faculty expertise and leadership in interprofessional collaborative practice to provide a current, high quality education to nursing, physician assistant, and medical students; Implement a culturally responsive and respectful collaborative interprofessional practice curriculum to prepare nurses, physician assistants, and medical students to deliver high quality, efficient, team-based care in a dynamically evolving environment; Focus interprofessional collaborative practice education on models and practices that lead to improvement in patient outcomes; and Evaluate the program and disseminate best practices. Findings from this pilot include strategies to engage different health professions' students and faculty, partnering with community agencies, building an effective interprofessional team to guide the project, and seeking funding for extension and expansion of the offerings.

  15. Interprofessional Collaborative Practice to Improve Patient Outcomes: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Jennifer Styron

    2014-10-01

    Full Text Available This project focused on a pilot project implemented during the 2013-2014 academic year. The overall purpose was to facilitate interprofessional collaborative practice innovations through the development of leadership, core competencies, and the use of technology, especially among nurses. Nursing, medicine, and physician assistant students were educated on the IOM competencies for interprofessional teams and the core competencies identified by the Interprofessional Education Collaborative Expert Panel [1] to develop knowledge, skills, and attitudes needed to practice in the collaborative practice environments. The project addressed four goals: Develop faculty expertise and leadership in interprofessional collaborative practice to provide a current, high quality education to nursing, physician assistant, and medical students; Implement a culturally responsive and respectful collaborative interprofessional practice curriculum to prepare nurses, physician assistants, and medical students to deliver high quality, efficient, team-based care in a dynamically evolving environment; Focus interprofessional collaborative practice education on models and practices that lead to improvement in patient outcomes; and Evaluate the program and disseminate best practices. Findings from this pilot include strategies to engage different health professions' students and faculty, partnering with community agencies, building an effective interprofessional team to guide the project, and seeking funding for extension and expansion of the offerings.

  16. Facilitating patient self-management through telephony and web technologies in seasonal influenza

    Directory of Open Access Journals (Sweden)

    Zsolt Nagykaldi

    2010-03-01

    Conclusions Primary care patients and their clinicians can adopt and successfully utilise influenza self-management technologies. Our pilot study suggests that web resources combined with telephony technology are feasible to set up and easy to use in primary care settings.

  17. Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) protocol: testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomised trial with an embedded process evaluation and cost analysis.

    Science.gov (United States)

    Bucknall, Tracey K; Harvey, Gill; Considine, Julie; Mitchell, Imogen; Rycroft-Malone, Jo; Graham, Ian D; Mohebbi, Mohammadreza; Watts, Jennifer; Hutchinson, Alison M

    2017-07-11

    Vital signs are the primary indicator of physiological status and for determining the need for urgent clinical treatment. Yet, if physiological signs of deterioration are missed, misinterpreted or mismanaged, then critical illness, unplanned intensive care admissions, cardiac arrest and death may ensue. Although evidence demonstrates the benefit of early recognition and management of deteriorating patients, failure to escalate care and manage deteriorating patients remains a relatively frequent occurrence in hospitals. A pragmatic cluster-randomised controlled trial design will be used to measure clinical effectiveness and cost of a facilitation intervention to improve nurses' vital sign measurement, interpretation, treatment and escalation of care for patients with abnormal vital signs. A cost consequence analysis will evaluate the intervention cost and effectiveness, and a process evaluation will determine how the implementation of the intervention contributes to outcomes. We will compare clinical outcomes and costs from standard implementation of clinical practice guidelines (CPGs) to facilitated implementation of CPGs. The primary outcome will be adherence to the CPGs by nurses, as measured by escalation of care as per organisational policy. The study will be conducted in four Australian major metropolitan teaching hospitals. In each hospital, eight to ten wards will be randomly allocated to intervention and control groups. Control wards will receive standard implementation of CPGs, while intervention wards will receive standard CPG implementation plus facilitation, using facilitation methods and processes tailored to the ward context. The intervention will be administered to all nursing staff at the ward level for 6 months. At each hospital, two types of facilitators will be provided: a hospital-level facilitator as the lead; and two ward-level facilitators for each ward. This study uses an innovative, networked approach to facilitation to enable uptake of

  18. Improving Visual Acuity of Myopes through Operant Training: The Evaluation of Psychological and Physiological Mechanisms Facilitating Acuity Enhancement

    Science.gov (United States)

    1988-12-01

    covert servo-controlled tracking optometer (Cornsweet & Crane, 1970) that made the near-instantaneous feedback of monocular accommodative state possible...and Crane infrared- optometer measures of accommodation into auditory tones that reflected the instantaneous refractive state of the eye. While an...performance change might as well have been facilitated by blur interpretation. Nonobtrusive incorporation of a covert tracking optometer (Cornsweet & Crane

  19. High-resolution melting facilitates mutation screening of PYGM in patients with McArdle disease

    DEFF Research Database (Denmark)

    Duno, M.; Quinlivan, R.; Vissing, J.

    2009-01-01

    variations. Thirteen of these are pathogenic, and three were classified as polymorphisms. Nine variations had not previously been described. One of the novel mutations, c.2430C > T, was initially predicted to result in a silent G810G change, but cDNA analysis demonstrated that the mutation led to abnormal m......Mutations in PYGM, encoding the muscle-specific glycogen phosphorylase (myophosphorylase), are responsible for McArdle disease. Among Caucasians, a large proportion of patients are homozygous for the R50X mutation, but other mutations can affect all the 20 exons of PYGM, making mutation detection...... laborious. We have developed a high-resolution melting (HRM) assay for mutation detection in PYGM. Twelve McArdle patients were investigated, in whom pre-screening had ruled out homozygosity or compound heterozygosity for the two common G205S and R50X mutations. In total, we identified 16 different...

  20. Facilitative effects of bi-hemispheric tDCS in cognitive deficits of Parkinson disease patients.

    Science.gov (United States)

    Leite, Jorge; Gonçalves, Oscar F; Carvalho, Sandra

    2014-02-01

    Parkinson's disease (PD) is a progressive neurodegenerative disorder, primarily characterized by motor symptoms such as tremor, rigidity, bradykinesia, stiffness, slowness and impaired equilibrium. Although the motor symptoms have been the focus in PD, slight cognitive deficits are commonly found in non-demented and non-depressed PD patients, even in early stages of the disease, which have been linked to the subsequent development of pathological dementia. Thus, strongly reducing the quality of life (QoL). Both levodopa therapy and deep brain stimulation (DBS) have yield controversial results concerning the cognitive symptoms amelioration in PD patients. That does not seems to be the case with transcranial direct current stimulation (tDCS), although better stimulation parameters are needed. Therefore we hypothesize that simultaneously delivering cathodal tDCS (or ctDCS), over the right prefrontal cortex delivered with anodal tDCS (or atDCS) to left prefrontal cortex could be potentially beneficial for PD patients, either by mechanisms of homeostatic plasticity and by increases in the extracellular dopamine levels over the striatum.

  1. Beyond consent--improving understanding in surgical patients.

    LENUS (Irish Health Repository)

    Mulsow, Jürgen J W

    2012-01-01

    Little is known of the actual understanding that underlies patient choices with regard to their surgical treatment. This review explores current knowledge of patient understanding and techniques that may be used to improve this understanding.

  2. Measuring and Facilitating Client Engagement with Financial Incentives: Implications for Improving Clinical Outcomes in a Mental Health Setting.

    Science.gov (United States)

    Kotwicki, Raymond J; Balzer, Alexandra M; Harvey, Philip D

    2016-09-26

    Significant numbers of individuals with severe mental illnesses are difficult to engage in treatment services, presenting challenges for care. To be able to assess the relationship between engagement and discharge outcomes, we modified the "Milestones of Recovery Scale". This scale was modified for content to match the current clinical setting, evaluated for inter-rater reliability after modification in a sample of 233 cases receiving psychiatric rehabilitation, and then was administered to 423 additional psychiatric rehabilitation clients over a 24-month study period. In an effort to determine whether provision of financial incentives lead to sustained increases in client engagement, a cut off for client eligibility for financial incentives was evaluated on the basis of the reliability study and the course of engagement was related to receipt of this incentive and successful completion of treatment in a new sample of 423 patients. Of this sample, 78 % received an initial financial incentive during treatment (were initially engaged), and 93.3 % of that subgroup sustained this level of engagement it over their entire course of treatment. Of the 22 % of cases not receiving an initial incentive, only 5.4 % improved in their engagement to levels required for the incentive. Longitudinal analysis demonstrated that individuals who maintained or increased their level of engagement over time were more likely to complete treatment in accordance with planned treatment goals. The initial engagement and the course of engagement in treatment predicted successful completion, but incentives did not lead to increased engagement in initially poorly engaged patients. These data are interpreted in terms of the likely success of extrinsic rewards to increase engagement in mental health services.

  3. Nursing role to improve care to infarct patients and patients undergoing heart surgery: 10 years' experience.

    Science.gov (United States)

    Wit, M A M; Bos-Schaap, A J C M; Hautvast, R W M; Heestermans, A A C M; Umans, V A W M

    2012-01-01

    The nurse practitioner may be the ideal healthcare worker to create a new environment and may facilitate in the process of expediting discharge and improving patient safety. They can play an intermediary role between the consultants, nurses and patients, thereby combining the aspects of care (nursing) and cure (physicians). We describe the contribution and role of the nurse practitioner in a teaching hospital and provide an overview of the changes in care and cure that were facilitated by two nurse practitioners in the treatment of cardiac surgery patients or non-complicated acute coronary syndrome patients. The nurse-led clinic for postoperative patients has registered 1967 patients in the past 10 years. These patients were transferred at a mean of 5.5 days after their bypass operation. All patients had an uneventful clinical course in our hospital and were discharged alive. The period between discharge and outpatient clinic visit could be set at 4 weeks. The post-acute coronary syndrome (ACS) group included 1236 patients. Mortality in this patient cohort was 4% while 0.4% of these patients experienced a re-myocardial infarction. Additional surgery was needed in only 2% of these stable post-infarction patients. The mean length of stay was 5.9 ± 14.5 days. This observational study confirms that a nurse-led postoperative care unit and post-ACS care unit is feasible and effective for the treatment of patients returning from cardiac surgery or transferred after uncomplicated ACS to a general cardiology ward.

  4. Look Through Patients' Eyes to Improve the Delivery of Care.

    Science.gov (United States)

    2016-07-01

    By developing and implementing a method for seeing the healthcare experience from the standpoint of patients and family members, the University of Pittsburgh Medical Center has improved care delivery, lowered costs, and improved patient satisfaction. Cross-functional, multidisciplinary teams use a six-step patient and family-centered care methodology to identify gaps and develop changes that will improve the patient experience and clinical outcomes. Committee members shadow patients and family members to get firsthand knowledge about what they are going through and what goes wrong and what goes right. The teams proposed minor and major changes, but none involve adding more staff and few involve more expenditures.

  5. Improved patient selection by stratified surgical intervention

    DEFF Research Database (Denmark)

    Wang, Miao; Bünger, Cody E; Li, Haisheng

    2015-01-01

    BACKGROUND CONTEXT: Choosing the best surgical treatment for patients with spinal metastases remains a significant challenge for spine surgeons. There is currently no gold standard for surgical treatments. The Aarhus Spinal Metastases Algorithm (ASMA) was established to help surgeons choose...... of the spinal metastases. This algorithm could help spine surgeons to discriminate the risks of surgeries. The ASMA provides a tool to guild surgeons to evaluate the spinal metastases patients, select potential optimal surgery, and avoid life-threatening risks....

  6. Advance care planning uptake among patients with severe lung disease: a randomised patient preference trial of a nurse-led, facilitated advance care planning intervention

    Science.gov (United States)

    Sinclair, Craig; Auret, Kirsten Anne; Evans, Sharon Frances; Williamson, Fiona; Dormer, Siobhan; Greeve, Kim; Koay, Audrey; Price, Dot; Brims, Fraser

    2017-01-01

    Objective Advance care planning (ACP) clarifies goals for future care if a patient becomes unable to communicate their own preferences. However, ACP uptake is low, with discussions often occurring late. This study assessed whether a systematic nurse-led ACP intervention increases ACP in patients with advanced respiratory disease. Design A multicentre open-label randomised controlled trial with preference arm. Setting Metropolitan teaching hospital and a rural healthcare network. Participants 149 participants with respiratory malignancy, chronic obstructive pulmonary disease or interstitial lung disease. Intervention Nurse facilitators offered facilitated ACP discussions, prompted further discussions with doctors and loved ones, and assisted participants to appoint a substitute medical decision-maker (SDM) and complete an advance directive (AD). Outcome measures The primary measure was formal (AD or SDM) or informal (discussion with doctor) ACP uptake assessed by self-report (6 months) and medical notes audit. Secondary measures were the factors predicting baseline readiness to undertake ACP, and factors predicting postintervention ACP uptake in the intervention arm. Results At 6 months, formal ACP uptake was significantly higher (p<0.001) in the intervention arm (54/106, 51%), compared with usual care (6/43, 14%). ACP discussions with doctors were also significantly higher (p<0.005) in the intervention arm (76/106, 72%) compared with usual care (20/43, 47%). Those with a strong preference for the intervention were more likely to complete formal ACP documents than those randomly allocated. Increased symptom burden and preference for the intervention predicted later ACP uptake. Social support was positively associated with ACP discussion with loved ones, but negatively associated with discussion with doctors. Conclusions Nurse-led facilitated ACP is acceptable to patients with advanced respiratory disease and effective in increasing ACP discussions and completion

  7. Aerobic training for improved memory in patients with stress-related exhaustion

    DEFF Research Database (Denmark)

    Eskilsson, Therese; Slunga Järvholm, Lisbeth; Malmberg Gavelin, Hanna

    2017-01-01

    oxygen uptake and episodic memory performance. No additional improvement in burnout, depression or anxiety was observed in the aerobic group compared with controls. CONCLUSION: Aerobic training at a moderate-vigorous intensity within a multimodal rehabilitation program for patients with exhaustion...... was cognitive function, and secondary outcome measures were psychological health variables and aerobic capacity. RESULTS: In total, 51% patients in the aerobic training group and 78% patients in the control group completed the intervention period. The aerobic training group significantly improved in maximal...... disorder facilitated episodic memory. A future challenge would be the clinical implementation of aerobic training and methods to increase feasibility in this patient group. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03073772 . Retrospectively registered 21 February 2017....

  8. What Facilitates "Patient Empowerment" in Cancer Patients During Follow-Up: A Qualitative Systematic Review of the Literature.

    Science.gov (United States)

    Jørgensen, Clara R; Thomsen, Thora G; Ross, Lone; Dietz, Susanne M; Therkildsen, Signe; Groenvold, Mogens; Rasmussen, Charlotte L; Johnsen, Anna T

    2017-07-01

    Empowerment is a concept of growing importance in cancer care, but little is known about cancer patients' experiences of empowerment during follow-up. To explore this area, a qualitative systematic literature review was conducted in PubMed, CINAHL, and PsycINFO. A total of 2,292 papers were identified and 38 articles selected and included in the review. The thematic synthesis of the papers resulted in seven analytical themes being identified: empowerment as an ongoing process, knowledge is power, having an active role, communication and interaction between patients and health care professionals, support from being in a group, religion and spirituality, and gender. Very few articles explicitly explored the empowerment of cancer patients during follow-up, and the review identified a lack of attention to patients' own understandings of empowerment, a lack of specific focus on empowerment during follow-up, and insufficient attention to collective empowerment, as well as ethnic, social, and gender differences.

  9. Patient-Centered Care Transition for Patients Admitted through the ED: Improving Patient and Employee Experience

    Directory of Open Access Journals (Sweden)

    Andrea Algauer BSN, RN

    2015-05-01

    Full Text Available With increasing wait times in emergency departments (ED across America, there is a need to streamline the inpatient admission process in order to decrease wait times and more important, to increase patient and employee satisfaction. One inpatient unit at New York-Presbyterian Weill Cornell Medical Center initiated a program to help expedite the inpatient admission process from the ED. The goal of the ED Bridge program is to ease the patient's transition from the ED to an inpatient unit by visiting the patient in the ED and introducing and setting expectations for the inpatient environment (i.e. telemetry alarms, roommates, hourly comfort rounds. Along with improving the patient experience, this program intends to improve the collaboration between ED nurses and inpatient nurses. With the continued support of our nurse management, hospital administrators and most important, our staff, this concept is aimed to increase patient satisfaction scores and subsequently employee satisfaction.

  10. "The group facilitates everything": meanings patients with type 2 diabetes mellitus assigned to health education groups.

    Science.gov (United States)

    de Melo, Lucas Pereira; de Campos, Edemilson Antunes

    2014-01-01

    to interpret the meanings patients with type 2 diabetes mellitus assign to health education groups. ethnographic study conducted with Hyperdia groups of a healthcare unit with 26 informants, with type 2 diabetes mellitus, and having participated in the groups for at least three years. Participant observation, social characterization, discussion groups and semi-structured interviews were used to collect data. Data were analyzed through the thematic coding technique. four thematic categories emerged: ease of access to the service and healthcare workers; guidance on diabetes; participation in groups and the experience of diabetes; and sharing knowledge and experiences. The most relevant aspect of this study is the social use the informants in relation to the Hyperdia groups under study. the studied groups are agents producing senses and meanings concerning the process of becoming ill and the means of social navigation within the official health system. We expect this study to contribute to the actions of healthcare workers coordinating these groups given the observation of the cultural universe of these individuals seeking professional care in the various public health care services.

  11. "The group facilitates everything": meanings patients with type 2 diabetes mellitus assigned to health education groups

    Directory of Open Access Journals (Sweden)

    Lucas Pereira de Melo

    2014-12-01

    Full Text Available OBJECTIVE: to interpret the meanings patients with type 2 diabetes mellitus assign to health education groups.METHOD: ethnographic study conducted with Hyperdia groups of a healthcare unit with 26 informants, with type 2 diabetes mellitus, and having participated in the groups for at least three years. Participant observation, social characterization, discussion groups and semi-structured interviews were used to collect data. Data were analyzed through the thematic coding technique.RESULTS: four thematic categories emerged: ease of access to the service and healthcare workers; guidance on diabetes; participation in groups and the experience of diabetes; and sharing knowledge and experiences. The most relevant aspect of this study is the social use the informants in relation to the Hyperdia groups under study.CONCLUSION: the studied groups are agents producing senses and meanings concerning the process of becoming ill and the means of social navigation within the official health system. We expect this study to contribute to the actions of healthcare workers coordinating these groups given the observation of the cultural universe of these individuals seeking professional care in the various public health care services.

  12. Improving patient safety culture in general practice: An interview study

    NARCIS (Netherlands)

    N.J. Verbakel (Natasha J.); A.A. de Bont (Antoinette); T.J. Verheij; C. Wagner (Cordula); D.L.M. Zwart (Dorien Lyd Marieke)

    2015-01-01

    textabstractBackground When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an interventio

  13. Applying athletic principles to medical rounds to improve teaching and patient care.

    Science.gov (United States)

    Southwick, Frederick; Lewis, Michelle; Treloar, Dina; Cherabuddi, Kartikeya; Radhakrishnan, Nila; Leverence, Robert; Han, Xiaoxia; Cottler, Linda

    2014-07-01

    Teaching hospital multidisciplinary work rounds are often inefficient, delaying the completion of patient care tasks and detracting from teaching. Participants often act as working groups rather than interdependent teams. Athletic principles were used to train multidisciplinary rounding teams to adopt the systems used by manufacturing to improve the efficiency and quality of patient care, as well as teamwork and didactic teaching. Experimental groups of general medical rounding teams-faculty member, house staff, medical students, bedside nurses, pharmacists, and a case manager-were introduced to individual job descriptions (playbooks), key customer-supplier relation ships, and efficient communication protocols, accompanied by weekly feed back (game films). A two-phase pilot 11-month prospective trial (February to July 2009 and September 2011 to January 2012) compared the experimental and control rounding teams on the basis of length of stay, 30-day readmission rates, and physician, student, and patient satisfaction. These interventions resulted in a 30% reduction in 30-day readmissions and, in the 2011-2012 phase, an 18% shorter length of stay. Anonymous surveys documented greater satisfaction of faculty, residents, and medical students, and student ratings of teaching were markedly improved. Patient satisfaction did not change. The new rounding system has the potential to reduce waste and improve the quality of patient care while improving caregiver satisfaction and medical student teaching. Adaptive leadership skills will be required to overcome resistance to change. The use of athletic analogies can improve teamwork and facilitate the adoption of a systems approach to the delivery of patient care.

  14. Using standardized insulin orders to improve patient safety in a tertiary care centre.

    Science.gov (United States)

    Doyle, Mary-Anne; Brez, Sharon; Sicoli, Silvana; De Sousa, Filomena; Keely, Erin; Malcom, Janine C

    2014-04-01

    To standardize insulin prescribing practices for inpatients, improve management of hypoglycemia, reduce reliance on sliding scales, increase use of basal-bolus insulin and improve patient safety. Patients with diabetes were admitted to 2 pilot inpatient units followed by corporate spread to all insulin-treated patients on noncritical care units in a Canadian tertiary care multicampus teaching hospital. Standardized preprinted insulin and hypoglycemia management orders, decision support tools and multidisciplinary education strategies were developed, tested and implemented by way of the Model for Improvement and The Ottawa Model for Research Process. Clinical and balance measures were evaluated through statistical process control. Patient safety was improved through a reduction in hypoglycemia and decreased dependence on correctional scales. Utilization of the preprinted orders approached the target of 70% at the end of the test period and was sustained at 89% corporately 3 years post-implementation. The implementation of a standardized, preprinted insulin order set facilitates best practices for insulin therapy, improves patient safety and is highly supported by treating practitioners. The utilization of formal quality-improvement methodology promoted efficiency, enhanced sustainability, increased support among clinicians and senior administrators, and was effective in instituting sustained practice change in a complex care centre. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  15. Improving patient participation in a challenging context: a 2-year evaluation study of an implementation project.

    Science.gov (United States)

    Jangland, Eva; Gunningberg, Lena

    2017-05-01

    To evaluate an implementation project on patient participation. Patient participation is one of the cornerstones of person-centred care. A previous intervention study resulted in improved patient participation in a surgical department in a large university hospital in Sweden. A subsequent implementation project was guided by the PARiSH framework and included several strategies over 2 years. Patients (n = 198) in five units completed a questionnaire and nurse managers (n = 5) were interviewed. Although the long-term implementation project did not improve patient participation in the units, the nurse managers described a changing culture in which staff grew to accept patients' involvement in their own care. Several barriers to change and sustainability were acknowledged. Improving patient participation in a busy environment is challenging. The framework was useful in the different steps of the project. In the future, the interrelationship of the core elements needs to be analysed in an ongoing and deeper way to allow both prediction and prevention of barriers to improvement. A dedicated leadership together with skilled facilitators should encourage and support staff to reflect on their attitudes and ways of working to increase person-centred care. © 2017 John Wiley & Sons Ltd.

  16. The use of balloon atrial septostomy to facilitate difficult transseptal access in patients undergoing catheter ablation for atrial fibrillation.

    Science.gov (United States)

    Zadeh, Andrew A; Cannom, David S; Macrum, Bruce L; Ho, Ivan C

    2011-07-01

    With the increasing number of patients undergoing repeat catheter ablation procedures for atrial fibrillation, it is not uncommon to encounter a fibrotic interatrial septum that resists the conventional manual advancement of the transseptal sheath. Forceful advancement of the transseptal apparatus can reduce fine control and potentially lead to a higher rate of perforation. We report a case where adjunctive balloon atrial septostomy was used to facilitate transseptal access in a patient with fibrotic interatrial septum. Using a small-caliber angioplasty balloon and under direct fluoroscopic and transesophageal echocardiogram visualization, balloon septostomy was performed with hand inflation until a "waist" was seen. This technique provides a safe way to control the size of the transseptal access created, and allows the passage of a relatively soft-tipped transseptal sheath across a resistive septum. To our knowledge this is the first published use of balloon atrial septostomy during transseptal puncture for left atrium access in a catheter ablation procedure. Balloon atrial septostomy should be considered as an alternative technique for safe transseptal cannulation in select patients in the electrophysiology laboratory or other interventional procedures requiring left atrial access or delivery of large-caliber catheters or sheaths. © 2010 Wiley Periodicals, Inc.

  17. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    Science.gov (United States)

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

  18. Improving patient-centredness in partnership with female patients: a cluster RCT in fertility care

    NARCIS (Netherlands)

    Huppelschoten, A.G.; Nelen, W.L.D.M.; Westert, G.P.; Golde, R.J.T. van; Adang, E.M.M.; Kremer, J.A.M.

    2015-01-01

    QUESTION: What is the effect of a multifaceted intervention with participation of patients on improvement of patient-centredness in fertility care? SUMMARY ANSWER: A multifaceted intervention with participation of patients did not improve total patient-centredness scores provided by women in fertili

  19. Regional anesthesia for the trauma patient: improving patient outcomes

    OpenAIRE

    Gadsden J; Warlick A

    2015-01-01

    Jeff Gadsden, Alicia Warlick Department of Anesthesiology, Duke University, Durham, NC, USA Abstract: Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional...

  20. Involving patients in care decisions improves satisfaction: an outcomes-based quality improvement project.

    Science.gov (United States)

    Leff, Ellen W

    2004-05-01

    A home care agency used quality improvement processes to improve patient satisfaction survey ratings. The focus was on involving patients in decisions about their care. A multidisciplinary team developed creative strategies to increase staff awareness and enhance customer service skills, which had dramatic results.

  1. Readability of patient information can be improved

    DEFF Research Database (Denmark)

    Pilegaard, Morten; Ravn, Hanne Berg

    2012-01-01

    Introduction: The number of participants in medical experiments has declined and consent often rests on perilous ground because the participant information sheet (PIS) on which informed consent rests preserves identification with the expert environment. This study explores to which extent research...... ethics committee (REC) members appreciate this problem. Material and methods: A retrospective analysis of ten REC applications were subjected to a naïve reading followed by structural analysis to generate themes and subthemes to guide structured REC member focus-group interviews. This analysis informed...... anatomy and physiology, diagnostic procedures and medicines. Contents problems centred on irrelevant and superfluous information and poor presentation. Conclusion: The language, structure and format of the PIS should be improved. Avoiding technical jargon or explaining it when it is used, using more...

  2. [Strategies for patient participation in continuing improvement of clinical safety].

    Science.gov (United States)

    Saturno, Pedro J

    2009-06-01

    Strategies for patient participation in quality improvement, as an active part of processes or providing relevant information when asked, have progressed to a great extent for the last few years, influenced by the emphasis on patient-focused care as a key dimension for quality and, lately, by the emphasis on patient safety -a dimension for which the patient contribution can not be ignored. However, these strategies have not been fully implemented and used in most quality management systems. This article aims to make it easier to select the appropriate strategies for a given context, by describing them, grouped in three main themes (mobilising patients for patient safety; promoting active participation of patients in the prevention of safety incidents; requesting and using the relevant information for quality improvement that patients can provide), illustrating them with examples, and pointing out some of the obstacles for implementing them.

  3. An interactive web-based learning unit to facilitate and improve intrapartum nursing care of nursing students.

    Science.gov (United States)

    Gerdprasert, Sailom; Pruksacheva, Tassanee; Panijpan, Bhinyo; Ruenwongsa, Pintip

    2011-07-01

    First clinical exposures are stressful situations for nursing students, especially, when practicing on the labour ward. The purpose of this study was to develop intrapartum nursing care web-based learning to facilitate students' acquisition of conceptual knowledge and performance skills. This web-based learning unit integrated the 5E-model and information technology with the lecture content. Eighty four nursing students were recruited in the study. The control group received traditional teaching, while the experimental group was supplemented with the web-based learning unit on intrapartum nursing care. The results showed that the students in the experimental group had significant higher scores in conceptual knowledge and performance skill. The students also had significant lower scores in ignorance - related stress when compared to those of the control group. The students supplemented with the web-based course showed a strong positive attitude toward the new learning method.

  4. Health information technology to facilitate communication involving health care providers, caregivers, and pediatric patients: a scoping review.

    Science.gov (United States)

    Gentles, Stephen James; Lokker, Cynthia; McKibbon, K Ann

    2010-06-18

    Pediatric patients with health conditions requiring follow-up typically depend on a caregiver to mediate at least part of the necessary two-way communication with health care providers on their behalf. Health information technology (HIT) and its subset, information communication technology (ICT), are increasingly being applied to facilitate communication between health care provider and caregiver in these situations. Awareness of the extent and nature of published research involving HIT interventions used in this way is currently lacking. This scoping review was designed to map the health literature about HIT used to facilitate communication involving health care providers and caregivers (who are usually family members) of pediatric patients with health conditions requiring follow-up. Terms relating to care delivery, information technology, and pediatrics were combined to search MEDLINE, EMBASE, and CINAHL for the years 1996 to 2008. Eligible studies were selected after three rounds of duplicate screening in which all authors participated. Data regarding patient, caregiver, health care provider, HIT intervention, outcomes studied, and study design were extracted and maintained in a Microsoft Access database. Stage of research was categorized using the UK's Medical Research Council (MRC) framework for developing and evaluating complex interventions. Quantitative and qualitative descriptive summaries are presented. We included 104 eligible studies (112 articles) conducted in 17 different countries and representing 30 different health conditions. The most common conditions were asthma, type 1 diabetes, special needs, and psychiatric disorder. Most studies (88, 85%) included children 2 to 12 years of age, and 73 (71%) involved home care settings. Health care providers operated in hospital settings in 96 (92%) of the studies. Interventions featured 12 modes of communication (eg, Internet, intranets, telephone, video conferencing, email, short message service [SMS], and

  5. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    Science.gov (United States)

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  6. The promise of multimedia technology for STI/HIV prevention: frameworks for understanding improved facilitator delivery and participant learning.

    Science.gov (United States)

    Khan, Maria R; Epperson, Matthew W; Gilbert, Louisa; Goddard, Dawn; Hunt, Timothy; Sarfo, Bright; El-Bassel, Nabila

    2012-10-01

    There is increasing excitement about multimedia sexually transmitted infection (STI) and HIV prevention interventions, yet there has been limited discussion of how use of multimedia technology may improve STI/HIV prevention efforts. The purpose of this paper is to describe the mechanisms through which multimedia technology may work to improve the delivery and uptake of intervention material. We present conceptual frameworks describing how multimedia technology may improve intervention delivery by increasing standardization and fidelity to the intervention material and the participant's ability to learn by improving attention, cognition, emotional engagement, skills-building, and uptake of sensitive material about sexual and drug risks. In addition, we describe how the non-multimedia behavioral STI/HIV prevention intervention, Project WORTH, was adapted into a multimedia format for women involved in the criminal justice system and provide examples of how multimedia activities can more effectively target key mediators of behavioral change in this intervention.

  7. Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study

    OpenAIRE

    Odusola, A.O.; Hendriks, M.; Schultsz, C; Bolarinwa, O.A.; Akande, T.; Osibogun, A.; Agyemang, C; G. Ogedegbe; Agbede, K.; Adenusi, P.; Lange, J; van Weert, H.; Stronks, K; Haafkens,J A

    2014-01-01

    Background Universal health care coverage has been identified as a promising strategy for improving hypertension treatment and control rates in sub Saharan Africa (SSA). Yet, even when quality care is accessible, poor adherence can compromise treatment outcomes. To provide information for adherence support interventions, this study explored what low income patients who received hypertension care in the context of a community based health insurance program in Nigeria perceive as inhibitors and...

  8. Facilitating change and adaptation: the experiences of current and bereaved carers of patients with severe chronic obstructive pulmonary disease.

    Science.gov (United States)

    Philip, Jennifer; Gold, Michelle; Brand, Caroline; Miller, Belinda; Douglass, Jo; Sundararajan, Vijaya

    2014-04-01

    Patients with severe chronic obstructive pulmonary disease (COPD) experience substantial symptom burden, psychological and social morbidity. The experience of this illness has an impact beyond the patient. This study seeks to understand the experiences and needs of family carers of people with severe COPD. Semistructured interviews were held with current and bereaved carers of people with severe COPD. Several areas of content were targeted in the interviews, including the experience of caring for someone with COPD, views of treatment and prognosis, information and communication needs, and the understanding of palliative care. Data were analyzed thematically. The carers' and bereaved carers' experiences and needs around COPD are best understood as a dynamic of change, recognition, and adaptation. Carers faced many changes as the patients' general condition deteriorated. These were changes in the nature of caring tasks, in their relationships, and their own expectations. Carers usually recognized change had happened and sought to adapt through new approaches, new equipment, a new stance of thinking, and in most cases, continued caring. Within this theme of change, recognition, and adaptation were a series of subthemes: (1) the impact of caring, (2) recognizing the role of the carer, and (3) the needs of the carer including their needs from palliative care services. The impact of caring borne by family carers is substantial and life changing. Health professionals may assist carers in their role through acknowledgement, facilitating recognition of the changes that have occurred (and their implications), and enabling creative adaptive responses for carers. Such assistance is likely to enhance the ability of carers to continue in this demanding role.

  9. Role of the clinical nurse specialist in improving patient outcomes after cardiac surgery.

    Science.gov (United States)

    Soltis, Lisa M

    2015-01-01

    Health care reform continues to focus on improving patient outcomes while reducing costs. Clinical nurse specialists (CNSs) should facilitate this process to ensure that best practice standards are used and patient safety is enhanced. One example of ensuring best practices and patient safety is early extubation after open heart surgery, which is a critical component of fast track protocols that reduces may reduce the development of pulmonary complications in the postoperative period while decreasing overall length of stay in the hospital. This project was an interdisciplinary endeavor, led by the CNS and nurse manager, which combined early extubation protocols with enhanced rounding initiatives to help decrease overall length of ventilation time as well as reduce pulmonary complications in patients in the cardiac surgery intensive care unit. The project resulted in a significant decrease in length of stay and a decrease in pulmonary complications in the postoperative period.

  10. Functionalization of graphene oxide nanostructures improves photoluminescence and facilitates their use as optical probes in preclinical imaging.

    Science.gov (United States)

    Prabhakar, Neeraj; Näreoja, Tuomas; von Haartman, Eva; Şen Karaman, Didem; Burikov, Sergey A; Dolenko, Tatiana A; Deguchi, Takahiro; Mamaeva, Veronika; Hänninen, Pekka E; Vlasov, Igor I; Shenderova, Olga A; Rosenholm, Jessica M

    2015-06-21

    Recently reported photoluminescent nanographene oxides (nGOs), i.e. nanographene oxidised with a sulfuric/nitric acid mixture (SNOx method), have tuneable photoluminescence and are scalable, simple and fast to produce optical probes. This material belongs to the vast class of photoluminescent carbon nanostructures, including carbon dots, nanodiamonds (NDs), graphene quantum dots (GQDs), all of which demonstrate a variety of properties that are attractive for biomedical imaging such as low toxicity and stable photoluminescence. In this study, the nGOs were organically surface-modified with poly(ethylene glycol)-poly(ethylene imine) (PEG-PEI) copolymers tagged with folic acid as the affinity ligand for cancer cells expressing folate receptors. The functionalization enhanced both the cellular uptake and quantum efficiency of the photoluminescence as compared to non-modified nGOs. The nGOs exhibited an excitation dependent photoluminescence that facilitated their detection with a wide range of microscope configurations. The functionalized nGOs were non-toxic, they were retained in the stained cell population over a period of 8 days and they were distributed equally between daughter cells. We have evaluated their applicability in in vitro and in vivo (chicken embryo CAM) models to visualize and track migratory cancer cells. The good biocompatibility and easy detection of the functionalized nGOs suggest that they could address the limitations faced with quantum dots and organic fluorophores in long-term in vivo biomedical imaging.

  11. Improving stroke care for patients at Cavan hospital [poster

    LENUS (Irish Health Repository)

    Murugasu, G Dr.

    2013-07-01

    Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

  12. Combining Chemotherapy with Bevacizumab Improves Outcomes for Ovarian Cancer Patients

    Science.gov (United States)

    Results from two phase III randomized clinical trials suggest that, at least for some patients with ovarian cancer, adding the antiangiogenesis agent bevacizumab to chemotherapy increases the time to disease progression and may improve survival.

  13. Recombinant human thyrotropin-stimulated radioiodine therapy of large nodular goiters facilitates tracheal decompression and improves inspiration

    DEFF Research Database (Denmark)

    Bonnema, Steen Joop; Nielsen, Viveque E; Boel-Jørgensen, Henrik;

    2008-01-01

    INTRODUCTION: The impact on tracheal anatomy and respiratory function of recombinant human (rh)TSH-stimulated (131)I therapy in patients with goiter is not clarified. METHODS: In a double-blinded design, patients (age 37-87 yr) with a large multinodular goiter (range, 99-440 ml) were randomized...... previously. In the placebo group, no significant changes in the lung function or SCAT were found throughout the study. In the rhTSH group, a slight decrease was observed in the forced vital capacity 1 wk after therapy, whereas the mean individual change in SCAT was significantly increased by 10.5% (95...

  14. Improved Survival with the Patients with Variceal Bleed

    OpenAIRE

    Praveen Sharma; Sarin, Shiv K.

    2011-01-01

    Variceal hemorrhage is a major cause of death in patients with cirrhosis. Over the past two decades new treatment modalities have been introduced in the management of acute variceal bleeding (AVB) and several recent studies have suggested that the outcome of patients with cirrhosis and AVB has improved. Improved supportive measures, combination therapy which include early use of portal pressure reducing drugs with low rates of adverse effects (somatostatin, octerotide or terlipressin) and end...

  15. Improving patient satisfaction with pain management using Six Sigma tools.

    Science.gov (United States)

    DuPree, Erin; Martin, Lisa; Anderson, Rebecca; Kathuria, Navneet; Reich, David; Porter, Carol; Chassin, Mark R

    2009-07-01

    Patient satisfaction as a direct and public measure of quality of care is changing the way hospitals address quality improvement. The feasibility of using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) methodology to improve patient satisfaction as it relates to pain management was evaluated. This project used the DMAIC methodology to improve patients' overall satisfaction with pain management on two inpatient units in an urban academic medical center. Pre- and postintervention patient surveys were conducted. The DMAIC methodology provided a data-driven structure to determine the optimal improvement strategies, as well as a long-term plan for maintaining any improvements. In addition, the Change Acceleration Process (CAP) was used throughout the project's various DMAIC stages to further the work of the team by creating a shared need to meet the objectives of the project. Overall satisfaction with pain management "excellent" ratings increased from 37% to 54%. Both units surpassed the goal of at least 50% of responses in the "excellent" category. Several key drivers of satisfaction with pain management were uncovered in the Analyze phase of the project, and each saw rating increases from the pre-intervention to postintervention surveys. Ongoing monitoring by the hospital inpatient satisfaction survey showed that the pain satisfaction score improved in subsequent quarters as compared with the pre-intervention period. The Six Sigma DMAIC methodology can be used successfully to improve patient satisfaction. The project led to measurable improvements in patient satisfaction with pain management, which have endured past the duration of the Six Sigma project. The Control phase of DMAIC allows the improvements to be incorporated into daily operations.

  16. Functionalization of graphene oxide nanostructures improves photoluminescence and facilitates their use as optical probes in preclinical imaging

    Science.gov (United States)

    Prabhakar, Neeraj; Näreoja, Tuomas; von Haartman, Eva; Şen Karaman, Didem; Burikov, Sergey A.; Dolenko, Tatiana A.; Deguchi, Takahiro; Mamaeva, Veronika; Hänninen, Pekka E.; Vlasov, Igor I.; Shenderova, Olga A.; Rosenholm, Jessica M.

    2015-06-01

    Recently reported photoluminescent nanographene oxides (nGOs), i.e. nanographene oxidised with a sulfuric/nitric acid mixture (SNOx method), have tuneable photoluminescence and are scalable, simple and fast to produce optical probes. This material belongs to the vast class of photoluminescent carbon nanostructures, including carbon dots, nanodiamonds (NDs), graphene quantum dots (GQDs), all of which demonstrate a variety of properties that are attractive for biomedical imaging such as low toxicity and stable photoluminescence. In this study, the nGOs were organically surface-modified with poly(ethylene glycol)-poly(ethylene imine) (PEG-PEI) copolymers tagged with folic acid as the affinity ligand for cancer cells expressing folate receptors. The functionalization enhanced both the cellular uptake and quantum efficiency of the photoluminescence as compared to non-modified nGOs. The nGOs exhibited an excitation dependent photoluminescence that facilitated their detection with a wide range of microscope configurations. The functionalized nGOs were non-toxic, they were retained in the stained cell population over a period of 8 days and they were distributed equally between daughter cells. We have evaluated their applicability in in vitro and in vivo (chicken embryo CAM) models to visualize and track migratory cancer cells. The good biocompatibility and easy detection of the functionalized nGOs suggest that they could address the limitations faced with quantum dots and organic fluorophores in long-term in vivo biomedical imaging.Recently reported photoluminescent nanographene oxides (nGOs), i.e. nanographene oxidised with a sulfuric/nitric acid mixture (SNOx method), have tuneable photoluminescence and are scalable, simple and fast to produce optical probes. This material belongs to the vast class of photoluminescent carbon nanostructures, including carbon dots, nanodiamonds (NDs), graphene quantum dots (GQDs), all of which demonstrate a variety of properties that are

  17. Phylogenetic and functional analysis of the Cation Diffusion Facilitator (CDF family: improved signature and prediction of substrate specificity

    Directory of Open Access Journals (Sweden)

    Jeandroz Sylvain

    2007-04-01

    Full Text Available Abstract Background The Cation Diffusion Facilitator (CDF family is a ubiquitous family of heavy metal transporters. Much interest in this family has focused on implications for human health and bioremediation. In this work a broad phylogenetic study has been undertaken which, considered in the context of the functional characteristics of some fully characterised CDF transporters, has aimed at identifying molecular determinants of substrate selectivity and at suggesting metal specificity for newly identified CDF transporters. Results Representative CDF members from all three kingdoms of life (Archaea, Eubacteria, Eukaryotes were retrieved from genomic databases. Protein sequence alignment has allowed detection of a modified signature that can be used to identify new hypothetical CDF members. Phylogenetic reconstruction has classified the majority of CDF family members into three groups, each containing characterised members that share the same specificity towards the principally-transported metal, i.e. Zn, Fe/Zn or Mn. The metal selectivity of newly identified CDF transporters can be inferred by their position in one of these groups. The function of some conserved amino acids was assessed by site-directed mutagenesis in the poplar Zn2+ transporter PtdMTP1 and compared with similar experiments performed in prokaryotic members. An essential structural role can be assigned to a widely conserved glycine residue, while aspartate and histidine residues, highly conserved in putative transmembrane domains, might be involved in metal transport. The potential role of group-conserved amino acid residues in metal specificity is discussed. Conclusion In the present study phylogenetic and functional analyses have allowed the identification of three major substrate-specific CDF groups. The metal selectivity of newly identified CDF transporters can be inferred by their position in one of these groups. The modified signature sequence proposed in this work can be

  18. Improving adolescent social competence and behavior: a randomized trial of an 11-week equine facilitated learning prevention program.

    Science.gov (United States)

    Pendry, Patricia; Carr, Alexa M; Smith, Annelise N; Roeter, Stephanie M

    2014-08-01

    There is growing evidence that promoting social competence in youth is an effective strategy to prevent mental, emotional, and behavioral disorders in adulthood. Research suggests that programs delivered in collaboration with schools are particularly effective when they target social and emotional skill building, utilize an interactive instructional style, provide opportunities for youth participation and self-direction, and include explicit attempts to enhance youth social competence. A relatively new but popular approach that incorporates these characteristics is human animal interaction, which can be implemented in educational settings. We report the results from a randomized clinical trial examining the effects of an 11-week equine facilitated learning (EFL) program on the social competence and behavior of 5th-8th grade children. Children (N = 131) were recruited through referral by school counselors and school-based recruitment and then screened for low social competence. Researchers randomly assigned children to an experimental (n = 53) or waitlisted control group (n = 60). Children in the experimental group participated in an 11-week EFL program consisting of once-weekly, 90-min sessions of individual and team-focused activities, whereas children in the control group served as a wait-listed control and participated 16 weeks later. Parents of children in both groups rated child social competence at pretest and posttest. Three independent raters observed and reported children's positive and negative behavior using a validated checklist during each weekly session. Results indicated that program participation had a moderate treatment effect (d = .55) on social competence (p = .02) that was independent of pretest levels, age, gender, and referral status. Results showed that higher levels of program attendance predicted children's trajectories of observed positive (β = .500; p = .003) and negative behavior (β = -.062; p < .001) over the 11-week program.

  19. Taking your medicine: relational steps to improving patient compliance.

    Science.gov (United States)

    Hausman, A

    2001-01-01

    Patient non-compliance with physicians' instructions is a major problem that costs billions of dollars each year. This study supports a significant role for communication, both as a form of information exchange and social support, and participative decision-making in improving patient compliance. These results, based on structural equation modeling, also support the interaction of communication and participative decision-making positively affecting compliance. Results suggest that one-way communication from physician to patient and patient education will not solve compliance problems by themselves. Instead the solution revolves around open, bi-directional information exchange, active listening by both parties, and truly informed consent on the part of patients.

  20. Effects of repetitive facilitative exercise with neuromuscular electrical stimulation, vibratory stimulation and repetitive transcranial magnetic stimulation of the hemiplegic hand in chronic stroke patients.

    Science.gov (United States)

    Etoh, Seiji; Noma, Tomokazu; Takiyoshi, Yuko; Arima, Michiko; Ohama, Rintaro; Yokoyama, Katsuya; Hokazono, Akihiko; Amano, Yumeko; Shimodozono, Megumi; Kawahira, Kazumi

    2016-11-01

    Repetitive facilitative exercise (RFE) is a developed approach to the rehabilitation of hemiplegia. RFE can be integrated with neuromuscular electrical stimulation (NMES), direct application of vibratory stimulation (DAVS) and repetitive transcranial magnetic stimulation (rTMS). The aims of the present study were to retrospectively compare the effects of RFE and NMES, DAVS with those of RFE and rTMS, and to determine the maximal effect of the combination of RFE with NMES, DAVS, rTMS and pharmacological treatments in stroke patients. Thirty-three stroke patients were enrolled and divided into three groups: 15 who received RFE with rTMS (4 min) (TMS4 alone), 9 who received RFE with NMES, DAVS (NMES, DAVS alone) and 9 who received RFE with NMES, DAVS and rTMS (10 min) (rTMS10 + NMES, DAVS). The subjects performed the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) before and after the 2-week session. The 18 patients in the NMES, DAVS alone and rTMS10 + NMES, DAVS group underwent the intervention for 4 weeks. There were no significant differences in the increases in the FMA, ARAT scores in the three groups. The FMA or ARAT scores in the NMES, DAVS alone and the rTMS10 + NMES, DAVS group were increased significantly. The FMA and ARAT scores were significantly improved after 4 weeks in the NMES, DAVS alone group. RFE with NMES, DAVS may be more effective than RFE with rTMS for the recovery of upper-limb function. Patients who received RFE with NMES, DAVS and pharmacological treatments showed significant functional recovery.

  1. Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians.

    Science.gov (United States)

    Broderick-Forsgren, Kathleen; Hunter, Wynn G; Schulteis, Ryan D; Liu, Wen-Wei; Boggan, Joel C; Sharma, Poonam; Thomas, Steven; Zaas, Aimee; Bae, Jonathan

    2016-05-01

    Background Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use. Results We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition. Conclusions Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.

  2. Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept.

    Science.gov (United States)

    Smedal, Tori; Lygren, Hildegunn; Myhr, Kjell-Morten; Moe-Nilssen, Rolf; Gjelsvik, Bente; Gjelsvik, Olav; Strand, Liv Inger; Inger, Liv

    2006-06-01

    Patients with multiple sclerosis (MS) tend to have movement difficulties, and the effect of physiotherapy for this group of patients has been subjected to limited systematic research. In the present study physiotherapy based on the Bobath concept, applied to MS patients with balance and gait problems, was evaluated. The ability of different functional tests to demonstrate change was evaluated. A single-subject experimental study design with ABAA phases was used, and two patients with relapsing-remitting MS in stable phase were treated. Tests were performed 12 times, three at each phase: A (at baseline); B (during treatment); A (immediately after treatment); and A (after two months). The key feature of treatment was facilitation of postural activity and selective control of movement. Several performance and self report measures and interviews were used. After intervention, improved balance was shown by the Berg Balance Scale (BBS) in both patients, and improved quality of gait was indicated by the Rivermead Visual Gait Assessment (RVGA). The patients also reported improved balance and gait function in the interviews and scored their condition as 'much improved'. Gait parameters, recorded by an electronic walkway, changed, but differently in the two patients. Among the physical performance tests the BBS and the RVGA demonstrated the highest change, while no or minimal change was demonstrated by the Rivermead Mobility Index (RMI) and Ratings of Perceived Exertion (RPE). The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS.

  3. Which patients improve the most from arthritis rehabilitation?

    DEFF Research Database (Denmark)

    Hagel, Sofia; Lindqvist, Elisabet; Petersson, Ingemar F

    2014-01-01

    Objective: To study health-related quality of life (HRQoL) in arthritis rehabilitation performed by multidisciplinary teams in patients with chronic inflammatory arthritis. Predictors of change in health-related quality of life and the proportion of patients with clinical improvement were investi...

  4. Improving Patient Safety Culture in Primary Care: A Systematic Review

    NARCIS (Netherlands)

    Verbakel, Natasha J.; Langelaan, Maaike; Verheij, Theo J. M.; Wagner, Cordula; Zwart, Dorien L. M.

    2016-01-01

    Background: Patient safety culture, described as shared values, attitudes and behavior of staff in a health-care organization, gained attention as a subject of study as it is believed to be related to the impact of patient safety improvements. However, in primary care, it is yet unknown, which effec

  5. [Strategies for improving care of oncologic patients: SHARE Project results].

    Science.gov (United States)

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

  6. Students improve patient care and prepare for professional practice: an interprofessional community-based study.

    Science.gov (United States)

    Anderson, Elizabeth Susan; Thorpe, Lucy Nichola

    2014-06-01

    We report on an education model that enables students to contribute to practice while experiencing the realities of complex team-working in the community. The study considers how interprofessional learning impacts on patient care and service delivery. A qualitative study using a realist approach. The views of practice-staff, patients and facilitators on how student team learning impacted on practice was obtained through focus groups, interviews and an e-questionnaire and compared to student analysis as feedback forms. Staff from six Primary Health Care Teams (n = 23) stated that the student teams had offered solutions to improve the quality of patient care and on organisational systems. The positive value of the student work was confirmed by the course facilitators (n = 8). In addition, practitioners were propelled to maintain high professional standards. Patients (n = 23) recalled benefits directly attributable to the student work confirmed by the 434 student feedback forms. Undergraduate interprofessional student teams in mid-training can support and help practice teams, and this subsequently benefits patient care. This practice-based interprofessional learning model offers learning, which is theory-based, and supports positive student contributions. This learning fits today's requirements for positive outcomes from education when mapped against the Kirkpatrick or the NHS (UK) education outcomes framework.

  7. Facilitation of ultrasonic microvesicles on homing and molecular mechanism of bone marrow mesenchymal stem cells in cerebral infarction patients.

    Science.gov (United States)

    Chang, F; Xiong, W; Wang, D; Liu, X-Z; Zhang, W; Zhang, M; Jing, P

    2017-10-01

    Cerebral infarction, or ischemia brain stroke, is a common cerebrovascular disease. Bone marrow mesenchymal stem cells (BMSCs) are widely used to treating ischemia disease such as cardiac infarction. Ultrasonic microvesicles may help the targeting of exogenous factors via localized energy blast. Therefore, this study aims to investigate the effect of ultrasonic microvesicles on the homing of BMSCs on artery thrombosis and the associated molecular mechanisms. Rat BMSCs were isolated and cultured. Rats were divided into sham, model, BMSCs, and microvesicles groups. Cerebral infarction model was prepared by ligation of cervical artery and middle cerebral artery. 3×106/kg BMSCs were transplanted via tail veins. Microvesicles were used for assisting BMSCs infusion. Sex-determining region Y (SRY) gene expression was measured by Real-time PCR, while 2,3,5-triphenyltetrazolium chloride (TTC) staining was employed for describing the area of cerebral infarction. The activity of caspase 3 was assayed by test kit. Vascular endothelial growth factor (VEGF), nuclear factor kappa B (NF-κB) mRNA/protein levels, were quantified by Real-time PCR, and Western blotting, respectively. Microvesicle group had significantly elevated SRY expression (pMicrovesicle induced BMSCs had more potent effects (pmicrovesicle facilitated homing of BMSCs in cerebral infarction, and improved infarction disease via up-regulating VEGF expression, inhibiting NF-κB expression, and modulating apoptosis.

  8. Can audio recording improve patients' recall of outpatient consultations?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    Introduction In order to give patients possibility to listen to their consultation again, we have designed a system which gives the patients access to digital audio recordings of their consultations. An Interactive Voice Response platform enables the audio recording and gives the patients access...... to replay their consultation. The intervention is evaluated in a randomised controlled trial with 5.460 patients in order to determine whether providing patients with digital audio recording of the consultation affects the patients overall perception of their consultation. In addition to this primary...... objective we want to investigate if replay of the consultations improves the patients’ recall of the information given. Methods Interviews are carried out with 40 patients whose consultations have been audio recorded. Patients are divided into two groups, those who have listened to their consultation...

  9. Facilitation of corticospinal excitability according to motor imagery and mirror therapy in healthy subjects and stroke patients.

    Science.gov (United States)

    Kang, Youn Joo; Ku, Jeonghun; Kim, Hyun Jung; Park, Hae Kyung

    2011-12-01

    To delineate the changes in corticospinal excitability when individuals are asked to exercise their hand using observation, motor imagery, voluntary exercise, and exercise with a mirror. The participants consisted of 30 healthy subjects and 30 stroke patients. In healthy subjects, the amplitudes and latencies of motor evoked potential (MEP) were obtained using seven conditions: (A) rest; (B) imagery; (C) observation and imagery of the hand activity of other individuals; (D) observation and imagery of own ipsilateral hand activity; (E) observation and imagery of the hand activity of another individual with a mirror; (F) observation and imagery of own symmetric ipsilateral hand activity (thumb abduction) with a mirror; and (G) observation and imagery of own asymmetric ipsilateral hand activity (little finger abduction) with a mirror. In stroke patients, MEPs were obtained in the A, C, D, E, F conditions. In both groups, increment of the percentage MEP amplitude (at rest) and latency decrement of MEPs were significantly higher during the observation of the activity of the hand of another individual with a mirror and during symmetric ipsilateral hand activity on their own hand with a mirror than they were without a mirror. In healthy subjects, the increment of percentage MEP amplitude and latency decrement were significantly higher during the observation of the symmetric ipsilateral hand activity with a mirror compared to the observation of the activity of the asymmetric ipsilateral hand with a mirror of their own hand. In both groups, corticospinal excitability was facilitated by viewing the mirror image of the activity of the ipsilateral hand. These findings provide neurophysiological evidence supporting the application of various mirror imagery programs during stroke rehabilitation.

  10. Improved quality of life in hyperthyroidism patients after surgery.

    Science.gov (United States)

    Bukvic, Branka; Zivaljevic, Vladan; Sipetic, Sandra; Diklic, Aleksandar; Tausanovic, Katarina; Stojanovic, Dragos; Stevanovic, Dejan; Paunovic, Ivan

    2015-02-01

    The most common causes of hyperthyroidism are Graves disease (GD) and toxic nodular goiter (TNG). GD and TNG might influence patients' quality of life (QoL). The aim of our study was to analyze and compare the QoL of patients with GD with that of TNG patients and to evaluate the influence of surgical treatment on their QoL. A prospective case-control study was conducted at the Center for Endocrine surgery in Belgrade, Serbia. The ThyPRO questionnaire was used in the QoL assessment of the GD and TNG patients (31 and 28, respectively) pre- and post-operatively. All patients were receiving antithyroid drugs, and none of the patients were overtly hyperthyroid at the time of completing the preoperative questionnaire. The QoL of the GD patients was worse than that of the TNG patients, with significant differences in eye symptoms, anxiety, and sex life domains (P < 0.001, P = 0.005, and P = 0.004, respectively), preoperatively, and in eye symptoms, anxiety, emotional susceptibility, and overall QoL (P = 0.001, P = 0.027, P = 0.005 and P = 0.013, respectively), postoperatively. The improvement in QoL in the GD patients was significant after surgical treatment in all ThyPRO domains. In the TNG patients, the improvement was significant in all but one ThyPRO domain, sex life (P = 0.066). The QoL of GD patients is worse than those of TNG patients. Surgery may improve QoL in patients with GD and TNG even if they have achieved satisfying thyroid status with medication treatment, preoperatively. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Use of an arm weight-bearing combined with upper-limb reaching apparatus to facilitate motor paralysis recovery in an incomplete spinal cord injury patient: a single case report

    Science.gov (United States)

    Hoei, Takashi; Kawahira, Kazumi; Fukuda, Hidefumi; Sihgenobu, Keizo; Shimodozono, Megumi; Ogura, Tadashi

    2017-01-01

    [Purpose] Training using an arm weight-bearing device combined with upper-limb reaching apparatus to facilitate motor paralysis recovery, named the “Reaching Robot”, as well as Repetitive Facilitation Exercise were applied to a patient with severe impairment of the shoulder and elbow due to incomplete spinal cord injury and the effects were examined. [Subjects and Methods] A 66-year-old man with incomplete spinal cord injury participated in an upper extremity rehabilitation program involving a Reaching Robot. The program was comprised of active motor suspension, continuous low amplitude neuromuscular electrical stimulation and functional vibratory stimulation, as well as Repetitive Facilitation Exercise combined with continuous low amplitude neuromuscular electrical stimulation. This protocol used a crossover design following an A1-B1-A2-B2. “A” consisted of 2 weeks of Repetitive Facilitation Exercise, and “B” consisted of 2 weeks of Reaching Robot training. [Results] Improvements were observed after all sessions. Active range of motion for shoulder flexion improved after 2 weeks of Reaching Robot sessions only. There were no adverse events. [Conclusion] Reaching Robot training for severe paretic upper-extremity after incomplete spinal cord injury was a safe and effective treatment. Reaching Robot training may be useful for rehabilitation of paretic upper-extremity after incomplete spinal cord injury. PMID:28210068

  12. Embedded-structure template for electronic records affects patient note quality and management for emergency head injury patients: An observational pre and post comparison quality improvement study.

    Science.gov (United States)

    Sonoo, Tomohiro; Iwai, Satoshi; Inokuchi, Ryota; Gunshin, Masataka; Kitsuta, Yoichi; Nakajima, Susumu

    2016-10-01

    Along with article-based checklists, structured template recording systems have been reported as useful to create more accurate clinical recording, but their contributions to the improvement of the quality of patient care have been controversial. An emergency department (ED) must manage many patients in a short time. Therefore, such a template might be especially useful, but few ED-based studies have examined such systems.A structured template produced according to widely used head injury guidelines was used by ED residents for head injury patients. The study was conducted by comparing each 6-month period before and after launching the system. The quality of the patient notes and factors recorded in the patient notes to support the head computed tomography (CT) performance were evaluated by medical students blinded to patient information.The subject patients were 188 and 177 in respective periods. The numbers of patient notes categorized as "CT indication cannot be determined" were significantly lower in the postintervention term (18% → 9.0%), which represents the patient note quality improvement. No difference was found in the rates of CT performance or CT skip without clearly recorded CT indication in the patient notes.The structured template functioned as a checklist to support residents in writing more appropriately recorded patient notes in the ED head injury patients. Such a template customized to each clinical condition can facilitate standardized patient management and can improve patient safety in the ED.

  13. Grid Patient Appointment Template Design to Improve Scheduling Effectiveness

    Directory of Open Access Journals (Sweden)

    Yu-Li Huang

    2015-01-01

    Full Text Available Current outpatient delivery systems have been problematic in their ability to effectively schedule appointments and grant patients access to care. A better appointment system has demonstrated improvement on these issues. The objective of this study is to develop a grid appointment system to further improve the scheduling flexibility by determining the minimum length of appointment slots that optimizes the total costs of patient waiting, physician idling, and overtime. This minimum length is used for the patient type requiring the least amount of treatment time such as return visit (RV, and multiplications of the minimum length are for patient types with longer treatment such as new patients (NP. The results indicated that the proposed grid system adjusts to demand changes at least 15% more cost-effective when grouping two RVs into an NP or dividing an NP into two RVs compared to the base-line scheduling approaches that build around the mean treatment time.

  14. Grid Patient Appointment Template Design to Improve Scheduling Effectiveness.

    Science.gov (United States)

    Huang, Yu-Li; Marcak, Justin

    2015-01-01

    Current outpatient delivery systems have been problematic in their ability to effectively schedule appointments and grant patients access to care. A better appointment system has demonstrated improvement on these issues. The objective of this study is to develop a grid appointment system to further improve the scheduling flexibility by determining the minimum length of appointment slots that optimizes the total costs of patient waiting, physician idling, and overtime. This minimum length is used for the patient type requiring the least amount of treatment time such as return visit (RV), and multiplications of the minimum length are for patient types with longer treatment such as new patients (NP). The results indicated that the proposed grid system adjusts to demand changes at least 15% more cost-effective when grouping two RVs into an NP or dividing an NP into two RVs compared to the base-line scheduling approaches that build around the mean treatment time.

  15. Functional electrical stimulation improves brain perfusion in cranial trauma patients

    Directory of Open Access Journals (Sweden)

    Bárbara Juarez Amorim

    2011-08-01

    Full Text Available OBJECTIVE: Demonstrate brain perfusion changes due to neuronal activation after functional electrical stimulation (FES. METHOD: It was studied 14 patients with hemiplegia who were submitted to a program with FES during fourteen weeks. Brain perfusion SPECT was performed before and after FES therapy. These patients were further separated into 2 groups according to the hemiplegia cause: cranial trauma and major vascular insults. All SPECT images were analyzed using SPM. RESULTS: There was a significant statistical difference between the two groups related to patient's ages and extent of hypoperfusion in the SPECT. Patients with cranial trauma had a reduction in the hypoperfused area and patients with major vascular insult had an increase in the hypoperfused area after FES therapy. CONCLUSION: FES therapy can result in brain perfusion improvement in patients with brain lesions due to cranial trauma but probably not in patients with major vascular insults with large infarct area.

  16. Effects of proprioceptive neuromuscular facilitation neck pattern exercise on the ability to control the trunk and maintain balance in chronic stroke patients.

    Science.gov (United States)

    Hwangbo, Pil Neo; Don Kim, Kyoung

    2016-03-01

    [Purpose] The aim of this study was to investigate the effects of proprioceptive neuromuscular facilitation neck pattern exercise on the ability to control the trunk and balance in chronic stroke patients. [Subjects and Methods] A total of 30 study subjects were selected and randomly divided into an experimental group of 15 subjects, who received the proprioceptive neuromuscular facilitation neck pattern exercise, and a control group of 15 subjects, who received a traditional rehabilitation treatment. [Results] Statistically significant changes in all the items of the Trunk Impairment Scale, the Trunk Impairment Scale total score, and the Berg Balance Scale were observed in both the experimental group and the control group. significant between-group differences were found in all items among the subitems of the Trunk Impairment Scale except the static sitting balance. [Conclusion] Proprioceptive neuromuscular facilitation neck pattern exercise was shown to have a positive effect on increasing the ability to control the trunk and maintain balance in chronic stroke patients.

  17. Cross-functional team processes and patient functional improvement.

    Science.gov (United States)

    Alexander, Jeffrey A; Lichtenstein, Richard; Jinnett, Kimberly; Wells, Rebecca; Zazzali, James; Liu, Dawei

    2005-10-01

    To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. Primary data were collected during the period 1992-1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S. A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables. Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument. Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning. Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the potential appropriateness of managerial interventions to encourage member investment in team processes.

  18. Process Improvements to Reform Patient Flow in the Emergency Department.

    Science.gov (United States)

    Whatley, Shawn D; Leung, Alexander K; Duic, Marko

    2016-01-01

    Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada.

  19. Kinesthetic taping improves walking function in patients with stroke

    DEFF Research Database (Denmark)

    Boeskov, Birgitte; Carver, Line Tornehøj; von Essen-Leise, Anders

    2014-01-01

    walking speed and clinical indices of spasticity in patients with stroke. METHODS: Thirty-two patients (9 women) receiving rehabilitation after stroke (average, 50 days since stroke) who had impaired walking ability were recruited. Primary outcome was maximal walking speed measured by the 10-meter walk...... be a valuable adjunct in physical therapy and rehabilitation of patients with stroke.......BACKGROUND: Stroke is an important cause of severe disability and impaired motor function. Treatment modalities that improve motor function in patients with stroke are needed. The objective of this study was to investigate the effect of kinesthetic taping of the anterior thigh and knee on maximal...

  20. Leveraging information technology to drive improvement in patient satisfaction.

    Science.gov (United States)

    Nash, Mary; Pestrue, Justin; Geier, Peter; Sharp, Karen; Helder, Amy; McAlearney, Ann Scheck

    2010-01-01

    A healthcare organization's commitment to quality and the patient experience requires senior leader involvement in improvement strategies, and accountability for goals. Further, improvement strategies are most effective when driven by data, and in the world of patient satisfaction, evidence is growing that nurse leader rounding and discharge calls are strategic tactics that can improve patient satisfaction. This article describes how The Ohio State University Medical Center (OSUMC) leveraged health information technology (IT) to apply a data-driven strategy execution to improve the patient experience. Specifically, two IT-driven approaches were used: (1) business intelligence reporting tools were used to create a meaningful reporting system including dashboards, scorecards, and tracking reports and (2) an improvement plan was implemented that focused on two high-impact tactics and data to hardwire accountability. Targeted information from the IT systems enabled clinicians and administrators to execute these strategic tactics, and senior leaders to monitor achievement of strategic goals. As a result, OSUMC's inpatient satisfaction scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey improved from 56% nines and tens in 2006 to 71% in 2009.

  1. Outcome measures in physiotherapy management of patients with stroke: A survey into self-reported use, and barriers to and facilitators for use

    NARCIS (Netherlands)

    Peppen, R.P.S. van; Maissan, F.J.F.; Genderen, F.R. van; Dolder, R. van; Meeteren, N.L.U. van

    2008-01-01

    Objective. To investigate physiotherapists' self-reported use of outcome measures as recommended in the Dutch Clinical Practice Guideline on Physiotherapy Management of Patients with Stroke (CPGPS) and to assess perceived barriers to and facilitators for the use of outcome measures in everyday pract

  2. Improving haemophilia patient care through sharing best practice.

    Science.gov (United States)

    de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian

    2015-10-01

    At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. A pilot study of omalizumab to facilitate rapid oral desensitization in high-risk peanut-allergic patients.

    Science.gov (United States)

    Schneider, Lynda C; Rachid, Rima; LeBovidge, Jennifer; Blood, Emily; Mittal, Mudita; Umetsu, Dale T

    2013-12-01

    Peanut allergy is a major public health problem that affects 1% of the population and has no effective therapy. To examine the safety and efficacy of oral desensitization in peanut-allergic children in combination with a brief course of anti-IgE mAb (omalizumab [Xolair]). We performed oral peanut desensitization in peanut-allergic children at high risk for developing significant peanut-induced allergic reactions. Omalizumab was administered before and during oral peanut desensitization. We enrolled 13 children (median age, 10 years), with a median peanut-specific IgE level of 229 kU(A)/L and a median total serum IgE level of 621 kU/L, who failed an initial double-blind placebo-controlled food challenge at peanut flour doses of 100 mg or less. After pretreatment with omalizumab, all 13 subjects tolerated the initial 11 desensitization doses given on the first day, including the maximum dose of 500 mg peanut flour (cumulative dose, 992 mg, equivalent to >2 peanuts), requiring minimal or no rescue therapy. Twelve subjects then reached the maximum maintenance dose of 4000 mg peanut flour per day in a median time of 8 weeks, at which point omalizumab was discontinued. All 12 subjects continued on 4000 mg peanut flour per day and subsequently tolerated a challenge with 8000 mg peanut flour (equivalent to about 20 peanuts), or 160 to 400 times the dose tolerated before desensitization. During the study, 6 of the 13 subjects experienced mild or no allergic reactions, 5 subjects had grade 2 reactions, and 2 subjects had grade 3 reactions, all of which responded rapidly to treatment. Among children with high-risk peanut allergy, treatment with omalizumab may facilitate rapid oral desensitization and qualitatively improve the desensitization process. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.

  4. Patient-centered outcomes research to improve asthma outcomes.

    Science.gov (United States)

    Anise, Ayodola; Hasnain-Wynia, Romana

    2016-12-01

    The Patient-Centered Outcomes Research Institute is funding 8 comparative effectiveness research projects to improve patient-centered outcomes for African American and Hispanic/Latino patients with uncontrolled asthma. These projects aim to compare multilevel interventions with known efficacy at the community, home, and health system levels to enhance patient and clinician uptake of the National Heart, Lung, and Blood Institute's National Asthma Education Prevention Program guidelines and improve outcomes. The National Asthma Education Prevention Program guidelines provide clinicians with a range of acceptable approaches for the diagnosis and management of asthma and define general practices that meet the needs of most patients. Yet disparities in asthma care and outcomes remain pervasive for African Americans and Hispanics/Latinos. The National Heart, Lung, and Blood Institute AsthmaNet consortium has identified several top research priorities for pediatric and adult populations, including a recommendation to examine tailored approaches based on race/ethnicity. In addition, the guidelines emphasize the need for studies that focus on multicomponent interventions recognizing that single interventions are generally ineffective. This article will describe the Patient-Centered Outcomes Research Institute-funded asthma projects and how they are individually and collectively addressing evidence gaps in asthma care by focusing on multicomponent and tailored approaches for improving outcomes and reducing disparities for African American and Hispanic/Latino patients. Copyright © 2016. Published by Elsevier Inc.

  5. Using clinical indicators to facilitate quality improvement via the accreditation process: an adaptive study into the control relationship.

    Science.gov (United States)

    Chuang, Sheuwen; Howley, Peter P; Hancock, Stephen

    2013-07-01

    The aim of the study was to determine accreditation surveyors' and hospitals' use and perceived usefulness of clinical indicator reports and the potential to establish the control relationship between the accreditation and reporting systems. The control relationship refers to instructional directives, arising from appropriately designed methods and efforts towards using clinical indicators, which provide a directed moderating, balancing and best outcome for the connected systems. Web-based questionnaire survey. Australian Council on Healthcare Standards' (ACHS) accreditation and clinical indicator programmes. Seventy-three of 306 surveyors responded. Half used the reports always/most of the time. Five key messages were revealed: (i) report use was related to availability before on-site investigation; (ii) report use was associated with the use of non-ACHS reports; (iii) a clinical indicator set's perceived usefulness was associated with its reporting volume across hospitals; (iv) simpler measures and visual summaries in reports were rated the most useful; (v) reports were deemed to be suitable for the quality and safety objectives of the key groups of interested parties (hospitals' senior executive and management officers, clinicians, quality managers and surveyors). Implementing the control relationship between the reporting and accreditation systems is a promising expectation. Redesigning processes to ensure reports are available in pre-survey packages and refined education of surveyors and hospitals on how to better utilize the reports will support the relationship. Additional studies on the systems' theory-based model of the accreditation and reporting system are warranted to establish the control relationship, building integrated system-wide relationships with sustainable and improved outcomes.

  6. Linking outcomes management and practice improvement. Structured care methodologies: evolution and use in patient care delivery.

    Science.gov (United States)

    Cole, L; Houston, S

    1999-01-01

    Structured care methodologies are tools that provide a comprehensive approach to patient care delivery. These tools have evolved in their application and purpose over the years. In many situations, multiple tools are needed to obtain the best outcomes for a patient. The presence of a SCM does not preclude clinical judgment. On the contrary, the fundamental purpose of any SCM is to assist practitioners in implementing practice patterns associated with good clinical judgment, research-based interventions, and improved patient outcomes. These tools support smooth operation and appropriate use of resources, establish a means of patient management across the continuum of care, facilitate collaboration among disciplines, reflect patient outcomes, and provide outcomes data. Data from SCMs permit benchmarking, comparison of pre-implementation and post-implementation outcomes, development of action plans for quality enhancement, identification of high-risk patients, identification of issues and problems in the system that require interventions, and the development of research protocols and studies. Structured care methodology development and implementation can be challenging, rewarding, and at times frustrating. When used appropriately, these tools can have a major impact on the standardization of care and the achievement of desired outcomes. However, individual patient needs may supersede adherence to a tool. The challenge then becomes one of balancing the unique needs of each patient and appropriate use of SCMs. Change comes slowly, but persistence pays off.

  7. Improving outcomes for patients receiving transarterial chemoembolization for hepatocellular carcinoma.

    Science.gov (United States)

    McCurdy, Heather M

    2013-01-01

    Hepatocellular carcinoma is a cancer with increasing incidence in the veteran population. This type of cancer can be treated with transarterial chemoembolization, an invasive procedure performed by specially trained interventional radiologists. The most common serious complications are liver failure, sepsis secondary to ischemic cholecystitis or liver abscess, gastrointestinal bleeding, and death. However, nursing staff and physicians often have little or no experience in caring for patients in the hospital who have had this procedure. Patient safety can be threatened by this lack of knowledge. Sources of threat to patient safety are described by the Institute of Medicine as falling into 4 categories: management, workforce, work processes, and organizational culture. To promote patient safety, defenses need to be deployed to address each category. In this article, the author provides a case example, describes threats to the patient's safety, and describes a plan to improve the care of all patients undergoing this procedure.

  8. Does pharmacotherapy improve cardiovascular outcomes in hemodialysis patients?

    Science.gov (United States)

    Mittal, Mayank; Aggarwal, Kul; Littrell, Rachel L; Agrawal, Harsh; Alpert, Martin A

    2015-10-01

    Cardiovascular disease (CVD) occurs commonly in patients with chronic kidney disease (CKD) including those treated with hemodialysis (HD), and is associated with poor outcomes in this population. Pharmacologic management of hypertension, dyslipidemia, acute and chronic coronary artery disease, and atrial fibrillation in the general population is supported by the results of high-quality, randomized, controlled clinical trials. Pharmacotherapy of these disorders in the general population is effective in improving clinical outcomes. In contrast, information concerning the effect of pharmacotherapy on mortality and cardiovascular outcomes in patients with CKD, and particularly in HD patients, is limited. Available data suggest that, in general, pharmacotherapy of hypertension and dyslipidemia, anti-platelet therapy of CVD, and anticoagulant therapy in patients with atrial fibrillation are less effective in HD patients than in the general population or even in patients with early stage of CKD.

  9. Lean intervention improves patient discharge times, improves emergency department throughput and reduces congestion.

    Science.gov (United States)

    Beck, Michael J; Okerblom, Davin; Kumar, Anika; Bandyopadhyay, Subhankar; Scalzi, Lisabeth V

    2016-12-01

    To determine if a lean intervention improved emergency department (ED) throughput and reduced ED boarding by improving patient discharge efficiency from a tertiary care children's hospital. The study was conducted at a tertiary care children's hospital to study the impact lean that changes made to an inpatient pediatric service line had on ED efficiency. Discharge times from the general pediatrics' service were compared to patients discharged from all other pediatric subspecialty services. The intervention was multifaceted. First, team staffing reconfiguration permitted all discharge work to be done at the patient's bedside using a new discharge checklist. The intervention also incorporated an afternoon interdisciplinary huddle to work on the following day's discharges. Retrospectively, we determined the impact this had on median times of discharge order entry, patient discharge, and percent of patients discharged before noon. As a marker of ED throughput, we determined median hour of day that admitted patients left the ED to move to their hospital bed. As marker of ED congestion we determined median boarding times. For the general pediatrics service line, the median discharge order entry time decreased from 1:43pm to 11:28am (p Lean principles implemented by one hospital service line improved patient discharge times enhanced patient ED throughput, and reduced ED boarding times.

  10. Improvement of neurofeedback therapy for improved attention through facilitation of brain activity using local sinusoidal extremely low frequency magnetic field exposure.

    Science.gov (United States)

    Zandi Mehran, Yasaman; Firoozabadi, Mohammad; Rostami, Reza

    2015-04-01

    Traditional neurofeedback (NF) is a training approach aimed at altering brain activity using electroencephalography (EEG) rhythms as feedback. In NF training, external factors such as the subjects' intelligence can have an effect. In contrast, a low-energy NF system (LENS) does not require conscious effort from the subject, which results in fewer attendance sessions. However, eliminating the subject role seems to eliminate an important part of the NF system. This study investigated the facilitating effect on the theta-to-beta ratio from NF training, using a local sinusoidal extremely low frequency magnetic field (LSELF-MF) versus traditional NF. Twenty-four healthy, intelligent subjects underwent 10 training sessions to enhance beta (15-18 Hz), and simultaneously inhibit theta (4-7 Hz) and high beta (22-30 Hz) activity, at the Cz point in a 3-boat-race video game. Each session consisted of 3 statuses, PRE, DURING, and POST. In the DURING status, the NF training procedure lasted 10 minutes. Subjects were led to believe that they would be exposed to a magnetic field during NF training; however, 16 of the subjects who were assigned to the experimental group were really exposed to 45 Hz-360 µT LSELF-MF at Cz. For the 8 other subjects, only the coil was located at the Cz point with no exposure. The duty cycle of exposure was 40% (2-second exposure and 3-second pause). The results show that the theta-to-beta ratio in the DURING status of each group differs significantly from the PRE and POST statuses. Between-group analysis shows that the theta-to-beta ratio in the DURING status of the experimental group is significantly (P < .001) lower than in the sham group. The result shows the effect of LSELF-MF on NF training.

  11. Improving Patient Outcomes With Oral Heart Failure Medications.

    Science.gov (United States)

    Sherrod, Melissa M; Cheek, Dennis J; Seale, Ashlie

    2016-05-01

    Hospitals are under immense pressure to reduce heart failure readmissions that occur within 30 days of discharge, and to improve the quality of care for these patients. Penalties mandated by the Affordable Care Act decrease hospital reimbursement and ultimately the overall cost of caring for these patients increases if they are not well managed. Approximately 25% of patients hospitalized for heart failure are at high risk for readmission and these rates have not changed over the past decade. As a result of an aging population, the incidence of heart failure is expected to increase to one in five Americans over the age of 65. Pharmacologic management can reduce the risk of death and help prevent unnecessary hospitalizations. Healthcare providers who have knowledge of heart failure medications and drug interactions and share this information with their patients contribute to improved long-term survival and physical functioning as well as fewer hospitalizations and a delay of progressive worsening of heart failure.

  12. Does Music Therapy Improve Anxiety and Depression in Alzheimer's Patients?

    Science.gov (United States)

    de la Rubia Ortí, José Enrique; García-Pardo, María Pilar; Cabañés Iranzo, Carmen; Cerón Madrigal, José Joaquin; Castillo, Sandra Sancho; Julián Rochina, Mariano; Prado Gascó, Vicente Javier

    2017-07-17

    To evaluate the effectiveness of the implementation of a short protocol of music therapy as a tool to reduce stress and improve the emotional state in patients with mild Alzheimer's disease. A sample of 25 patients with mild Alzheimer's received therapy based on the application of a music therapy session lasting 60 min. Before and after the therapy, patient saliva was collected to quantify the level of salivary cortisol using the Enzyme-Linked ImmunoSorbent Assay (ELISA) immunoassay technique and a questionnaire was completed to measure anxiety and depression (Hospital Anxiety and Depression Scale). The results show that the application of this therapy lowers the level of stress and decreases significantly depression and anxiety, establishing a linear correlation between the variation of these variables and the variation of cortisol. A short protocol of music therapy can be an alternative medicine to improve emotional variables in Alzheimer patients.

  13. [Improved treatment options for a short bowel syndrome patient].

    Science.gov (United States)

    Pakarinen, Mikko

    2014-01-01

    Short bowel syndrome necessitates long-term parenteral nutrition, which exposes to decreased quality of life and increased morbidity. In recent years the understanding of short bowel pathophysiology and related complications has expanded, forming the basis for improved treatment options. In addition to evolving nutritional therapy, new pharmacological and surgical therapies have emerged, enhancing the patients' possibilities to achieve intestinal autonomy. Increasingly efficient prevention of intestinal failure-associated liver disease and central line-associated septic episodes improves patient survival. Bowel function can be restored by intestinal transplantation in those developing life-threatening complications.

  14. Multidisciplinary in-hospital teams improve patient outcomes: A review

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2014-01-01

    Full Text Available Background: The use of multidisciplinary in-hospital teams limits adverse events (AE, improves outcomes, and adds to patient and employee satisfaction. Methods: Acting like "well-oiled machines," multidisciplinary in-hospital teams include "staff" from different levels of the treatment pyramid (e.g. staff including nurses′ aids, surgical technicians, nurses, anesthesiologists, attending physicians, and others. Their enhanced teamwork counters the "silo effect" by enhancing communication between the different levels of healthcare workers and thus reduces AE (e.g. morbidity/mortality while improving patient and healthcare worker satisfaction. Results: Multiple articles across diverse disciplines incorporate a variety of concepts of "teamwork" for staff covering emergency rooms (ERs, hospital wards, intensive care units (ICUs, and most critically, operating rooms (ORs. Cohesive teamwork improved communication between different levels of healthcare workers, and limited adverse events, improved outcomes, decreased the length of stay (LOS, and yielded greater patient "staff" satisfaction. Conclusion: Within hospitals, delivering the best medical/surgical care is a "team sport." The goals include: Maximizing patient safety (e.g. limiting AE and satisfaction, decreasing the LOS, and increasing the quality of outcomes. Added benefits include optimizing healthcare workers′ performance, reducing hospital costs/complications, and increasing job satisfaction. This review should remind hospital administrators of the critical need to keep multidisciplinary teams together, so that they can continue to operate their "well-oiled machines" enhancing the quality/safety of patient care, while enabling "staff" to optimize their performance and enhance their job satisfaction.

  15. Improving organizational climate for excellence in patient care.

    Science.gov (United States)

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

  16. [Olanzapine improves chorea in patients with Huntington's disease].

    Science.gov (United States)

    Jiménez-Jiménez, F J; de Toledo, M; Puertas, I; Barón, M; Zurdo, M; Barcenilla, B

    The main treatment for choreatic movements associated to Huntington s disease are the neuroleptic drugs, however, its use causes long term troubles. We describe two patients with a predominantly choreic Huntington s disease, who experience improvement of choreatic movements after introduction of olanzapine to their treatment, being this drug well tolerated. The improvement of chorea suggests that olanzapine has a dopaminergic D2 receptors blocking action.

  17. Implementing Ask Me 3 to improve African American patient satisfaction and perceptions of physician cultural competency.

    Science.gov (United States)

    Michalopoulou, Georgia; Falzarano, Pamela; Arfken, Cynthia; Rosenberg, David

    2010-01-01

    Improve African American patient satisfaction and perceptions of physician cultural competency through the implementation of Ask Me 3 pamphlet which encourages patients to ask questions of physicians. Intervention participants received the pamphlet prior to their visit with the physician. Analysis evaluated differences in patient satisfaction and perceptions of physician cultural competency between intervention participants and controls. Intervention participants who saw their regular physician reported higher satisfaction. All found the questions to be helpful and reported knowing more about their medical condition or illness after the visit. The Ask Me 3 pamphlet is a low cost and logistically feasible tool that could be readily implemented in medical settings to facilitate physician-patient interaction. Improved satisfaction with the visit was found when the pamphlet was implemented during visits with a regular physician. Thus, our research findings suggest implementation of the Ask Me 3 pamphlet has the potential to improve health care behaviors and health outcomes and may ultimately lead to a reduction in health care disparities.

  18. Improving activity and engagement for patients with dementia.

    Science.gov (United States)

    Bray, Jennifer; Evans, Simon; Bruce, Mary; Carter, Christine; Brooker, Dawn; Milosevic, Sarah; Thompson, Rachel; Hutt, Louise

    2015-10-01

    This is the second in a short series that presents case study examples of the positive work achieved by trusts that participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. Staff often think that there is insufficient time to get to know patients and carers, especially with large and challenging workloads. Combined with a lack of activities and stimulation for patients with dementia in hospital, this can result in poor engagement and a disconnect between staff and patients. To improve these relationships and give staff more time with patients, Cambridge University Hospitals NHS Foundation Trust has introduced bay nursing for patients with dementia, where one nurse is responsible for monitoring a bay alongside a healthcare assistant for an entire shift. Part of Betsi Cadwaladr University Health Board, Glan Clwyd Hospital in north Wales has focused on improving stimulation by creating an activity room with a specially trained activity worker, providing a relaxed and friendly setting where patients with dementia can take part in a range of activities and have lunch together.

  19. Improving pain assessment and managment in stroke patients.

    Science.gov (United States)

    Nesbitt, Julian; Moxham, Sian; Ramadurai, Gopinath; Williams, Lucy

    2015-01-01

    Stroke patients can experience a variety of pain. Many stroke patients have co-morbidities such as osteoporosis, arthritis or diabetes causing diabetic neuropathy. As well as pain from other long term conditions, stroke patients can experience central post-stroke pain, headaches, and musculoskeletal issues such as hypertonia, contractures, spasticity, and subluxations. These stroke patients can also have communication difficulties in the form of expressive dysphasia and/or global aphasia. Communication difficulties can result in these patients not expressing their pain and therefore not having it assessed, leading to inadequate pain relief that could impact their rehabilitation and recovery. By implementing an observational measurement of pain such as the Abbey pain scale, patients with communication difficulties can have their pain assessed and recorded. Initially 30% of patients on the acute stroke ward did not have their pain assessed and adequately recorded and 15% of patients had inadequate pain relief. The patient was assessed if they were in pain and therefore not receiving adequate pain relief by measuring their pain on the Abbey pain scale. After introducing the Abbey pain scale and creating a nurse advocate, an improvement was shown such that only 5% of patients did not have their pain recorded and all had adequate pain relief.

  20. Improving Hypertension Control and Patient Engagement Using Digital Tools.

    Science.gov (United States)

    Milani, Richard V; Lavie, Carl J; Bober, Robert M; Milani, Alexander R; Ventura, Hector O

    2017-01-01

    Hypertension is present in 30% of the adult US population and is a major contributor to cardiovascular disease. The established office-based approach yields only 50% blood pressure control rates and low levels of patient engagement. Available home technology now provides accurate, reliable data that can be transmitted directly to the electronic medical record. We evaluated blood pressure control in 156 patients with uncontrolled hypertension enrolled into a home-based digital-medicine blood pressure program and compared them with 400 patients (matched to age, sex, body mass index, and blood pressure) in a usual-care group after 90 days. Digital-medicine patients completed questionnaires online, were asked to submit at least one blood pressure reading/week, and received medication management and lifestyle recommendations via a clinical pharmacist and a health coach. Blood pressure units were commercially available that transmitted data directly to the electronic medical record. Digital-medicine patients averaged 4.2 blood pressure readings per week. At 90 days, 71% of digital-medicine vs 31% of usual-care patients had achieved target blood pressure control. Mean decrease in systolic/diastolic blood pressure was 14/5 mm Hg in digital medicine, vs 4/2 mm Hg in usual care (P digital-medicine group (P = .004). Mean patient activation increased from 41.9 to 44.1 (P = .008), and the percentage of patients with low patient activation decreased from 15% to 6% (P = .03) in the digital-medicine group. A digital hypertension program is feasible and associated with significant improvement in blood pressure control rates and lifestyle change. Utilization of a virtual health intervention using connected devices improves patient activation and is well accepted by patients.

  1. Overexpression of CD44 in neural precursor cells improves trans-endothelial migration and facilitates their invasion of perivascular tissues in vivo.

    Directory of Open Access Journals (Sweden)

    Cyrille Deboux

    Full Text Available Neural precursor (NPC based therapies are used to restore neurons or oligodendrocytes and/or provide neuroprotection in a large variety of neurological diseases. In multiple sclerosis models, intravenously (i.v -delivered NPCs reduced clinical signs via immunomodulation. We demonstrated recently that NPCs were able to cross cerebral endothelial cells in vitro and that the multifunctional signalling molecule, CD44 involved in trans-endothelial migration of lymphocytes to sites of inflammation, plays a crucial role in extravasation of syngeneic NPCs. In view of the role of CD44 in NPCs trans-endothelial migration in vitro, we questioned presently the benefit of CD44 overexpression by NPCs in vitro and in vivo, in EAE mice. We show that overexpression of CD44 by NPCs enhanced over 2 folds their trans-endothelial migration in vitro, without impinging on the proliferation or differentiation potential of the transduced cells. Moreover, CD44 overexpression by NPCs improved significantly their elongation, spreading and number of filopodia over the extracellular matrix protein laminin in vitro. We then tested the effect of CD44 overexpression after i.v. delivery in the tail vein of EAE mice. CD44 overexpression was functional invivo as it accelerated trans-endothelial migration and facilitated invasion of HA expressing perivascular sites. These in vitro and in vivo data suggest that CD44 may be crucial not only for NPC crossing the endothelial layer but also for facilitating invasion of extravascular tissues.

  2. Multi-modal intervention improved oral intake in hospitalized patients

    DEFF Research Database (Denmark)

    Holst, M; Beermann, T; Mortensen, M N

    2015-01-01

    : A 12-months observational multi-modal intervention study was done, using the top-down and bottom-up principle. All hospitalized patients (>3 days) were included. Setting: A university hospital with 758 beds and all specialities. Measurements: Record audit of GNP, energy- and protein-intake by 24-h......BACKGROUND: Good nutritional practice (GNP) includes screening, nutrition plan and monitoring, and is mandatory for targeted treatment of malnourished patients in hospital. AIMS: To optimize energy- and protein-intake in patients at nutritional risk and to improve GNP in a hospital setting. METHODS...

  3. Listening to Those at the Frontline: Patient and Healthcare Personnel Perspectives on Tuberculosis Treatment Barriers and Facilitators in High TB Burden Regions of Argentina

    Directory of Open Access Journals (Sweden)

    Sarah J. Iribarren

    2014-01-01

    Full Text Available Purpose. In Argentina, tuberculosis (TB control measures have not achieved key treatment targets. The purpose of this study was to identify modes of treatment delivery and explore patient and healthcare personnel perceptions of barriers and facilitators to treatment success. Methods. We used semistructured group and individual interviews for this descriptive qualitative study. Eight high burden municipalities were purposively selected. Patients in treatment for active TB (n=16, multidisciplinary TB team members (n=26, and TB program directors (n=12 at local, municipal, regional, and national levels were interviewed. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis. Results. Modes of treatment delivery varied across municipalities and types of healthcare facility and were highly negotiated with patients. Self-administration of treatment was common in hospital-based and some community clinics. Barriers to TB treatment success were concentrated at the system level. This level relied heavily on individual personal commitment, and many system facilitators were operating in isolation or in limited settings. Conclusions. We outline experiences and perspectives of the facilitating and challenging factors at the individual, structural, social, and organizational levels. Establishing strong patient-healthcare personnel relationships, responding to patient needs, capitalizing on community resources, and maximizing established decentralized system could mitigate some of the barriers.

  4. Intensive care unit without walls: seeking patient safety by improving the efficiency of the system.

    Science.gov (United States)

    Gordo, F; Abella, A

    2014-10-01

    The term "ICU without walls" refers to innovative management in Intensive Care, based on two key elements: (1) collaboration of all medical and nursing staff involved in patient care during hospitalization and (2) technological support for severity early detection protocols by identifying patients at risk of deterioration throughout the hospital, based on the assessment of vital signs and/or laboratory test values, with the clear aim of improving critical patient safety in the hospitalization process. At present, it can be affirmed that there is important work to be done in the detection of severity and early intervention in patients at risk of organ dysfunction. Such work must be adapted to the circumstances of each center and should include training in the detection of severity, multidisciplinary work in the complete patient clinical process, and the use of technological systems allowing intervention on the basis of monitored laboratory and physiological parameters, with effective and efficient use of the information generated. Not only must information be generated, but also efficient management of such information must also be achieved. It is necessary to improve our activity through innovation in management procedures that facilitate the work of the intensivist, in collaboration with other specialists, throughout the hospital environment. Innovation is furthermore required in the efficient management of the information generated in hospitals, through intelligent and directed usage of the new available technology.

  5. The Psychosocial Improvement after Strabismus Surgery in Iranian Patients

    Directory of Open Access Journals (Sweden)

    Guita Ghiasi

    2013-10-01

    Full Text Available Purpose: To compare the psychosocial status before and after successful strabismus surgery on Iranian strabismic patientsMethods: One hundred twenty-four strabismic patients, older than 15 years were evaluated between 2009 and 2010. They were asked to complete a questionnaire about their psychosocial experiences, before and three months after successful strabismus surgery. Effects of strabismus on self-esteem, self-confidence, and self-assessment of intelligence, employment and interpersonal relationships were compared.Results: Fifty-six percent of patients had problems in adjusting to society, and 71% had developed a mannerism to camouflage their misalignment before surgery. The preoperative scores of self-esteem, self-confidence, and interpersonal relationship were 4.33±2.07, 4.23±2.53 and 6.06±2.33 which changed to 8.33±3.02, 7.29±2.89 and 6.72±3.17 after surgery, respectively (p<0.001 for all of values. More esotropic patients reported to be discriminated against compared to exotropic patients. Postoperatively, 79% of patients reported improvements in their ability to meet new people, and 82% in interpersonal relationships. Scores of self-confidence and self-esteem increased up to three and four units, respectively (p<0.001 for both values.Conclusion: Patients with strabismus have psychosocial problems and successful strabismus surgery improves their psychosocial status.

  6. Improved radiographic outcomes with patient-specific total knee arthroplasty.

    Science.gov (United States)

    Ivie, Conrad B; Probst, Patrick J; Bal, Amrit K; Stannard, James T; Crist, Brett D; Sonny Bal, B

    2014-11-01

    Patient-specific guides can improve limb alignment and implant positioning in total knee arthroplasty, although not all studies have supported this benefit. We compared the radiographs of 100 consecutively-performed patient-specific total knees to a similar group that was implanted with conventional instruments instead. The patient-specific group showed more accurate reproduction of the theoretically ideal mechanical axis, with fewer outliers, but implant positioning was comparable between groups. Our odds ratio comparison showed that the patient-specific group was 1.8 times more likely to be within the desired +3° from the neutral mechanical axis when compared to the standard control group. Our data suggest that reliable reproduction of the limb mechanical axis may accrue from patient-specific guides in total knee arthroplasty when compared to standard, intramedullary instrumentation.

  7. Collaborating With Music Therapists to Improve Patient Care.

    Science.gov (United States)

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane

    2016-09-01

    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care.

  8. Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi

    Directory of Open Access Journals (Sweden)

    Peter MacPherson

    2012-12-01

    Full Text Available Introduction: Linkage from HIV testing and counselling (HTC to initiation of antiretroviral therapy (ART is suboptimal in many national programmes in sub-Saharan Africa, leading to delayed initiation of ART and increased risk of death. Reasons for failure of linkage are poorly understood. Methods: Semi-structured qualitative interviews were undertaken with health providers and HIV-positive primary care patients as part of a prospective cohort study at primary health centres in Blantyre, Malawi. Patients successful and unsuccessful in linking to ART were included. Results: Progression through the HIV care pathway was strongly influenced by socio-cultural norms, particularly around the perceived need to regain respect lost during a period of visibly declining health. Capacity to call upon the support of networks of families, friends and employers was a key determinant of successful progression. Over-busy clinics, non-functioning laboratories and unsuitable tools used for ART eligibility assessment (WHO clinical staging system and centralized CD4 count measurement were important health systems determinants of drop-out. Conclusions: Key interventions that could rapidly improve linkage include guarantee of same-day, same-clinic ART eligibility assessments; utilization of the support offered by peer-groups and community health workers; and integration of HTC and ART programmes.

  9. Measuring and improving patient safety through health information technology: The Health IT Safety Framework.

    Science.gov (United States)

    Singh, Hardeep; Sittig, Dean F

    2016-04-01

    Health information technology (health IT) has potential to improve patient safety but its implementation and use has led to unintended consequences and new safety concerns. A key challenge to improving safety in health IT-enabled healthcare systems is to develop valid, feasible strategies to measure safety concerns at the intersection of health IT and patient safety. In response to the fundamental conceptual and methodological gaps related to both defining and measuring health IT-related patient safety, we propose a new framework, the Health IT Safety (HITS) measurement framework, to provide a conceptual foundation for health IT-related patient safety measurement, monitoring, and improvement. The HITS framework follows both Continuous Quality Improvement (CQI) and sociotechnical approaches and calls for new measures and measurement activities to address safety concerns in three related domains: 1) concerns that are unique and specific to technology (e.g., to address unsafe health IT related to unavailable or malfunctioning hardware or software); 2) concerns created by the failure to use health IT appropriately or by misuse of health IT (e.g. to reduce nuisance alerts in the electronic health record (EHR)), and 3) the use of health IT to monitor risks, health care processes and outcomes and identify potential safety concerns before they can harm patients (e.g. use EHR-based algorithms to identify patients at risk for medication errors or care delays). The framework proposes to integrate both retrospective and prospective measurement of HIT safety with an organization's existing clinical risk management and safety programs. It aims to facilitate organizational learning, comprehensive 360 degree assessment of HIT safety that includes vendor involvement, refinement of measurement tools and strategies, and shared responsibility to identify problems and implement solutions. A long term framework goal is to enable rigorous measurement that helps achieve the safety

  10. Cancer Carepartners: Improving patients' symptom management by engaging informal caregivers

    Directory of Open Access Journals (Sweden)

    Silveira Maria J

    2011-11-01

    Full Text Available Abstract Background Previous studies have found that cancer patients undergoing chemotherapy can effectively manage their own symptoms when given tailored advice. This approach, however, may challenge patients with poor performance status and/or emotional distress. Our goal is to test an automated intervention that engages a friend or family member to support a patient through chemotherapy. Methods/Design We describe the design and rationale of a randomized, controlled trial to assess the efficacy of 10 weeks of web-based caregiver alerts and tailored advice for helping a patient manage symptoms related to chemotherapy. The study aims to test the primary hypothesis that patients whose caregivers receive alerts and tailored advice will report less frequent and less severe symptoms at 10 and 14 weeks when compared to patients in the control arm; similarly, they will report better physical function, fewer outpatient visits and hospitalizations related to symptoms, and greater adherence to chemotherapy. 300 patients with solid tumors undergoing chemotherapy at two Veteran Administration oncology clinics reporting any symptom at a severity of ≥4 and a willing informal caregiver will be assigned to either 10 weeks of automated telephonic symptom assessment (ATSA alone, or 10 weeks of ATSA plus web-based notification of symptom severity and problem solving advice to their chosen caregiver. Patients and caregivers will be surveyed at intake, 10 weeks and 14 weeks. Both groups will receive standard oncology, hospice, and palliative care. Discussion Patients undergoing chemotherapy experience many symptoms that they may be able to manage with the support of an activated caregiver. This intervention uses readily available technology to improve patient caregiver communication about symptoms and caregiver knowledge of symptom management. If successful, it could substantially improve the quality of life of veterans and their families during the stresses of

  11. Knowledge translation for nephrologists: strategies for improving the identification of patients with proteinuria.

    Science.gov (United States)

    Hemmelgarn, Brenda R; Manns, Braden J; Straus, Sharon; Naugler, Christopher; Holroyd-Leduc, Jayna; Braun, Ted C; Levin, Adeera; Klarenbach, Scott; Lee, Patrick F; Hafez, Kevin; Schwartz, Daniel; Jindal, Kailash; Ervin, Kathy; Bello, Aminu; Turin, Tanvir Chowdhury; McBrien, Kerry; Elliott, Meghan; Tonelli, Marcello

    2012-01-01

    For health scientists, knowledge translation refers to the process of facilitating uptake of knowledge into clinical practice or decision making. Since high-quality clinical research that is not applied cannot improve outcomes, knowledge translation is critical for realizing the value and potential for all types of health research. Knowledge translation is particularly relevant for areas within health care where gaps in care are known to exist, which is the case for some areas of management for people with chronic kidney disease (CKD), including assessment of proteinuria. Given that proteinuria is a key marker of cardiovascular and renal risk, forthcoming international practice guidelines will recommend including proteinuria within staging systems for CKD. While this revised staging system will facilitate identification of patients at higher risk for progression of CKD and mortality who benefit from intervention, strategies to ensure its appropriate uptake will be particularly important. This article describes key elements of effective knowledge translation strategies based on the knowledge-to-action cycle framework and describes options for effective knowledge translation interventions related to the new CKD guidelines, focusing on recommendations related to assessment for proteinuria specifically. The article also presents findings from a multidisciplinary meeting aimed at developing knowledge translation intervention strategies, with input from key stakeholders (researchers, knowledge users, decision makers and collaborators), to facilitate implementation of this guideline. These considerations are relevant for dissemination and implementation of guidelines on other topics and in other clinical settings.

  12. Rolipram improves facilitation of contextual fear extinction in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced mouse model of Parkinson's disease

    Directory of Open Access Journals (Sweden)

    Ken-ichi Kinoshita

    2017-05-01

    Full Text Available Cognitive impairment often occurs in Parkinson's disease (PD, but the mechanism of onset remains unknown. Recently, we reported that PD model mice produced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP show facilitation of hippocampal memory extinction, which may be the cause of cognitive impairment in PD. When we examined the cAMP/CREB signaling in the hippocampus, decreased levels of cAMP and phosphorylated CREB were observed in the dentate gyrus (DG of MPTP-treated mice. Administration of rolipram improved the memory deficits with concomitant recovery of cAMP and phosphorylated CREB levels, suggesting that reduced cAMP/CREB signaling in the DG leads to cognitive impairment in MPTP-treated mice.

  13. Creating an improvement culture for enhanced patient safety: service improvement learning in pre-registration education.

    Science.gov (United States)

    Christiansen, Angela; Robson, Linda; Griffith-Evans, Christine

    2010-10-01

    The present study reports a descriptive survey of nursing students' experience of service improvement learning in the university and practice setting. Opportunities to develop service improvement capabilities were embedded into pre-registration programmes at a university in the Northwest of England to ensure future nurses have key skills for the workplace. A cross-sectional survey designed to capture key aspects of students' experience was completed by nursing students (n = 148) who had undertaken a service improvement project in the practice setting. Work organizations in which a service improvement project was undertaken were receptive to students' efforts. Students reported increased confidence to undertake service improvement and service improvement capabilities were perceived to be important to future career development and employment prospects. Service improvement learning in pre-registration education appears to be acceptable, effective and valued by students. Further research to identify the impact upon future professional practice and patient outcomes would enhance understanding of this developing area. Nurse Managers can play an active role in creating a service culture in which innovation and improvement can flourish to enhance patient outcomes, experience and safety. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  14. Lessons Learned From a Collaborative to Improve Care for Patients With Diabetes in 17 Community Health Centers, Massachusetts, 2006

    OpenAIRE

    Lemay, Celeste A.; Beagan, Brianne M.; Ferguson, Warren J.; Lee, J.

    2010-01-01

    Introduction In 2006, the Massachusetts League of Community Health Centers convened a collaborative to systematically improve health care delivery for patients with diabetes in 17 community health centers. Our goal was to identify facilitators of and barriers to success reported by teams that participated in this collaborative. Methods The collaborative's activities lasted 13 months. At their conclusion, we interviewed participating team members. We asked about their teams' successes, challen...

  15. How to improve patient satisfaction when patients are already satisfied: a continuous process-improvement approach.

    Science.gov (United States)

    Friesner, Dan; Neufelder, Donna; Raisor, Janet; Bozman, Carl S

    2009-01-01

    The authors present a methodology that measures improvement in customer satisfaction scores when those scores are already high and the production process is slow and thus does not generate a large amount of useful data in any given time period. The authors used these techniques with data from a midsized rehabilitation institute affiliated with a regional, nonprofit medical center. Thus, this article functions as a case study, the findings of which may be applicable to a large number of other healthcare providers that share both the mission and challenges faced by this facility. The methodology focused on 2 factors: use of the unique characteristics of panel data to overcome the paucity of observations and a dynamic benchmarking approach to track process variability over time. By focusing on these factors, the authors identify some additional areas for process improvement despite the institute's past operational success.

  16. Facilitating the use of non-standard in vivo studies in health risk assessment of chemicals: a proposal to improve evaluation criteria and reporting.

    Science.gov (United States)

    Beronius, Anna; Molander, Linda; Rudén, Christina; Hanberg, Annika

    2014-06-01

    To improve data availability in health risk assessment of chemicals and fill information gaps there is a need to facilitate the use of non-standard toxicity studies, i.e. studies not conducted according to any standardized toxicity test guidelines. The purpose of this work was to propose criteria and guidance for the evaluation of reliability and relevance of non-standard in vivo studies, which could be used to facilitate systematic and transparent evaluation of such studies for health risk assessment. Another aim was to propose user friendly guidance for reporting of non-standard studies intended to promote an improvement in reporting of studies that could be of use in risk assessment. Requirements and recommendations for the design and execution of in vivo toxicity studies were identified from The Organisation for Economic Co-operation and Development (OECD) test guidelines, and served as basis for the data evaluation criteria and reporting guidelines. Feedback was also collected from experts within the field of toxicity testing and risk assessment and used to construct a two-tiered framework for study evaluation, as well as refine the reporting guidelines. The proposed framework emphasizes the importance of study relevance and an important aspect is to not completely dismiss studies from health risk assessment based on very strict criteria for reliability. The suggested reporting guidelines provide researchers with a tool to fulfill reporting requirements as stated by regulatory agencies. Together, these resources provide an approach to include all relevant data that may fill information gaps and reduce scientific uncertainty in health risk assessment conclusions, and subsequently also in chemical policy decisions. Copyright © 2014 John Wiley & Sons, Ltd.

  17. Can pegylated interferon improve the outcome of polycythemia vera patients?

    Science.gov (United States)

    Crisà, Elena; Cerrano, Marco; Beggiato, Eloise; Benevolo, Giulia; Lanzarone, Giuseppe; Manzini, Paola Maria; Borchiellini, Alessandra; Riera, Ludovica; Boccadoro, Mario; Ferrero, Dario

    2017-01-13

    Pegylated interferon (peg-IFN) was proven by phase II trials to be effective in polycythemia vera (PV); however, it is not clear whether it could improve patient outcome compared to hydroxyurea (HU). Here, we present an observational study on 65 PV patients aged 65 years or younger, who received either peg-IFN (30) or HU (35) according to the physician choice. Median follow-up was 75 months. The two cohorts were comparable for patient and disease characteristics. Eighty-seven percent of the patients treated with peg-INF responded, with a CR rate of 70% as compared to 100 and 49% with HU, respectively. Discontinuation rate was similar in the two groups (20% in peg-IFN vs 17% in HU). JAK2 allele burden was monitored in peg-INF arm only, and a reduction was observed in 88% of the patients. No thrombotic events were observed during peg-IFN treatment compared to three on HU. Disease progression to myelofibrosis or acute myeloid leukemia occurred to a patient only in peg-INF, compared to three in HU. Overall, three second malignancies were observed during the study, two in patients who received HU only, and one in a patient largely treated HU who received also peg-IFN for 3 months. Overall survival was significantly better for peg-IFN patients compared to HU, p = 0.027. Our study, albeit limited by small patient and event number and lack of randomization, confirms the efficacy of peg-INF in PV and shows a significant survival advantage for peg-INF-treated patients. Waiting for confirming data from the ongoing phase III trials, our study can support peg-INF as a first-line treatment option for PV, at least for younger patients.

  18. Can pegylated interferon improve the outcome of polycythemia vera patients?

    Directory of Open Access Journals (Sweden)

    Elena Crisà

    2017-01-01

    Full Text Available Abstract Pegylated interferon (peg-IFN was proven by phase II trials to be effective in polycythemia vera (PV; however, it is not clear whether it could improve patient outcome compared to hydroxyurea (HU. Here, we present an observational study on 65 PV patients aged 65 years or younger, who received either peg-IFN (30 or HU (35 according to the physician choice. Median follow-up was 75 months. The two cohorts were comparable for patient and disease characteristics. Eighty-seven percent of the patients treated with peg-INF responded, with a CR rate of 70% as compared to 100 and 49% with HU, respectively. Discontinuation rate was similar in the two groups (20% in peg-IFN vs 17% in HU. JAK2 allele burden was monitored in peg-INF arm only, and a reduction was observed in 88% of the patients. No thrombotic events were observed during peg-IFN treatment compared to three on HU. Disease progression to myelofibrosis or acute myeloid leukemia occurred to a patient only in peg-INF, compared to three in HU. Overall, three second malignancies were observed during the study, two in patients who received HU only, and one in a patient largely treated HU who received also peg-IFN for 3 months. Overall survival was significantly better for peg-IFN patients compared to HU, p = 0.027. Our study, albeit limited by small patient and event number and lack of randomization, confirms the efficacy of peg-INF in PV and shows a significant survival advantage for peg-INF-treated patients. Waiting for confirming data from the ongoing phase III trials, our study can support peg-INF as a first-line treatment option for PV, at least for younger patients.

  19. Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people.

    Science.gov (United States)

    Nyström, Monica Elisabeth; Strehlenert, Helena; Hansson, Johan; Hasson, Henna

    2014-09-18

    Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies. A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries. This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care. There is no blue-print on how to approach the challenging task of

  20. Improving patient information leaflets: developing and applying an evaluative model of patient-centredness for text.

    Science.gov (United States)

    Fage-Butler, Antoinette

    2013-01-01

    The purpose of this paper is to present an evaluative model of patient-centredness for text and to illustrate how this can be applied to patient information leaflets (PILs) that accompany medication in the European Union. Patients have criticized PILs for sidelining their experiences, knowledge and affective needs, and denying their individuality. The health communication paradigm of patient-centredness provides valuable purchase on these issues, taking its starting point in the dignity and integrity of the patient as a person. Employing this evaluative model involves two stages. First, a Foucauldian Discourse Analysis is performed of sender and receiver and of the main discourses in PILs. These aspects are then evaluated using the perspectives of patient-centredness theory relating to the medical practitioner, patient and content. The evaluative model is illustrated via a PIL for medication for depression and panic attacks. Evaluation reveals a preponderance of biomedical statements, with a cluster of patient-centred statements primarily relating to the construction of the patient. The paper contributes a new method and evaluative approach to PIL and qualitative health research, as well as outlining a method that facilitates the investigation of interdiscursivity, a recent focus of critical genre analysis.

  1. Increasing Patient Activation Could Improve Outcomes for Patients with Inflammatory Bowel Disease.

    Science.gov (United States)

    Shah, Shawn L; Siegel, Corey A

    2015-12-01

    Inflammatory bowel disease (IBD) is a complex disease process that often requires the integration of skills from various health care providers to adequately meet the needs of patients with IBD. The medical and surgical treatment options for IBD have become more complicated and are frequently a source of angst for both the patient and provider. However, it has become more important than ever to engage patients in navigating the treatment algorithm. Although novel in the IBD world, the concept of patients' becoming more active and effective managers of their care has been well studied in other disease processes such as diabetes mellitus and mental illness. This idea of patient activation refers to a patient understanding his or her role in the care process and having the skill sets and self-reliance necessary to manage his or her own health care. Over the past decade, evidence supporting the role of patient activation in chronic illness has grown, revealing improved health outcomes, enhanced patient experiences, and lower overall costs. Patient activation can be measured, and interventions have been shown to improve levels of activation over time and influence outcomes. A focus on patient activation is very appropriate for patients with IBD because this may potentially serve as a tool for IBD providers to not only improve patient outcomes and experience but also reduce health care costs.

  2. Perceived Barriers, Facilitators and Benefits for Regular Physical Activity and Exercise in Patients with Rheumatoid Arthritis: A Review of the Literature.

    Science.gov (United States)

    Veldhuijzen van Zanten, Jet J C S; Rouse, Peter C; Hale, Elizabeth D; Ntoumanis, Nikos; Metsios, George S; Duda, Joan L; Kitas, George D

    2015-10-01

    Rheumatoid arthritis (RA) is an autoimmune disease, which not only affects the joints but can also impact on general well-being and risk for cardiovascular disease. Regular physical activity and exercise in patients with RA have numerous health benefits. Nevertheless, the majority of patients with RA are physically inactive. This indicates that people with RA might experience additional or more severe barriers to physical activity or exercise than the general population. This narrative review provides an overview of perceived barriers, benefits and facilitators of physical activity and exercise in RA. Databases were searched for articles published until September 2014 using the terms 'rheumatoid arthritis', 'physical activity', 'exercise', 'barriers', 'facilitators', 'benefits', 'motivation', 'motivators' and 'enablers'. Similarities were found between disease-specific barriers and benefits of physical activity and exercise, e.g. pain and fatigue are frequently mentioned as barriers, but reductions in pain and fatigue are perceived benefits of physical activity and exercise. Even though exercise does not influence the existence of barriers, physically active patients appear to be more capable of overcoming them. Therefore, exercise programmes should enhance self-efficacy for exercise in order to achieve long-term physical activity and exercise behaviour. Encouragement from health professionals and friends/family are facilitators for physical activity and exercise. There is a need for interventions that support RA patients in overcoming barriers to physical activity and exercise and help sustain this important health behaviour.

  3. Improving patient care through student leadership in team quality improvement projects.

    Science.gov (United States)

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

    2015-01-01

    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

  4. Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project.

    Science.gov (United States)

    Sheth, Heena; Moreland, Larry; Peterson, Hilary; Aggarwal, Rohit

    2017-01-01

    To improve herpes zoster (HZ) vaccination rates in high-risk patients with rheumatoid arthritis (RA) being treated with immunosuppressive therapy. This quality improvement project was based on the pre- and post-intervention design. The project targeted all patients with RA over the age of 60 years while being treated with immunosuppressive therapy (not with biologics) seen in 13 rheumatology outpatient clinics. The study period was from July 2012 to June 2013 for the pre-intervention and February 2014 to January 2015 for the post-intervention phase. The electronic best practice alert (BPA) for HZ vaccination was developed; it appeared on electronic medical records during registration and medication reconciliation of the eligible patient by the medical assistant. The BPA was designed to electronically identify patient eligibility and to enable the physician to order the vaccine or to document refusal or deferral reason. Education regarding vaccine guidelines, BPA, vaccination process, and feedback were crucial components of the project interventions. The vaccination rates were compared using the chi-square test. We evaluated 1823 and 1554 eligible patients with RA during the pre-intervention and post-intervention phases, respectively. The HZ vaccination rates, reported as patients vaccinated among all eligible patients, improved significantly from the pre-intervention period of 10.1% (184/1823) to 51.7% (804/1554) during the intervention phase (p Electronic identification of vaccine eligibility and BPA significantly improved HZ vaccination rates. The process required minimal modification of clinic work flow and did not burden the physician's time, and has the potential for self-sustainability and generalizability.

  5. Improved quality of life over one year is associated with improved adherence in patients with schizophrenia.

    Science.gov (United States)

    Hayhurst, K P; Drake, R J; Massie, J A; Dunn, G; Barnes, T R E; Jones, P B; Lewis, S W

    2014-03-01

    Quality of life (QoL) is increasingly considered an important outcome in health research. We wished to explore the determinants of change in QoL in patients with schizophrenia over the course of a one-year RCT. Predictors of change in observer-rated QoL (Quality of Life Scale: QLS) were assessed in 363 patients with schizophrenia during the CUtLASS clinical trial. Change in QLS score over the course of a year correlated with change in psychotic and depressive symptoms and treatment adherence. Linear regression showed that improvement in QoL was predicted by reduction in negative and depressive symptoms and improvement in adherence rating. These three change scores together explained 38% of the variance in QLS change. Exploration of the direction of any possible causal effect, using TETRAD, indicated that improved adherence leads to improved QoL, and that change in depression also leads to QoL change. The relationship between QoL and negative symptoms suggests that greater social activity (reflected as better QoL scores) improves negative symptoms. Such a direct relationship between treatment adherence and QoL has not been reported before. Improving adherence to medication would appear to be a key approach to improving measured quality of life in people with schizophrenia. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  6. Malnourished patients on hemodialysis improve after receiving a nutritional intervention

    Directory of Open Access Journals (Sweden)

    Adaiane Calegari

    2011-12-01

    Full Text Available INTRODUCTION: Malnutrition is multifactorial and may be modified by nutritional intervention. We aimed to assess the impact of an intervention on the nutritional status of malnourished hemodialysis patients and their acceptance of a non-industrialized nutritional supplement. METHODS: 18 patients were studied, they were selected from a previous nutritional assessment where nutritional risk was defined as: subjective global assessment > 15 plus one criterion for malnutrition. The following variables were assessed: anthropometric parameters, subjective global assessment, dietary intake, six-minute walking test, quality of life (SF-36, and biochemical tests. Patients were randomized to either Control or Intervention Groups. The Intervention Group received a dietetic supplement during dialysis containing 355 kcal, prepared from simple ingredients. After three months, subjects from the Control Group and other patients also considered at nutritional risk underwent the same intervention. The study groups were compared after three months, and all patients were analyzed before and after the intervention. RESULTS: Fifteen men and three women, aged 56.4 ± 15.6 years-old, nine in each group, were studied. The Intervention Group showed an improvement in the subjective global assessment (p = 0.04. There were differences in role physical and bodily pain domains of SF-36, with improvement in the Intervention Group and worsening in the Control Group (p = 0.034 and p = 0.021. Comparisons before and after intervention for all patients showed improvement in the subjective global assessment (16.18 ± 4.27 versus 14.37 ± 4.20, p = 0.04, and in the six-minute walking test (496.60 ± 132.59 versus 547.80 ± 132.48 m; p = 0.036. The nutritional supplement was well tolerated by all patients, and it did not cause side effects. CONCLUSIONS: The nutritional intervention improved the subjective global assessment and quality of life of hemodialysis patients at short-term. A

  7. Improving patient outcomes in psoriasis: strategies to ensure treatment adherence

    Directory of Open Access Journals (Sweden)

    Yélamos O

    2015-07-01

    Full Text Available Oriol Yélamos, Sandra Ros, Lluís Puig Department of Dermatology, Hospital de la Santa Creu i Sant Pau – Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain Abstract: Psoriasis is a frequent inflammatory disease with a chronic and relapsing course. Therefore, patients with psoriasis are likely to undergo different treatments for long periods of time. Traditionally, therapies used in psoriasis have been associated with poor levels of adherence due to the complexity of the regimens and the poor results obtained with the topical therapies. These poor outcomes are associated with high levels of frustration and anxiety, which decrease adherence and worsen the disease. With the recent introduction of highly efficacious biologic therapies, patients can achieve very good and prolonged responses. However, most patients with psoriasis have mild disease and may be treated with skin-directed therapies. Therefore, it is important to develop strategies to improve adherence in order to achieve better outcomes, and to improve the overall quality of life. Hence, acknowledging the causes of nonadherence is crucial for implementing these strategies. In this summary, we review the causes of nonadherence, and we provide behavioral strategies in order to improve adherence and, ultimately, the outcome of patients with psoriasis. Keywords: psoriasis, adherence, outcome, drug therapy, psychotherapy

  8. Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis.

    Directory of Open Access Journals (Sweden)

    Roberto Sávio Silva Santos

    Full Text Available Restless leg syndrome (RLS is a sleep disorder with high prevalence among patients on hemodialysis. It has been postulated that high phosphate and high parathyroid hormone may be implicated in its pathogenesis. Standard international criteria and face-to-face interview are not always applied.this was an interventional prospective study in which 19 patients (6 men, aged 48±11 years with severe hyperparathyroidism were evaluated. RLS diagnosis and rating scale were accessed based on the International RLS Study Group pre- and post-parathyroidectomy. Patients also underwent standard polysomnography.At baseline, RLS was present in 10 patients (52.6%, and pain was the most reported symptom associated with the diagnosis. Patients with RLS had higher serum phosphate (p = 0.008 that remained independently associated with RLS in a logistic regression model, adjusted for hemoglobin, age and gender (HR = 7.28;CI = 1.14-46.3, p = 0.035. After parathyroidectomy, there was a reduction of serum parathyroid hormone, phosphate, calcium and alkaline phosphatase, and an increase of 25(OH-vitamin D, and Fetuin-A. Parathyroidectomy alleviated RLS (from 52% to 21%; p = 0.04, which was accompanied by a decrease in severity scale, in association with relief of pain and pruritus. Polysomnography in these patients showed an improvement of sleep parameters as measured by sleep efficiency, sleep latency and percentage of REM sleep.RLS is associated with high levels of phosphate in patients with severe secondary hyperparathyroidism on hemodialysis. Pain is most reported complain in these patients. Parathyroidectomy provided an opportunity to relief RLS. Whether the reduction of serum phosphorus or parathyroid hormone contributed to this improvement merits further investigation.

  9. Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis

    Science.gov (United States)

    Santos, Roberto Sávio Silva; Coelho, Fernando Morgadinho Santos; da Silva, Bruno Caldin; Graciolli, Fabiana Giorgeti; Dominguez, Wagner Velasquez; de Menezes Montenegro, Fabio Luiz; Jorgetti, Vanda; Moysés, Rosa Maria Affonso; Elias, Rosilene Motta

    2016-01-01

    Background Restless leg syndrome (RLS) is a sleep disorder with high prevalence among patients on hemodialysis. It has been postulated that high phosphate and high parathyroid hormone may be implicated in its pathogenesis. Standard international criteria and face-to-face interview are not always applied. Methods this was an interventional prospective study in which 19 patients (6 men, aged 48±11 years) with severe hyperparathyroidism were evaluated. RLS diagnosis and rating scale were accessed based on the International RLS Study Group pre- and post-parathyroidectomy. Patients also underwent standard polysomnography. Results At baseline, RLS was present in 10 patients (52.6%), and pain was the most reported symptom associated with the diagnosis. Patients with RLS had higher serum phosphate (p = 0.008) that remained independently associated with RLS in a logistic regression model, adjusted for hemoglobin, age and gender (HR = 7.28;CI = 1.14–46.3, p = 0.035). After parathyroidectomy, there was a reduction of serum parathyroid hormone, phosphate, calcium and alkaline phosphatase, and an increase of 25(OH)-vitamin D, and Fetuin-A. Parathyroidectomy alleviated RLS (from 52% to 21%; p = 0.04), which was accompanied by a decrease in severity scale, in association with relief of pain and pruritus. Polysomnography in these patients showed an improvement of sleep parameters as measured by sleep efficiency, sleep latency and percentage of REM sleep. Conclusion RLS is associated with high levels of phosphate in patients with severe secondary hyperparathyroidism on hemodialysis. Pain is most reported complain in these patients. Parathyroidectomy provided an opportunity to relief RLS. Whether the reduction of serum phosphorus or parathyroid hormone contributed to this improvement merits further investigation. PMID:27196740

  10. Traditional Japanese Medicine Daikenchuto Improves Functional Constipation in Poststroke Patients

    Directory of Open Access Journals (Sweden)

    Takehiro Numata

    2014-01-01

    Full Text Available Poststroke patients with functional constipation, assessed by the Rome III criteria, from 6 hospitals were recruited in a study on the effects of the traditional Japanese medicine Daikenchuto (DKT on constipation. Thirty-four patients (17 men and 17 women; mean age: 78.1 ± 11.6 years were randomly assigned to 2 groups; all patients received conventional therapy for constipation, and patients in the DKT group received 15 g/day of DKT for 4 weeks. Constipation scoring system (CSS points and the gas volume score (GVS (the measure of the intestinal gas volume calculated from plain abdominal radiographs were recorded before and after a 4-week observation period. The total score on the CSS improved significantly in the DKT group compared to the control (P<0.01. In addition, scores for some CSS subcategories (frequency of bowel movements, feeling of incomplete evacuation, and need for enema/disimpaction significantly improved in the DKT group (P<0.01, P=0.049, and P=0.03, resp.. The GVS was also significantly reduced in the DKT group compared to the control (P=0.03. DKT in addition to conventional therapy is effective in treating functional constipation in poststroke patients. This study was a randomized controlled trial and was registered in the UMIN Clinical Trial Registry (no. UMIN000007393.

  11. Improved denture retention in patients with retracted tongues.

    Science.gov (United States)

    Lee, Ji-Hua; Chen, Jen-Hao; Lee, Huey-Er; Chang, Hong-Po; Chen, Hong-Sen; Yang, Yi-Hsin; Chou, Tsau-Mau

    2009-08-01

    Patients who wear mandibular dentures and hold their tongues in retracted positions alter the dimensions of the sublingual space and disrupt the peripheral seal that is needed for optimal denture retention. The authors studied whether retention could be improved if patients moved their tongues from a retracted resting position to an ideal resting position. The authors observed and classified the mandibular residual ridge morphologies of 85 participants who wore complete dentures. The authors recorded and compared the retention of the mandibular denture before and after repositioning the tongue to the ideal resting position. When the participants' tongues were in a retracted resting position, the average retention of the mandibular denture was 75.38 gram weight (+/- 81.83 standard deviation [SD]). After participants repositioned their tongues to the ideal resting position, the average retention of the mandibular denture was 118.89 gw (+/- 93.00 SD), an increase of 57.73 percent. In all morphological classes, when participants held their tongues in the ideal resting position, the average mandibular denture retention increased by 57.73 percent, a statistically significant improvement compared with when participants held their tongues in a retracted resting position. Clinicians are encouraged to evaluate carefully the tongue resting position in all patients who wear dentures, help create reasonable therapeutic expectations by informing patients about the significant effect that tongue position will have on future denture retention and provide helpful neuromuscular training for patients with retracted-tongue habits.

  12. Improving personal health records for patient-centered care

    Science.gov (United States)

    Feldman, Henry J; Ross, Stephen E; Safran, Charles

    2010-01-01

    Objective To assess the patient-centeredness of personal health records (PHR) and offer recommendations for best practice guidelines. Design Semi-structured interviews were conducted in seven large early PHR adopter organizations in 2007. Organizations were purposively selected to represent a variety of US settings, including medium and large hospitals, ambulatory care facilities, insurers and health plans, government departments, and commercial sectors. Measurements Patient-centeredness was assessed against a framework of care that includes: (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Within this framework we used evidence for patient preferences (where it exists) to compare existing PHR policies, and propose a best practice model. Results Most organizations enable many patient-centered functions such as data access for proxies and minors. No organization allows patient views of clinical progress notes, and turnaround times for PHR reporting of normal laboratory results can be up to 7 days. Conclusion Findings suggest patient-centeredness for personal health records can be improved, and recommendations are made for best practice guidelines. PMID:20190063

  13. Patient counseling: the key to improving success with OCs.

    Science.gov (United States)

    1995-07-01

    The most important step in counseling patients about the use of oral contraceptives (OCs) is to uncover patient fears because patients will not use a product if they believe it is not good for them. Clinicians can ask patients what negative stories they have heard about OCs, and clinicians should also introduce such stories in the conversation. Clinicians can then provide accurate information about the risks of OCs and warn patients about the dangers of cigarette smoking. Then, clinicians should provide information on the health benefits of OC use. Some women can cite menstrual cycle benefits of OC use, but few US women know that OCs can protect against ovarian and endometrial cancer, anemia, ectopic pregnancy, pelvic inflammatory diseases, or benign breast disease. Health benefit counseling may improve patient continuation as well as compliance. Patients also need specific information on how to take the OC, what to do about a missed pill, how to handle common nuisance side effects, and who to call with questions. More frequent follow-up visits should be scheduled for teenagers.

  14. Measuring and improving the patient experience in radiology.

    Science.gov (United States)

    Brook, Olga R; Siewert, Bettina; Weinstein, Jeffrey; Ahmed, Muneeb; Kruskal, Jonathan

    2017-04-01

    Recently enacted healthcare legislation and the associated payment reforms have shifted the focus from traditional fee for service models to adding measurable and appreciable value to the patient experience. The value equation links quality to costs, and quality metrics are now directly related to patient outcomes and the patient experience. To participate effectively in this new paradigm requires not only that we provide excellent, timely and appropriate patient-centric care at all times, but that we are able to measure and manage the feedback we obtain from our patients. Of course, in order to provide value-added care, we must know not only who our customers are, but what they value. In this review, we explore factors that impact patient perception and experience with imaging services. We further illustrate different ways that patient feedback can be elicited and provide pros and cons of each approach. Collecting appropriate data is insufficient by itself; such data must be carefully analyzed, and opportunities for improvement must be identified, introduced, and monitored ahead of future surveys.

  15. Kaiser Permanente's performance improvement system, part 3: multisite improvements in care for patients with sepsis.

    Science.gov (United States)

    Whippy, Alan; Skeath, Melinda; Crawford, Barbara; Adams, Carmen; Marelich, Gregory; Alamshahi, Mezhgan; Borbon, Josefina

    2011-11-01

    In 2008, Kaiser Permanente Northern California implemented an initiative to improve sepsis care. Early detection and expedited implementation of sepsis treatment bundles that include early goal-directed therapy (EGDT) for patients with severe sepsis were implemented. In a top-down, bottom-up approach to performance improvement, teams at 21 medical centers independently decided how to implement treatment bundles, using a "playbook" developed by rapid cycle pilot testing at two sites and endorsed by a sepsis steering committee of regional and medical center clinical leaders. The playbook contained treatment algorithms, standardized order sets and flow charts, best practice alerts, and chart abstraction tools. Regional mentors and improvement advisers within the medical centers supported team-building and rapid implementation. Timely and actionable data allowed ongoing identification of improvement opportunities. A consistent approach to performance improvement propelled local rapid improvement cycles and joint problem solving across facilities. The number of sepsis diagnoses per 1,000 admissions increased from a baseline value of 35.7 in July 2009 to 119.4 in May 2011. The percent of admitted patients who have blood cultures drawn who also have a serum lactate level drawn increased from a baseline of 27% to 97% in May 2011. The percent of patients receiving EGDT who had a second and lower lactate level within six hours increased from 52% at baseline to 92% in May 2011. Twenty-one cross-functional frontline teams redesigned processes of care to provide regionally standardized, evidence-based treatment algorithms for sepsis, substantially increasing the identification and risk stratification of patients with suspected sepsis and the provision of a sepsis care bundle that included EGDT.

  16. Concept mapping: a tool for improving patient care.

    Science.gov (United States)

    Aberdeen, Suzanne

    2015-07-29

    This article reviews the use of concept mapping as a person-centred problem-solving aid to assessment, risk management, care evaluation and care planning for nurses. Concept maps are diagrams that are used to organise, represent and create knowledge, and provide a useful framework for critical analysis and problem solving. Concept mapping is discussed and demonstrated in relation to improving the quality of care for patients and as a tool for clinical leadership and teamwork. The benefits of concept mapping for patients' wellbeing and safety, staff satisfaction and team learning are evidenced.

  17. Neuromuscular electrical stimulation of the median nerve facilitates low motor cortex excitability in patients with spinocerebellar ataxia.

    Science.gov (United States)

    Chen, Chih-Chung; Chuang, Yu-Fen; Yang, Hsiao-Chu; Hsu, Miao-Ju; Huang, Ying-Zu; Chang, Ya-Ju

    2015-02-01

    The neuromodulation of motor excitability has been shown to improve functional movement in people with central nervous system damage. This study aimed to investigate the mechanism of peripheral neuromuscular electrical stimulation (NMES) in motor excitability and its effects in people with spinocerebellar ataxia (SCA). This single-blind case-control study was conducted on young control (n=9), age-matched control (n=9), and SCA participants (n=9; 7 SCAIII and 2 sporadic). All participants received an accumulated 30 min of NMES (25 Hz, 800 ms on/800 ms off) of the median nerve. The central motor excitability, measured by motor evoked potential (MEP) and silent period, and the peripheral motor excitability, measured by the H-reflex and M-wave, were recorded in flexor carpi radialis (FCR) muscle before, during, and after the NMES was applied. The results showed that NMES significantly enhanced the MEP in all 3 groups. The silent period, H-reflex and maximum M-wave were not changed by NMES. We conclude that NMES enhances low motor excitability in patients with SCA and that the mechanism of the neuromodulation was supra-segmental. These findings are potentially relevant to the utilization of NMES for preparation of motor excitability. The protocol was registered at Clinicaltrials.gov (NCT02103075).

  18. Acute nicotine improves social decision-making in non-smoking but not in smoking schizophrenia patients.

    Science.gov (United States)

    Quisenaerts, Charel; Morrens, Manuel; Hulstijn, Wouter; de Boer, Peter; Timmers, Maarten; Sabbe, B; de Bruijn, Ellen R A

    2013-01-01

    Schizophrenia patients are characterized by severe social impairments. Recently, social cognition has been put forward as an important mediator in schizophrenia between the often-reported neurocognitive deficits and functional outcome and is thus an important target for treatments. Nicotine has been reported to improve neurocognitive processes in schizophrenia patients but no studies have investigated possible nicotine-induced facilitation of social cognition. The current placebo-controlled crossover study aimed at bridging this gap by investigating whether the administration of active (1 mg or 2 mg) or placebo oromucosal nicotine spray resulted in improved social decision-making in non-smoking (N = 15) and smoking (N = 16) schizophrenia patients. All patients played the role of responder in a variant of the ultimatum game that allowed detailed measurements of fairness and intentionality considerations. The results showed impaired social decision-making in the non-smoking patients under placebo, but not in the smoking patients. Interestingly, this impairment normalized after administration of 1 mg of nicotine, but not after 2 mg of nicotine. Nicotine had no effect on performance in the smoking patients. The present study indicates that nicotine improves social decision-making in non-smoking patients. The present results suggest that acute nicotine effects may result in a facilitation of proactive control through improved attentional processes. However, the efficacy seems limited and although nicotine may thus be an interesting target for (social) cognitive enhancement in the subset of patients that do not smoke, more research is needed on the long-lasting effects of nicotine-based treatments.

  19. Acute nicotine improves social decision-making in non-smoking but not in smoking schizophrenia patients.

    Directory of Open Access Journals (Sweden)

    Charel eQuisenaerts

    2013-10-01

    Full Text Available Schizophrenia patients are characterized by severe social impairments. Recently, social cognition has been put forward as an important mediator in schizophrenia between the often-reported neurocognitive deficits and functional outcome and is thus an important target for treatments. Nicotine has been reported to improve neurocognitive processes in schizophrenia patients but no studies have investigated possible nicotine-induced facilitation of social cognition. The current placebo-controlled crossover study aimed at bridging this gap by investigating whether the administration of active (1 mg or 2 mg or placebo oromucosal nicotine spray resulted in improved social decision-making in non-smoking (N=15 and smoking (N=16 schizophrenia patients. All patients played the role of responder in a variant of the ultimatum game that allowed detailed measurements of fairness and intentionality considerations. The results showed impaired social decision-making in the non-smoking patients under placebo, but not in the smoking patients. Interestingly, this impairment normalized after administration of 1 mg of nicotine, but not after 2 mg of nicotine. Nicotine had no effect on performance in the smoking patients. The present study indicates that nicotine improves social decision-making in non-smoking patients. The present results suggest that acute nicotine effects may result in a facilitation of proactive control through improved attentional processes. However, the efficacy seems limited and although nicotine may thus be an interesting target for (socialcognitive enhancement in the subset of patients that do not smoke, more research is needed on the long-lasting effects of nicotine-based treatments.

  20. [Primary care for diabetic patients: a quality improvement cycle].

    Science.gov (United States)

    Navarro-Martínez, A; Suárez-Beke, M P; Sánchez-Nicolás, J A; Lázaro-Aragues, P; de Jesús Jiménez-Vázquez, E; Huertas-de Mora, O

    2014-01-01

    The aim of this study was to evaluate and improve the quality of medical care provided to diabetic patients following the standards proposed by the American Diabetes Association. The study was conducted in three phases by analyzing data from the computerized clinical history of a sample of 340 patients. First phase (2010): cross-sectional, descriptive study which assessed the proportion of patients who met the standards related to the screening of diabetes, and goals of control and treatment. Subsequently, health professionals reviewed the results in order to promote the implementation of corrective action. Finally (2012), a new assessment with the same standards was performed. An increase in the number of patients treated with insulin (12.7% in 2010 and 20.2% in 2012) was observed (P < .01). There were also percentage increases in the number of patients who met the screening standards as regards analytical determinations: glycosylated hemoglobin (from 44.4% to 68.2%), lipid profile (47.6%-73.8%), creatinine (32.5% - 73.5%), and albumin-creatinine ratio (9.2%-24.4%) (P < .001). Only 6.4% (CI: 3.2- 9.8) of diabetic patients attained the composite target of glycosylated hemoglobin < 7%, blood pressure < 130/80 mmHg and low-density lipoprotein cholesterol < 100 mg/dl in 2012. This study shows that medical care has improved the goals related to analytical determinations and the number of insulin-treated diabetic type 2 patients. An optimal level was also maintained in metabolic control of diabetes, but there was still poor control of risk factors for cardiovascular disease. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  1. Randomized controlled comparative study on effect of training to improve lower limb motor paralysis in convalescent patients with post-stroke hemiplegia

    OpenAIRE

    Kawakami, Kenji; Miyasaka, Hiroyuki; Nonoyama, Sayaka; HAYASHI, Kazuya; Tonogai, Yusuke; Tanino, Genichi; Wada, Yosuke; Narukawa, Akihisa; Okuyama, Yuko; Tomita, Yutaka; ,; Sonoda, Shigeru

    2015-01-01

    [Purpose] The motor paralysis-improving effect on the hemiplegic lower limb was compared among mirror therapy, integrated volitional-control electrical stimulation, therapeutic electrical stimulation, repetitive facilitative exercises, and the standard training method in post-stroke hemiplegia patients. [Subjects and Methods] Eighty one stroke patients admitted to a convalescent rehabilitation ward were randomly allocated to the above 5 treatment groups. Each patient performed functional trai...

  2. Developing Unique Engineering Solutions to Improve Patient Safety

    Directory of Open Access Journals (Sweden)

    Bradley V. Watts

    2012-01-01

    Full Text Available Many efforts to improve healthcare safety have focused on redesigning processes of care or retraining clinicians. Far less attention has been focused on the use of new technologies to improve safety. We present the results of a unique collaboration between the VA National Center for Patient Safety (NCPS and the Thayer School of Engineering at Dartmouth College. Each year, the NCPS identifies safety problems across the VA that could be addressed with newly-engineered devices. Teams of Thayer students and faculty participating in a senior design course evaluate and engineer a solution for one of the problems. Exemplar projects have targeted surgical sponge retention, nosocomial infections, surgical site localization, and remote monitoring of hospitalized patients undergoing diagnostic testing and procedures. The program has served as an avenue for engineering students and health care workers to solve problems together. The success of this academic-clinical partnership could be replicated in other settings.

  3. Investigating the use of patient involvement and patient experience in quality improvement in Norway

    DEFF Research Database (Denmark)

    Wiig, Siri; Storm, Marianne; Aase, Karina;

    2013-01-01

    BACKGROUND: Patient involvement in health care decision making is part of a wider trend towards a more bottom-up approach to service planning and provision, and patient experience is increasingly conceptualized as a core dimension of health care quality.The aim of this multi-level study is two......-fold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve...... the quality of care they provide. METHODS: This multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews and non-participant observation of key meetings and shadowing of staff at the meso and micro levels in two purposively...

  4. Nurse practitioner care improves renal outcome in patients with CKD.

    Science.gov (United States)

    Peeters, Mieke J; van Zuilen, Arjan D; van den Brand, Jan A J G; Bots, Michiel L; van Buren, Marjolijn; Ten Dam, Marc A G J; Kaasjager, Karin A H; Ligtenberg, Gerry; Sijpkens, Yvo W J; Sluiter, Henk E; van de Ven, Peter J G; Vervoort, Gerald; Vleming, Louis-Jean; Blankestijn, Peter J; Wetzels, Jack F M

    2014-02-01

    Treatment goals for patients with CKD are often unrealized for many reasons, but support by nurse practitioners may improve risk factor levels in these patients. Here, we analyzed renal endpoints of the Multifactorial Approach and Superior Treatment Efficacy in Renal Patients with the Aid of Nurse Practitioners (MASTERPLAN) study after extended follow-up to determine whether strict implementation of current CKD guidelines through the aid of nurse practitioners improves renal outcome. In total, 788 patients with moderate to severe CKD were randomized to receive nurse practitioner support added to physician care (intervention group) or physician care alone (control group). Median follow-up was 5.7 years. Renal outcome was a secondary endpoint of the MASTERPLAN study. We used a composite renal endpoint of death, ESRD, and 50% increase in serum creatinine. Event rates were compared with adjustment for baseline serum creatinine concentration and changes in estimated GFR were determined. During the randomized phase, there were small but significant differences between the groups in BP, proteinuria, LDL cholesterol, and use of aspirin, statins, active vitamin D, and antihypertensive medications, in favor of the intervention group. The intervention reduced the incidence of the composite renal endpoint by 20% (hazard ratio, 0.80; 95% confidence interval, 0.66 to 0.98; P=0.03). In the intervention group, the decrease in estimated GFR was 0.45 ml/min per 1.73 m(2) per year less than in the control group (P=0.01). In conclusion, additional support by nurse practitioners attenuated the decline of kidney function and improved renal outcome in patients with CKD.

  5. The Use of Electronic Medical Records To Facilitate Identification of Patients Presenting With Oro-facial Complaints To The General Medical Practitioners

    OpenAIRE

    Chan, Sze Seng

    2014-01-01

    ABSTRACTThe University of ManchesterSzeSeng ChanMaster of Philosophy in Oral and Maxillofacial SurgeryThe Use of Electronic Medical Records to Facilitate Identification of Patients Presenting With Oro-facial Complaints To The General Medical PractitionersJanuary 2014Aims : To study the pattern of attendance of patients who present to General Medical Practitioners (GMPs) with oro-facial or/and dental complaints. Data Source : All the Primary Medical Cares (PMCs) in the North West e-health data...

  6. Does implementation of ISO standards in hospitals improve patient satisfaction?

    Directory of Open Access Journals (Sweden)

    Vahid Keshtkar

    2017-01-01

    Full Text Available Introduction: Around the world, a large number of projects have been developed with the aim of assessing patient satisfaction especially in hospitals. As an important indicator of the quality of health care system, Patients’ perception of health care has been the center of attention over the recent 20 years. Method: 402 patients who were hospitalized in teaching hospitals affiliated to the Shiraz University of Medical Sciences were investigated. Patients’ satisfactions of the health care services were assessed using the translated and modified version of the KQCAH consisted of 44 questions divided to7 categories of Respect and Caring, Effectiveness and Continuity, Appropriateness, Information, Efficiency, Meals, First Impression, Staff Diversity. All of the patients were asked to fill out the questionnaire (with written informed consents at the time of discharge from the hospitals. Results: Regarding total score of patient satisfaction the ISO-certified hospitals did not show advantages over the uncertified hospitals. The total score of patients’ satisfaction ranged from 66.5 to 77.5 in. Overall, only in one ISO-certified hospital the total score of patient satisfaction representing all dimensions, was significantly higher comparing to other hospitals included in the study. Conclusion: It seems that solitary application of ISO standards could not improve patient satisfaction in hospitals affiliated to Shiraz University of Medical Sciences.

  7. Patient-centered transfer process for patients admitted through the ED boosts satisfaction, improves safety.

    Science.gov (United States)

    2013-02-01

    To improve safety and patient flow, administrators at Hallmark Health System, based in Melrose, MA, implemented a new patient-centered transfer process for patients admitted through the ED at the health system's two hospitals. Under the new approach, inpatient nurses come down to the ED to take reports on new patients in a process that includes the ED care team as well as family members. The inpatient nurses then accompany the patients up to their designated floors. Since the new patient-transfer process was implemented in June 2012, patient satisfaction has increased by at least one point on patient satisfaction surveys. Administrators anticipate that medical errors or omissions related to the handoff process will show a drop of at least 50%, when data is tabulated.

  8. Enhancing patient safety: improving the patient handoff process through appreciative inquiry.

    Science.gov (United States)

    Shendell-Falik, Nancy; Feinson, Michael; Mohr, Bernard J

    2007-02-01

    Patient transfers from one care giver to another are an area of high safety consequence, as is evident by many studies and the Joint Commission on Accreditation of Healthcare Organization's Patient Safety Goals. The authors describe how one hospital made measurable improvements in a patient handoff process by using an unconventional approach to change called appreciative inquiry. Rather than identifying the root causes of ineffective handoffs, appreciative inquiry was used to engage staff in identifying and building on their most effective handoff experiences.

  9. Improved survival with the patients with variceal bleed.

    Science.gov (United States)

    Sharma, Praveen; Sarin, Shiv K

    2011-01-01

    Variceal hemorrhage is a major cause of death in patients with cirrhosis. Over the past two decades new treatment modalities have been introduced in the management of acute variceal bleeding (AVB) and several recent studies have suggested that the outcome of patients with cirrhosis and AVB has improved. Improved supportive measures, combination therapy which include early use of portal pressure reducing drugs with low rates of adverse effects (somatostatin, octerotide or terlipressin) and endoscopic variceal ligation has become the first line treatment in the management of AVB. Short-term antibiotic prophylaxis, early use of lactulose for prevention of hepatic encephalopathy, application of early transjugular intrahepatic portasystemic shunts (TIPS), fully covered self-expandable metallic stent in patients for AVB may be useful in those cases where balloon tamponade is considered. Early and wide availability of liver transplantation has changed the armamentarium of the clinician for patients with AVB. High hepatic venous pressure gradient (HVPG) >20 mmHg in AVB has become a useful predictor of outcomes and more aggressive therapies with early TIPS based on HVPG measurement may be the treatment of choice to reduce mortality further.

  10. Improved Survival with the Patients with Variceal Bleed

    Directory of Open Access Journals (Sweden)

    Praveen Sharma

    2011-01-01

    Full Text Available Variceal hemorrhage is a major cause of death in patients with cirrhosis. Over the past two decades new treatment modalities have been introduced in the management of acute variceal bleeding (AVB and several recent studies have suggested that the outcome of patients with cirrhosis and AVB has improved. Improved supportive measures, combination therapy which include early use of portal pressure reducing drugs with low rates of adverse effects (somatostatin, octerotide or terlipressin and endoscopic variceal ligation has become the first line treatment in the management of AVB. Short-term antibiotic prophylaxis, early use of lactulose for prevention of hepatic encephalopathy, application of early transjugular intrahepatic portasystemic shunts (TIPS, fully covered self-expandable metallic stent in patients for AVB may be useful in those cases where balloon tamponade is considered. Early and wide availability of liver transplantation has changed the armamentarium of the clinician for patients with AVB. High hepatic venous pressure gradient (HVPG >20 mmHg in AVB has become a useful predictor of outcomes and more aggressive therapies with early TIPS based on HVPG measurement may be the treatment of choice to reduce mortality further.

  11. Strategies to improve self-management in heart failure patients.

    Science.gov (United States)

    Toback, Mehnosh; Clark, Nancy

    2017-02-01

    Heart failure is one of the most common causes of hospitalization, hospital readmission and death. Patients with heart failure have many complications, with multiple co-existing diagnoses which result in polypharmacy. Following instructions provided by many physicians, medication adjustments based on changes in their symptoms are required. Behavioral adjustments concerning diet and exercise regime are recommended. Therefore, the patient plays a crucial role in the management of heart failure. To review the available studies on heart failure self-management, and investigate educational, behavioral and psychosocial strategies that plays an important role to improve patient self-management. A literature review was conducted based upon the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidance. The articles identified through an extensive search using PubMed and UpToDate from 1999 to 2016. Improved self-management will increase compliance, promote patient quality-of-life, advance clinical outcomes, reduce hospital re-admission and will decrease hospitalization costs.

  12. Improving outpatient access and patient experiences in academic ambulatory care.

    Science.gov (United States)

    O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

    2012-02-01

    Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume.

  13. Can asthma control be improved by understanding the patient's perspective?

    Directory of Open Access Journals (Sweden)

    Østrem Anders

    2007-05-01

    agreement between the healthcare professional and patient on a predefined target regarding asthma control and a treatment plan to achieve this. Summary Optimum review of asthma is essential to improve control. A key priority is the development of simple and effective tools for identifying poor control for individual patients coupled with a tailored approach to treatment to enable patients to set and achieve realistic goals for asthma control.

  14. Support System to Improve Reading Activity in Parkinson’s Disease and Essential Tremor Patients

    Directory of Open Access Journals (Sweden)

    Franklin Parrales Bravo

    2017-05-01

    Full Text Available The use of information and communication technologies (ICTs to improve the quality of life of people with chronic and degenerative diseases is a topic receiving much attention nowadays. We can observe that new technologies have driven numerous scientific projects in e-Health, encompassing Smart and Mobile Health, in order to address all the matters related to data processing and health. Our work focuses on helping to improve the quality of life of people with Parkinson’s Disease (PD and Essential Tremor (ET by means of a low-cost platform that enables them to read books in an easy manner. Our system is composed of two robotic arms and a graphical interface developed for Android platforms. After several tests, our proposal has achieved a 96.5% accuracy for A4 80 gr non-glossy paper. Moreover, our system has outperformed the state-of-the-art platforms considering different types of paper and inclined surfaces. The feedback from ET and PD patients was collected at “La Princesa” University Hospital in Madrid and was used to study the user experience. Several features such as ease of use, speed, correct behavior or confidence were measured via patient feedback, and a high level of satisfaction was awarded to most of them. According to the patients, our system is a promising tool for facilitating the activity of reading.

  15. Predicting patient volume in cardiac catheterization laboratory to improve resource management.

    Science.gov (United States)

    Liu, Jianhua; Santangelo, Jennifer; James, Randy; Watters, Coyt D; Orsini, Anthony; Mekhjian, Hagop; Kamal, Jyoti

    2008-11-06

    Using historical data within the Information Warehouse of the Ohio State University Medical Center, prediction on daily patient volume to catheterization laboratory was attempted to facilitate resource management and planning.

  16. Robotic neurorehabilitation in patients with chronic stroke: psychological well-being beyond motor improvement.

    Science.gov (United States)

    Calabrò, Rocco S; De Cola, Maria C; Leo, Antonino; Reitano, Simone; Balletta, Tina; Trombetta, Giovanni; Naro, Antonino; Russo, Margherita; Bertè, Francesco; De Luca, Rosaria; Bramanti, Placido

    2015-09-01

    Although gait abnormality is one of the most disabling events following stroke, cognitive, and psychological impairments can be devastating. The Lokomat is a robotic that has been used widely for gait rehabilitation in several movement disorders, especially in the acute and subacute phases. The aim of this study was to evaluate the effectiveness of gait robotic rehabilitation in patients affected by chronic stroke. Psychological impact was also taken into consideration. Thirty patients (13 women and 17 men) affected by chronic stroke entered the study. All participants underwent neurological examination with respect to ambulation, Ashworth, Functional Independence Measure, and Tinetti scales to assess their physical status, and Hamilton Rating Scale for Depression, Psychological General Well-being Index, and Coping Orientation to Problem Experienced to evaluate the Lokomat-related psychological impact before and after either a conventional treatment or the robotic training. During each rehabilitation period (separated by a no-treatment period), patients underwent a total of 40 1 h training sessions (i.e. five times a week for 8 weeks). After the conventional treatment, the patients did not achieve a significant improvement in the functional status, except balance (Probotic rehabilitation, significant improvements were detected in almost all the motor and psychological scales that we investigated, particularly for Psychological General Well-being Index and Coping Orientation to Problem Experienced. Manual and robotic-assisted body weight-supported treadmill training optimizes the sensory inputs relevant to step training, repeated practice, as well as neuroplasticity. Several controlled trials have shown a superior effect of Lokomat treatment in stroke patients' walking ability and velocity in particular. Therefore, our preliminary results proved that active robotic training not only facilitates gait and physical function but also the psychological status, even in

  17. Facilitation skills for nurses

    Directory of Open Access Journals (Sweden)

    F Cilliers

    2000-09-01

    Full Text Available Using the pcrson-centered approach, facilitation in this study was conceptualised as providing opportunities for personal growth in the patient, and operationalised in a skills workshop for 40 nurses from different hospitals in Gauteng. The first objective was to evaluate the workshop and the second to ascertain its effect on the participant’s experienced performance. A combined quantitative and qualitative research design was used. The quantitative measurement (Personal Orientation Inventory, Carkhuff scales indicated that the workshop stimulated self-actualisation in terms of intrapersonal awareness, and the interpersonal skills of respect, realness, concreteness, empathy, as well as in terms of attending and responding behaviour. The qualitative measurement (a semi-structured interview indicated that the participants were able to empower patients to find their own answers to difficult personal questions. The alternative hypothesis was accepted, namely that this workshop in facilitations skills significantly enhanced the intra- and interpersonal characteristics associated with self-actualisation and the facilitation of growth in patients. The findings highlighted the difference between the two roles of instructor and facilitator, and recommendations to this effect were formulated.

  18. Medication Discussion Questions (MedDQ): developing a guide to facilitate patient-clinician communication about heart medications.

    Science.gov (United States)

    Garavalia, Linda; Garavalia, Brian; Spertus, John A; Decker, Carole

    2011-01-01

    Adherence to evidence-based therapies has emerged as one of the great challenges of translating discoveries to clinical care to optimize patient outcomes. In particular, nonadherence to lifesaving medications continues to trouble health care systems. We conducted a series of studies to investigate why cardiac patients stop life-sustaining medications and to develop a tool to proactively address medication adherence issues. We could find no available preventive tools for communicating with patients about their medications in the clinical setting. In this article, we summarize the process of developing such a tool. We used a mixed-methods approach in a series of studies that included examining quantitative data from a large patient registry, conducting in-depth qualitative patient interviews, creating items representative of the qualitative findings, pilot testing items with heart patients, surveying an expert panel to establish content validity, and conducting in-depth interviews with health care providers to assess implementation opportunities. Patient interviews revealed that patients' values and beliefs, barriers to treatment, and prior medication-taking behavior were of primary importance in understanding medication discontinuance. Pilot testing, expert panel review, and an implementation feasibility evaluation resulted in an 11-item communication guide to be used in a variety of health care settings. Clinicians need an efficient way of systematically communicating with patients about heart medications to identify barriers and to initiate preventive interventions when patients report barriers or challenges to medication adherence. Copyright © 2011 Lippincott Williams & Wilkins.

  19. A novel melatonin agonist Neu-P11 facilitates memory performance and improves cognitive impairment in a rat model of Alzheimer' disease.

    Science.gov (United States)

    He, Pingping; Ouyang, Xinping; Zhou, Shouhong; Yin, Weidong; Tang, Chaoke; Laudon, Moshe; Tian, Shaowen

    2013-06-01

    Previous studies have shown that melatonin is implicated in modulating learning and memory processing. Melatonin also exerts neuroprotective activities against Aβ-induced injury in vitro and in vivo. Neu-P11 (piromelatine, N-(2-(5-methoxy-1H-indol-3-yl)ethyl)-4-oxo-4H-pyran-2-carboxamide) is a novel melatonin (MT1/MT2) receptor agonist and a serotonin 5-HT1A/1D receptor agonist recently developed for the treatment of insomnia. In the present study we firstly investigated whether Neu-P11 and melatonin enhance memory performance in the novel object recognition (NOR) task in rats, and then assessed whether Neu-P11 and melatonin improve neuronal and cognitive impairment in a rat model of Alzheimer' disease (AD) induced by intrahippocampal Aβ(1-42) injection. The results showed that a single morning or afternoon administration of Neu-P11 enhanced object recognition memory measured at 4 or 24h after training. Melatonin was effective in the memory facilitating effects only when administered in the afternoon. Further results showed that intrahippocampal Aβ(1-42) injection resulted in hippocampal cellular loss, as well as decreased learning ability and memory in the Y maze and NOR tasks in rats. Neu-P11 but not melatonin attenuated cellular loss and cognitive impairment in the rat AD model. The current data suggest that Neu-P11 may serve as a novel agent for the treatment of AD.

  20. Improved nutritional status in elderly patients 6 months after stroke.

    Science.gov (United States)

    Brynningsen, P K; Damsgaard, E M S; Husted, S E

    2007-01-01

    Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery, length of stay in hospital and infectious complications. 89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months and 6 months. Nutritional status was evaluated by body weight, body mass index (BMI), mid upper arm circumference (MAC), triceps skinfold thickness (TSF) and serum concentrations of albumin and transferrin. Malnutrition was defined if the patients had 2 or more abnormal nutritional variables. We found a significant increase in albumin from 1 week to 6 months (P nutritional variables was 31 (35 %) at 1 week and was reduced to 20 (22 %) at 6 months. 35 % of elderly patients with ischemic stroke admitted to a geriatric rehabilitation unit were malnourished 1 week after stroke. Particularly serum proteins and body fat were affected. Follow-up of nutritional variables showed improvement for serum proteins, and 22 % of the patients were malnourished 6 months after stroke.

  1. Improving the quality of care for patients with hypertension in Moshupa District, Botswana: Quality improvement cycle

    Directory of Open Access Journals (Sweden)

    Cathy Kande

    2014-01-01

    Full Text Available Background: Although there are no prevalence studies on hypertension in Botswana, this condition is thought to be common and the quality of care to be poor.Aim: The aim of this project was to assess and improve the quality of primary care forhypertension.Setting: Moshupa clinic and catchment area, Botswana.Methods: Quality improvement cycle.Results: Two hundred participants were included in the audit. Sixty-eight per cent were women with a mean age of 55 years. In the baseline audit none of the target standards were met. During the re-audit six months later, six out of nine structural target standards, five out of 11 process target standards and one out of two outcome target standards were achieved. Statistically-significant improvement in performance (p < 0.05 was shown in 10 criteria although the target standard was not always met. In the re-audit, the target of achieving blood pressure control (< 140/90 in 70% of patients was achieved.Conclusion: The quality of care for hypertension was suboptimal in our setting. Simple interventions were designed and implemented to improve the quality of care. These interventions led to significant improvement in structural and process criteria. A corresponding significant improvement in the control of blood pressure was also seen.

  2. In patients with schizophrenia, symptoms improvement can be uncorrelated with quality of life improvement.

    Science.gov (United States)

    Wilson-d'Almeida, K; Karrow, A; Bralet, M-C; Bazin, N; Hardy-Baylé, M-C; Falissard, B

    2013-03-01

    Quality of life has been found to be associated with symptoms in patients with schizophrenia. Nevertheless, the mechanism that underlies this association is still unclear. The objective of this paper is to prospectively evaluate the quality of life of patients with schizophrenia in relation to the concurrent evolution of their symptoms, their expectations and their perceived position in life. Participants included 306 outpatients with schizophrenia who were interviewed at baseline, 6 and 12 months, about their quality of life (Outcome revealed by Preference in Schizophrenia, OPS) and symptoms (Positive and Negative Syndrome Scale, PANSS). Quality of life relative to subject expectations remained stable over time. A decrease in symptoms was correlated to an increase in both expectations and perceived position in life but did not correlate to quality of life. The level of expectations seems to play a major role in the subjective assessment of quality of life in patients with schizophrenia. Symptom improvement is not necessarily associated with quality of life improvement relative to subject expectations. Caregivers should be aware of this result so as to deal with possible disappointments in patients receiving a new efficient treatment. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  3. Improving patient access to an interventional US clinic.

    Science.gov (United States)

    Steele, Joseph R; Clarke, Ryan K; Terrell, John A; Brightmon, Tonya R

    2014-01-01

    A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures. © RSNA, 2014.

  4. Rare disease policies to improve care for patients in Europe.

    Science.gov (United States)

    Rodwell, Charlotte; Aymé, Ségolène

    2015-10-01

    Rare diseases are those with a particularly low prevalence; in Europe, diseases are considered to be rare when they affect not more than 5 in 10000 persons in the European Union. The specificities of rare diseases make the area a veritable public health challenge: the limited number of patients and scarcity of knowledge and expertise single rare diseases out as a distinctive domain of high European added-value. The Orphan Medicinal Product Regulation of 1999 was the first European legislative text concerning rare diseases, followed by many initiatives, including recommendations by the Council of Ministers of the European Union in 2009. These initiatives contributed to the development of rare diseases policies at European and national level aimed at improving care for patients with rare diseases. A review of the political framework at European level and in European countries is provided to demonstrate how legislation has created a dynamic that is progressively improving care for patients with rare diseases. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)".

  5. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    Directory of Open Access Journals (Sweden)

    Swaminathan A

    2014-07-01

    Full Text Available Aparna Swaminathan,1 Sreekanth Vemulapalli,1,2 Manesh R Patel,1,2 W Schuyler Jones1,2 1Department of Medicine, Duke University Medical Center, Durham, NC, USA; 2Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA Abstract: Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE amputation (LEA, although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. Keywords: peripheral artery disease, lower extremity amputation, mortality

  6. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    Science.gov (United States)

    Swaminathan, Aparna; Vemulapalli, Sreekanth; Patel, Manesh R; Jones, W Schuyler

    2014-01-01

    Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. PMID:25075192

  7. Approaches to improve adherence to pharmacotherapy in patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Shuler KM

    2014-05-01

    enhanced team-oriented approach to managing patients with schizophrenia improves adherence and supports corresponding reductions in relapse rates, inpatient admissions, and associated costs. Conclusion: Optimization of medication and involvement of caregivers are important to promoting adherence. A multidisciplinary team approach may be invaluable in identifying barriers to adherence and helping schizophrenia patients overcome them. Keywords: medication adherence, schizophrenia, community mental health services, social work, psychiatric

  8. SU-E-J-29: Audiovisual Biofeedback Improves Tumor Motion Consistency for Lung Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, D; Pollock, S; Makhija, K; Keall, P [The University of Sydney, Camperdown, NSW (Australia); Greer, P [The University of Newcastle, Newcastle, NSW (Australia); Calvary Mater Newcastle Hospital, Newcastle, NSW (Australia); Arm, J; Hunter, P [Calvary Mater Newcastle Hospital, Newcastle, NSW (Australia); Kim, T [The University of Sydney, Camperdown, NSW (Australia); University of Virginia Health System, Charlottesville, VA (United States)

    2014-06-01

    Purpose: To investigate whether the breathing-guidance system: audiovisual (AV) biofeedback improves tumor motion consistency for lung cancer patients. This will minimize respiratory-induced tumor motion variations across cancer imaging and radiotherapy procedues. This is the first study to investigate the impact of respiratory guidance on tumor motion. Methods: Tumor motion consistency was investigated with five lung cancer patients (age: 55 to 64), who underwent a training session to get familiarized with AV biofeedback, followed by two MRI sessions across different dates (pre and mid treatment). During the training session in a CT room, two patient specific breathing patterns were obtained before (Breathing-Pattern-1) and after (Breathing-Pattern-2) training with AV biofeedback. In each MRI session, four MRI scans were performed to obtain 2D coronal and sagittal image datasets in free breathing (FB), and with AV biofeedback utilizing Breathing-Pattern-2. Image pixel values of 2D images after the normalization of 2D images per dataset and Gaussian filter per image were used to extract tumor motion using image pixel values. The tumor motion consistency of the superior-inferior (SI) direction was evaluated in terms of an average tumor motion range and period. Results: Audiovisual biofeedback improved tumor motion consistency by 60% (p value = 0.019) from 1.0±0.6 mm (FB) to 0.4±0.4 mm (AV) in SI motion range, and by 86% (p value < 0.001) from 0.7±0.6 s (FB) to 0.1±0.2 s (AV) in period. Conclusion: This study demonstrated that audiovisual biofeedback improves both breathing pattern and tumor motion consistency for lung cancer patients. These results suggest that AV biofeedback has the potential for facilitating reproducible tumor motion towards achieving more accurate medical imaging and radiation therapy procedures.

  9. Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients

    Directory of Open Access Journals (Sweden)

    Anne Kittler

    2004-11-01

    Conclusions Physicians’ fears about being overwhelmed with messages were not realised. While physicians were generally enthusiastic about the application, none used it directly to communicate with patients. Over three-quarters of respondents indicated that they would be more enthusiastic about electronic communication with patients if this time were compensated.

  10. Interventions to improve or facilitate linkage to or retention in pre-ART (HIV care and initiation of ART in low- and middle-income settings – a systematic review

    Directory of Open Access Journals (Sweden)

    Darshini Govindasamy

    2014-08-01

    Full Text Available Introduction: Several approaches have been taken to reduce pre-antiretroviral therapy (ART losses between HIV testing and ART initiation in low- and middle-income countries, but a systematic assessment of the evidence has not yet been undertaken. The aim of this systematic review is to assess the potential for interventions to improve or facilitate linkage to or retention in pre-ART care and initiation of ART in low- and middle-income settings. Methods: An electronic search was conducted on Medline, Embase, Global Health, Web of Science and conference databases to identify studies describing interventions aimed at improving linkage to or retention in pre-ART care or initiation of ART. Additional searches were conducted to identify on-going trials on this topic, and experts in the field were contacted. An assessment of the risk of bias was conducted. Interventions were categorized according to key domains in the existing literature. Results: A total of 11,129 potentially relevant citations were identified, of which 24 were eligible for inclusion, with the majority (n=21 from sub-Saharan Africa. In addition, 15 on-going trials were identified. The most common interventions described under key domains included: health system interventions (i.e. integration in the setting of antenatal care; patient convenience and accessibility (i.e. point-of-care CD4 count (POC testing with immediate results, home-based ART initiation; behaviour interventions and peer support (i.e. improved communication, patient referral and education and incentives (i.e. food support. Several interventions showed favourable outcomes: integration of care and peer supporters increased enrolment into HIV care, medical incentives increased pre-ART retention, POC CD4 testing and food incentives increased completion of ART eligibility screening and ART initiation. Most studies focused on the general adult patient population or pregnant women. The majority of published studies were

  11. Improving quality of care among patients hospitalised with schizophrenia

    DEFF Research Database (Denmark)

    Jørgensen, Mette; Mainz, Jan; Svendsen, Marie Louise

    2015-01-01

    -based cohort study, we identified 14 228 patients admitted to psychiatric departments between 2004 and 2011 from The Danish Schizophrenia Registry. The registry systematically monitors the adherence to guideline recommended processes of care. RESULTS: The overall proportion of all relevant recommended...... processes of care increased from 64 to 76% between 2004 and 2011. The adherence to individual processes of care increased over time, including assessment of psychopathology using a diagnostic interview (relative risk (RR): 2.01, 95% CI: 1.51-2.68), contact with relatives (RR: 1.44, 95% CI: 1.......27-1.62), psychoeducation (RR: 1.33, 95% CI: 1.19-1.48), psychiatric aftercare (RR: 1.06, 95% CI: 1.01-1.11) and suicide risk assessment (RR: 1.31, 95% CI: 1.21-1.42). CONCLUSIONS: Quality of care improved from 2004 to 2011 among patients hospitalised with schizophrenia in Denmark. DECLARATION OF INTEREST: None. COPYRIGHT...

  12. Nasal highflow improves ventilation in patients with COPD

    Directory of Open Access Journals (Sweden)

    Bräunlich J

    2016-05-01

    Full Text Available Jens Bräunlich,* Marcus Köhler,* Hubert WirtzDepartment of Respiratory Medicine, University of Leipzig, Leipzig, Germany *These authors contributed equally to this workBackground: Nasal highflow (NHF provides a warmed and humidified air stream up to 60 L/min. Recent data demonstrated a positive effect in patients with acute hypoxemic respiratory failure, especially when caused by pneumonia. Preliminary data show a decrease in hypercapnia in patients with COPD. Therefore, NHF should be evaluated as a new ventilatory support device. This study was conducted to assess the impact of different flow rates on ventilatory parameters in patients with COPD.Materials and methods: This interventional clinical study was performed with patients suffering from severe COPD. The aim was to characterize flow-dependent changes in mean airway pressure, breathing volumes, breathing frequency, and decrease in partial pressure of CO2 (pCO2. Mean airway pressure was measured in the nasopharyngeal space (19 patients. To evaluate breathing volumes, we used a polysomnographic device (18 patients. All patients received 20 L/min, 30 L/min, 40 L/min, and 50 L/min and – to illustrate the effects – nasal continuous positive airway pressure and nasal bilevel positive airway pressure. Capillary blood gas analyses were performed in 54 patients with hypercapnic COPD before and two hours after the use of NHF. We compared the extent of decrease in pCO2 when using 20 L/min and 30 L/min. Additionally, comfort and dyspnea during the use of NHF were surveyed.Results: NHF resulted in a minor flow dependent increase in mean airway pressure. Tidal volume increased, and breathing rate decreased. The calculated minute volume decreased under NHF breathing. In spite of this fact, hypercapnia decreased with increasing flow (20 L/min vs 30 L/min. Additionally, an improvement in dyspnea was observed. The rapid shallow breathing index shows a decrease when using NHF.Conclusion: NHF

  13. Need for improved monitoring in patients with acromegaly

    Science.gov (United States)

    Silverstein, Julie M

    2015-01-01

    Acromegaly is a rare and insidious disease characterized by the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF1) and is most commonly due to a pituitary adenoma. Patients with acromegaly who experience prolonged exposure to elevated levels of GH and IGF1 have an increased mortality risk and progressive worsening of disease-related comorbidities. Multimodal treatment with surgery, medical therapy, and radiotherapy provides biochemical control, defined by recent acromegaly clinical guidelines from the Endocrine Society as a reduction of GH levels to acromegaly, even those without clinical symptoms of disease, require long-term monitoring of GH and IGF1 levels if the benefits associated with biochemical control are to be maintained and the risk of developing recurrent disease is to be abated. However, suboptimal monitoring is common in patients with acromegaly, and this can have negative health effects due to delays in detection of recurrent disease and implementation of appropriate treatment. Because of the significant health consequences associated with prolonged exposure to elevated levels of GH and IGF1, optimal monitoring in patients with acromegaly is needed. This review article will discuss the biochemical assessments used for therapeutic monitoring in acromegaly, the importance of monitoring after surgery and medical therapy or radiotherapy, the consequences of suboptimal monitoring, and the need for improved monitoring algorithms for patients with acromegaly. PMID:26381160

  14. A Coaxial Guide Wire-Catheter Technique to Facilitate Right Adrenal Vein Sampling: Evaluation in 76 Patients.

    Science.gov (United States)

    Andrews, James C; Thompson, Scott M; Young, William F

    2015-12-01

    A technique to facilitate blood sampling from the right adrenal vein is described. Between May 2012 and February 2015, 148 adrenal vein sampling (AVS) procedures were attempted. In 72 procedures, a simple 5-F end-hole catheter was employed. In 76, a coaxial guide wire technique was used when blood could not be aspirated, whereby a 0.018-inch guide wire was passed through the catheter and into a branch of the right adrenal vein and the sample was drawn around the wire by using a side-arm adaptor. Successful sampling was achieved in 71 of the 72 catheter-only procedures (98.6%) and in 75 of the 76 coaxial wire-assisted procedures (98.7%). This simple technique may eliminate the need for multiple catheter exchanges during AVS. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

  15. Sourcing the crowd for health services improvement: The reflexive patient and "share-your-experience" websites.

    Science.gov (United States)

    Adams, Samantha A

    2011-04-01

    In countries where the notion of "reflexive patients" dominates the health policy landscape, patients are increasingly encouraged to publicize their personal experiences with health services provision by reviewing hospitals and professionals on the web. The number of websites where patients can review one or more aspects of their care (and read reviews posted by others) is growing. These sites are an example of the practice of crowdsourcing, where applications that facilitate user-generated content solicit feedback from a given public; site administrators then use this feedback for product development, quality improvement and policy change. The research presented here examines such developments in the context of ongoing discussions about reflexive consumerism and increased transparency in healthcare. It draws on data from a three-year study of share-your-experience sites in the U.S., U.K., and The Netherlands. Data is taken primarily from a discourse analysis of four of the six sites under study, including patient reviews of institutions and professionals (n=450). Supplementary data from interviews with stakeholders related to the Dutch sites (n=15) is also used. This is the first known study of multiple share-your-experience websites in different countries. It shows that monitoring as "reflexive" behavior is not automatic, but is encouraged by website creators who, hoping to use the posts for other purposes, act as mediators between patients and other healthcare stakeholders. It further argues that patients demonstrate more reflexivity than some stakeholders realize, although not necessarily in the way that Giddens proposed. It concludes with the argument that the focus on reflexivity in healthcare means that not only institutions must be more transparent about their performance; patients are expected to be more transparent about their choices, as well. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Plasma proteomics classifiers improve risk prediction for renal disease in patients with hypertension or type 2 diabetes

    DEFF Research Database (Denmark)

    Pena, Michelle J; Jankowski, Joachim; Heinze, Georg

    2015-01-01

    OBJECTIVE: Micro and macroalbuminuria are strong risk factors for progression of nephropathy in patients with hypertension or type 2 diabetes. Early detection of progression to micro and macroalbuminuria may facilitate prevention and treatment of renal diseases. We aimed to develop plasma...... proteomics classifiers to predict the development of micro or macroalbuminuria in hypertension or type 2 diabetes. METHODS: Patients with hypertension (n = 125) and type 2 diabetes (n = 82) were selected for this case-control study from the Prevention of REnal and Vascular ENd-stage Disease cohort....... RESULTS: In hypertensive patients, the classifier improved risk prediction for transition in albuminuria stage on top of the reference model (C-index from 0.69 to 0.78; P diabetes, the classifier improved risk prediction for transition from micro to macroalbuminuria (C-index from 0...

  17. Dual-hemisphere tDCS facilitates greater improvements for healthy subjects' non-dominant hand compared to uni-hemisphere stimulation

    Directory of Open Access Journals (Sweden)

    Cerruti Carlo

    2008-10-01

    Full Text Available Abstract Background Transcranial direct current stimulation (tDCS is a non-invasive technique that has been found to modulate the excitability of neurons in the brain. The polarity of the current applied to the scalp determines the effects of tDCS on the underlying tissue: anodal tDCS increases excitability, whereas cathodal tDCS decreases excitability. Research has shown that applying anodal tDCS to the non-dominant motor cortex can improve motor performance for the non-dominant hand, presumably by means of changes in synaptic plasticity between neurons. Our previous studies also suggest that applying cathodal tDCS over the dominant motor cortex can improve performance for the non-dominant hand; this effect may result from modulating inhibitory projections (interhemispheric inhibition between the motor cortices of the two hemispheres. We hypothesized that stimultaneously applying cathodal tDCS over the dominant motor cortex and anodal tDCS over the non-dominant motor cortex would have a greater effect on finger sequence performance for the non-dominant hand, compared to stimulating only the non-dominant motor cortex. Sixteen right-handed participants underwent three stimulation conditions: 1 dual-hemisphere – with anodal tDCS over the non-dominant motor cortex, and cathodal tDCS over the dominant motor cortex, 2 uni-hemisphere – with anodal tDCS over the non-dominant motor cortex, and 3 sham tDCS. Participants performed a finger-sequencing task with the non-dominant hand before and after each stimulation. The dependent variable was the percentage of change in performance, comparing pre- and post-tDCS scores. Results A repeated measures ANOVA yielded a significant effect of tDCS condition (F(2,30 = 4.468, p = .037. Post-hoc analyses revealed that dual-hemisphere stimulation improved performance significantly more than both uni-hemisphere (p = .021 and sham stimulation (p = .041. Conclusion We propose that simultaneously applying cathodal t

  18. Exercise Interventions to Reduce Cancer-Related Fatigue and Improve Health-Related Quality of Life in Cancer Patients.

    Science.gov (United States)

    Scott, Kelly; Posmontier, Bobbie

    Cancer-related fatigue (CRF) is the most common and debilitating side effect of patients receiving treatment of cancer. It is reported that 60% to 100% of patients will develop CRF as a result of the treatment or the cancer itself. The effects last for years posttreatment and lower overall quality of life. The purpose of this integrative review was to determine whether exercise interventions could reduce CRF and improve overall health-related quality of life (HRQOL) among selected cancer patients. Clinical Key, ProQuest Nursing and Allied Health Source, Cochrane Library, Mosby's Nursing Consult, and MEDLINE (Ovid) were the databases searched. Key terms searched were fatigue, exercise, cancer fatigue, holistic, spiritual, quality of life, and prevention. Findings from most studies suggest that exercise can decrease the effects of CRF among cancer patients, leading to an overall improved HRQOL. No negative results on the effects of exercise on CRF were reported. Nurses can be instrumental in developing holistic multidisciplinary exercise programs to assist in the management of CRF and improve HRQOL among cancer patients during and after cancer treatment. Recommendations for future research include the need for larger study sample sizes, a universal definition of fatigue, determination of the best exercise regimens, more consistent fatigue measures to facilitate better comparison across studies, and specifically assess patient improvements in overall mental and spiritual well-being within a holistic framework.

  19. Using performance tasks employing IOM patient safety competencies to introduce quality improvement processes in medical laboratory science education.

    Science.gov (United States)

    Golemboski, Karen; Otto, Catherine N; Morris, Susan

    2013-01-01

    In order to contribute to improved healthcare quality through patient-centered care, laboratory professionals at all levels of practice must be able to recognize the connection between non-analytical factors and laboratory analysis, in the context of patient outcomes and quality improvement. These practices require qualities such as critical thinking (CT), teamwork skills, and familiarity with the quality improvement process, which will be essential for the development of evidence-based laboratory science practice. Performance tasks (PT) are an educational strategy which can be used to teach and assess CT and teamwork, while introducing Medical Laboratory Science (MLS) students at both baccalaureate and advanced-practice levels to the concepts of quality improvement processes and patient outcomes research. PT presents students with complex, realistic scenarios which require the incorporation of subject-specific knowledge with competencies such as effective team communication, patient-centered care, and successful use of information technology. A PT with assessment rubric was designed for use in a baccalaureate-level MLS program to teach and assess CT and teamwork competency. The results indicated that, even when students were able to integrate subject-specific knowledge in creative ways, their understanding of teamwork and quality improvement was limited. This indicates the need to intentionally teach skills such as collaboration and quality system design. PT represent one of many strategies that may be used in MLS education to develop essential professional competencies, encourage expert practice, and facilitate quality improvement.

  20. Service innovation in glaucoma management: using a Web-based electronic patient record to facilitate virtual specialist supervision of a shared care glaucoma programme.

    Science.gov (United States)

    Wright, Heathcote R; Diamond, Jeremy P

    2015-03-01

    To assess the importance of specialist supervision in a new model of glaucoma service delivery. An optometrist supported by three technicians managed each glaucoma clinic. Patients underwent testing and clinical examination before the optometrist triaged them into one of five groups: 'normal', 'stable', 'low risk', 'unstable' and 'high risk'. Patient data were uploaded to an electronic medical record to facilitate virtual review by a glaucoma specialist. 24 257 glaucoma reviews at three glaucoma clinics during a 31-month period were analysed. The clinic optometrists and glaucoma specialists had substantial agreement (κ 0.69). 13 patients were identified to be high risk by the glaucoma specialist that had not been identified as such by the optometrist. Glaucoma specialists amended 13% of the optometrists' interim decisions resulting in an overall reduction in review appointments by 2.4%. Employing technicians and optometrists to triage glaucoma patients into groups defined by risk of blindness allows higher risk patients to be directed to a glaucoma specialist. Virtual review allows the glaucoma specialist to remain in overall control while reducing the risk that patients are treated or followed-up unnecessarily. Demand for glaucoma appointments can be reduced allowing scarce medical resources to be directed to patients most in need. 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.

  1. Advancing user experience research to facilitate and enable patient-centered research: current state and future directions.

    Science.gov (United States)

    Payne, Philip R O

    2013-01-01

    Human-computer interaction and related areas of user experience (UX) research, such as human factors, workflow evaluation, and data visualization, are thus essential to presenting data in ways that can further the analysis of complex data sets such as those used in patient-centered research. However, a review of available data on the state of UX research as it relates to patient-centered research demonstrates a significant underinvestment and consequently a large gap in knowledge generation. In response, this report explores trends in funding and research productivity focused on UX and patient-centered research and then presents a set of recommendations to advance innovation at this important intersection point. Ultimately, the aim is to catalyze a community-wide dialogue concerning future directions for research and innovation in UX as it applies to patient-centered research.

  2. Preoperative computed tomography and scintigraphy to facilitate the detection of accessory spleen in patients with hematologic disorders

    Energy Technology Data Exchange (ETDEWEB)

    Koyanagi, Nobuhiro; Kanematsu, Takashi; Sugimachi, Keizo

    1988-01-01

    Accessory spleens of 1.5 cm in size were preoperatively identified by the combined use of computerized tomography and splenic scintigraphy in two patients with hematologic diseases. After the accessory spleen had been removed from the first patient, who had persistent hereditary spherocytosis and had undergone a splenectomy 15 months before, a postoperative decrease in hyperbilirubinemia was noted. In the other patient who had idiopathic thrombocytopenic purpura, a successful accessory splenectomy was done at the same time as her splenectomy, and was followed by 6 months' complete remission. These events indicate that preoperative investigations using computerized tomography and scintigraphy are indispensable for ruling out an accessory spleen in those patients for whom splenectomy needs to be done in order to alleviate hematologic disorders.

  3. Improving the transition of care in patients transferred through the ochsner medical center transfer center.

    Science.gov (United States)

    Amedee, Ronald G; Maronge, Genevieve F; Pinsky, William W

    2012-01-01

    Patient transfers from other hospitals within the Ochsner Health System to the main campus are coordinated through a Transfer Center that was established in fall 2008. We analyzed the transfer process to assess distinct opportunities to enhance the overall transition of patient care. We surveyed internal medicine residents and nocturnists to determine their satisfaction with transfers in terms of safety, efficiency, and usefulness of information provided at the time of transfer. After a kaizen event at which complementary goals for the institution and members of the study team were recognized and implemented, we resurveyed the group to evaluate improvement in the transfer process. The preintervention average satisfaction score was 1.18 (SD=0.46), while the postintervention score was 3.7 (SD=1.01). A t test showed a significant difference in the average scores between the preintervention and postintervention surveys (Pkaizen event), data were collected that facilitated fewer and higher quality handoffs that were performed in less time. In addition, the process resulted in increased awareness of the value of resident participation in institutional quality improvement projects.

  4. [Walkrounds and briefings in the improvement of the patient safety].

    Science.gov (United States)

    Menéndez, M D; Martínez, A B; Fernandez, M; Ortega, N; Díaz, J M; Vazquez, F

    2010-01-01

    Training, to increase the safety culture, the reporting of adverse events, and to implement improvements using WalkRounds and Briefings. Monte Naranco Hospital, hospital with 200 beds and mainly with geriatric patients. Patient safety surveys and evaluations of the leaders. face-to-face 1/2h interviews with the healthworkers (3-5 people), and in the changes of shifts from 2004-2009. Analysis tools: a) Patient safety surveys (University of Texas and Agency for Healthcare Research and Quality - AHRQ); b) WalkRounds and Briefings forms; c) classification of contributory factors, and the severity of adverse events. Surveys were conduted on 36.9% and 33.8% of the healthworkers, respectively). WalkRounds training: 84 healthworkers. Number of WalkRounds: with Pharmacy Service (493), and with Patient Complaints Service (147), and Briefings: 307. Reporting of adverse events: Medication errors (71.1%), equipment (7.2%), others (21.7%). Contributory factors Working environment (30.1%), work team (29.2%), others (40.7%). In the post-briefing survey 86.7% of the healthworkers thought that it was a useful tool. New needs: feedback of the personnel with control charts. WalkRounds and Briefings allow a higher number of adverse events (more than 20%) to be detected, and are useful for the training of healthworkers. There is better feedback and there was less problems with equipment and outpatient units. Face-to-face communication with the healthworkers is a key element in patient safety and helps to know the needs to the front line wards.

  5. Pioglitazone Improves Survival In Patients With Cancer: The Hypothesis

    Directory of Open Access Journals (Sweden)

    Banshi Saboo

    2015-12-01

    Full Text Available Pioglitazone is currently the only thiazolidinedione approved by regulatory agencies worldwide for the treatment of type 2 diabetes mellitus (T2DM. The use of pioglitazone in patients with T2DM has been limited because earlier studies showed moderate weight gain and an increased incidence of heart failure, osteoporotic fractures, and bladder cancer. However, new studies have shown that pioglitazone improves both systolic and diastolic left ventricular function and that there is no association between pioglitazone and bladder cancer. Furthermore, pioglitazone is associated with a reduced risk of all-cause mortality in patients with T2DM. Pioglitazone was also found to reduce the incidence of lung, head and neck, breast, colorectal, and hepatocellular cancer. There is tremendous preclinical evidence that links thiazolidinediones with anti-cancer effects. Three possible mechanisms of anti-proliferative effects induced by peroxisome proliferator activated receptor gamma (PPARG agonists emerge: 1 activation of PPARG and epidermal growth factor receptor, which actives several intracellular pathways involved in carcinogenesis; 2 increase in serum adiponectin levels and decrease in serum leptin levels, which are associated with lower cancer risk and more favorable outcomes in patients with cancer; 3 modulate insulin-like growth factor 1 (IGF-1 receptor signaling by decreasing IGF-1 levels and increasing the expression of IGF binding protein 1. To date, there are no prospective, placebo-controlled trials that have analyzed the efficacy of pioglitazone in chemotherapy and chemoprevention. Only one ongoing study has shown that pioglitazone has an excellent capability of eradicating quiescent leukemia stem cells in patients with chronic myeloid leukemia and achieving a complete molecular response. Current evidence supports our theory that future case-control studies examining pioglitazone as chemotherapy, or adjuvant chemotherapy, should be performed in

  6. Xenon Anesthesia Improves Respiratory Gas Exchanges in Morbidly Obese Patients

    Directory of Open Access Journals (Sweden)

    Antonio Abramo

    2010-01-01

    Full Text Available Background. Xenon-in-oxygen is a high density gas mixture and may improve PaO2/FiO2 ratio in morbidly obese patients uniforming distribution of ventilation during anesthesia. Methods. We compared xenon versus sevoflurane anesthesia in twenty adult morbidly obese patients (BMI>35 candidate for roux-en-Y laparoscopic gastric bypass and assessed PaO2/FiO2 ratio at baseline, at 15 min from induction of anaesthesia and every 60 min during surgery. Differences in intraoperative and postoperative data including heart rate, systolic and diastolic pressure, oxygen saturation, plateau pressure, eyes opening and extubation time, Aldrete score on arrival to the PACU were compared by the Mann-Whitney test and were considered as secondary aims. Moreover the occurrence of side effects and postoperative analgesic demand were assessed. Results. In xenon group PaO2-FiO2 ratio was significantly higher after 60 min and 120 min from induction of anesthesia; heart rate and overall remifentanil consumption were lower; the eyes opening time and the extubation time were shorter; morphine consumption at 72 hours was lower; postoperative nausea was more common. Conclusions. Xenon anesthesia improved PaO2/FiO2 ratio and maintained its distinctive rapid recovery times and cardiovascular stability. A reduction of opioid consumption during and after surgery and an increased incidence of PONV were also observed in xenon group.

  7. IL-17A facilitates platelet function through the ERK2 signaling pathway in patients with acute coronary syndrome.

    Directory of Open Access Journals (Sweden)

    Shuang Zhang

    Full Text Available BACKGROUND: Platelet aggregation mediated by inflammation played a critical role in the development of coronary heart diseases (CHD. Our previous clinical researches showed that Th17 cells and their characteristic cytokine IL-17A were associated with the plaque destabilization in patients with acute coronary syndrome (ACS. However, the potent effect of IL-17A on platelets-induced atherothrombosis remains unknown. METHODS AND RESULTS: In this study, we detected the plasma IL-17A levels and platelet aggregation in patients with stable angina (SA, unstable angina (UA, acute myocardial infarction (AMI and chest pain syndrome (CPS. In addition, the markers of platelet activation (CD62P/PAC-1 and the mitogen-activated protein kinases (MAPKs pathway were detected in platelets from ACS patients. We found that plasma IL-17A levels and platelet aggregation in patients with ACS (UA and AMI were significantly higher than patients with SA and CPS, and the plasma IL-17A levels were positively correlated with the platelet aggregation (R = 0.47, P<0.01. In addition, in patients with ACS, the platelet aggregation, CD62P/PAC-1 and the phosphorylation of ERK2 signaling pathway were obviously elevated in platelets pre-stimulated with IL-17A in vitro. Furthermore, the specific inhibitor of ERK2 could attenuate platelet aggregation and activation triggered by IL-17A. CONCLUSION: Our experiment firstly proved that IL-17A could promote platelet function in patients with ACS via activating platelets ERK2 signaling pathway and may provide a novel target for antiplatelet therapies in CHD.

  8. Success of patient training in improving proficiency of eyedrop administration among various ophthalmic patient populations

    Directory of Open Access Journals (Sweden)

    Feng A

    2016-08-01

    Full Text Available Alexander Feng, John O’Neill, Mitchell Holt, Catherine Georgiadis, Martha M Wright, Sandra R Montezuma Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA Purpose: The purpose of this study is to evaluate the success and usefulness of patient education in eyedrop self-administration technique via an educational handout and a short instructional video. Patients and methods: We conducted a prospective study that included 34 patients who were self-administering ophthalmic drops. Of the total patients included, 12% had used drops for <12 months, and 88% had used drops for >12 months. Average age of patients in the study was 67 years, with an age range of 19–91 years. Of the total patients included, 82% had glaucoma, 6% had dry eyes, and 12% did not have a specific diagnosis. Subjects were video recorded and assessed by a trained observer on two occasions: at baseline and after they viewed a demonstrational video and handout. A maximum score of 15 points was awarded based on 15 criteria. A written self-assessment was administered at the end of each study. Results: Pre- and post-teaching assessment scores improved significantly with education. Patients initially scored an average 2.53 points compared to a post-education score of 6.15 out of 15 points, demonstrating a 2.43 (P=0.008 factor of improvement. After education, 94% of patients versus 47% pre-teaching (P=0.0001 pulled down their lower eyelids. A total of 91% pre-teaching versus 59% post-teaching (P=0.0042 patients squeezed one drop into the lower fornix, 74% pre-teaching versus 26% post-teaching (P=0.0002 patients released the eyelid and closed the eye for 1 minute, and 56% pre-teaching versus 3% post-teaching (P=0.0001 patients applied nasal digital pressure on each eye. We found no significant difference in score changes between those who previously received education and those who had not (P=0.37. A total of 91% patients responded in a

  9. Three-dimensional images facilitate to understand anorectal pull-through route for patients with imperforate anus

    Energy Technology Data Exchange (ETDEWEB)

    Ueno, Shigeru; Yokoyama, Seishichi; Soeda, Jinichi [Tokai Univ., Isehara, Kanagawa (Japan). School of Medicine] [and others

    1996-12-01

    On reconstructing infrapelvic structure in patients with imperforate anus, it is essential to pull the anorectum through correctly. To apprehend the ideal pull-through route stereoscopically, three-dimensional images of the pelvic structure were obtained after processing MR images from 10 patients with the anomaly and 7 controls. In controls, the infrapelvic muscle structure, which is composed of bilateral superficial perineal muscles, levator muscle complex and sphincter muscle complex, was demonstrated to converge at the center. The rectum was shown stereoscopically to descend through this central portion of the muscle, making an anorectal angle to reach the anal orifice. In those with a low-type anomaly, the rectum was shown to descend in front of the levator muscle complex and the fistula ran through the anterior portion of the sphincter complex without making an anorectal angle. The purpose of the anoplasty for those patients was considered to make a correct anorectal angle. In those with a high-type anomaly, three-dimensional position of the rectal pouch was visualized within the normally-positioned muscle complex but the sphincter muscle was thinner than control patients. For the ideal anoplasty in those patients, the rectum should be conducted into the center of the muscle complex and pulled through in the midst of the thin sphincter mass after making an anorectal angle. Anoplasty procedures should be reevaluated whether they are good for making an ideal pull-through route by three-dimensional images of the infrapelvic organs. (author)

  10. Improving health outcomes with better patient understanding and education

    Directory of Open Access Journals (Sweden)

    Robert John Adams

    2010-10-01

    Full Text Available Robert John AdamsThe Health Observatory, The Queen Elizabeth Hospital Campus, The University of Adelaide, Woodville, South Australia, AustraliaAbstract: A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual’s competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly

  11. “PHE in Action”: Development and modeling of an intervention to improve patient engagement among older adults

    Directory of Open Access Journals (Sweden)

    Julia Menichetti

    2016-09-01

    Full Text Available The increasing prevalence of chronic conditions among older adults constitutes a major public health problem. Thus, changes in lifestyles are required to prevent secondary conditions and sustain good care practices. While patient engagement received great attention in the last years as key strategy to solve this issue, to date no interventions exist to sustain the engagement of older chronic patients towards their health management. This study describes the design, development, and optimization of PHEinAction, a theoretically-driven intervention program to increase patient engagement in older chronic populations, and, consequently, to foster healthy changes that can help reduce risks of health problems. The development process followed the UK Medical Research Council’s (MRC guidelines and involved selecting the theoretical base for the intervention, identifying the relevant evidence-based literature, and conducting exploratory research to qualitatively evaluate program’s feasibility, acceptability and comprehension.The result was a user-endorsed intervention designed to improve older patients’ engagement in health management based on the theoretical framework of the Patient Health Engagement (PHE model. The intervention program, which emerged from this process, consisted of two monthly face-to-face 1-hour sessions delivered by a trained facilitator and one brief telephonic consultation, and aimed to facilitate a range of changes for patient engagement (e.g., motivation to change, health information seeking and use, emotional adjustment, health behaviors planning. PHEinAction is the first example of a theoretically-based patient engagement intervention designed for older chronic targets. The intervention program is based on psychological theory and evidence; it facilitates emotional, psychological, and behavioral processes to support patient engagement and lifestyle change and maintenance. It provides estimates of the extent to which it

  12. An automated approach to improve efficacy in detecting residual malignant cancer cell for facilitating prognostic assessment of leukemia: an initial study

    Science.gov (United States)

    Qiu, Yuchen; Lu, Xianglan; Tan, Maxine; Li, Shibo; Liu, Hong; Zheng, Bin

    2015-03-01

    The purpose of this study is to investigate the feasibility of applying automatic interphase FISH cells analysis method for detecting the residual malignancy of post chemotherapy leukemia patients. In the experiment, two clinical specimens with translocation between chromosome No. 9 and 22 or No. 11 and 14 were selected from the patients underwent leukemia diagnosis and treatment. The entire slide of each specimen was first digitalized by a commercial fluorescent microscope using a 40× objective lens. Then, the scanned images were processed by a computer-aided detecting (CAD) scheme to identify the analyzable FISH cells, which is accomplished by applying a series of features including the region size, Brenner gradient and maximum intensity. For each identified cell, the scheme detected and counted the number of the FISH signal dots inside the nucleus, using the adaptive threshold of the region size and distance of the labeled FISH dots. The results showed that the new CAD scheme detected 8093 and 6675 suspicious regions of interest (ROI) in two specimens, among which 4546 and 3807 ROI contain analyzable interphase FISH cell. In these analyzable ROIs, CAD selected 334 and 405 residual malignant cancer cells, which is substantially more than those visually detected in a cytogenetic laboratory of our medical center (334 vs. 122, 405 vs. 160). This investigation indicates that an automatic interphase FISH cell scanning and CAD method has the potential to improve the accuracy and efficiency of the prognostic assessment for leukemia and other genetic related cancer patients in the future.

  13. Building a Safer NHS for Patient. Improving Medication Safety

    Directory of Open Access Journals (Sweden)

    Laura Murianni

    2005-12-01

    Full Text Available

    Medication errors occur in all health care systems and in all health care settings. If the errors are identified through an active management and effective reporting system they can be removed before they can cause harm to patients. In order to reduce the risk it is important to understand the causes of medication errors.

    The NHS Report aims to provide a guide to current knowledge of the frequency, nature and causes of errors, the risk factors inherent in current medication processes and helping the NHS organizations and health professionals in achieving a reduction in serious medication errors. In July 2001 the UK Government established the National Patient Safety Agency (NPSA, http:// www.npsa.nhs.uk which, in 2004, implemented a national reporting and learning system to enable the NHS to report all type of adverse incidents including those involving medicines. The NPSA core purpose is to improve patient safety and to accomplish this task; it looks at the identification of patterns and trends in avoidable adverse events so that the NHS can entrust practice and management to reduce the risk of recurrence. Before the establishment of the NPSA, there had been no attempt to establish a unified mechanism for reporting and analyzing medication errors. Despite the many published studies there is no clear definition for medication errors and thus they do not distinguish between errors and adverse drug reactions. The Report defines and highlights the differences between medical errors and drug reactions.

  14. Intentional Weight Loss Improved Performance in Obese Ischaemic Heart Patient

    DEFF Research Database (Denmark)

    Geiker, Nina; Myint, Khin Swe; Heck, Patrick

    2014-01-01

    Aims: The risk of heart failure (HF) increases with BMI, but paradoxically obesity has been associated with reduced mortality in patients with HF. The effect of intentional or therapeutic weight loss on HF is not well known. We examined the effect of weight loss induced by low energy diet (LED......) on physical performance and cardiovascular risk factors in obese patients with moderate-to-severe HF and/or ischaemic heart disease (IHD). Methods and Results: Results from two weight loss interventions at two centres, one in Denmark (DK - 12 week intervention in 21 subjects (14 LED, 7 controls)) and one.......1 in the intervention group versus -22.1% ± 25.6 in the control group (P=0.000). Treatment also improved triglycerides (P=0.000), very low lipoprotein (P=0.001) and C-reactive protein (P=0.010). Conclusion: Weight loss induced by LED in obese patients with moderate-to-severe HF or IHD resulted in clinically significant...

  15. Improving the likelihood of neurology patients being examined using patient feedback.

    Science.gov (United States)

    Appleton, Jason Philip; Ilinca, Andreea; Lindgren, Arne; Puschmann, Andreas; Hbahbih, Majed; A Siddiqui, Khurram; de Silva, Rajith; Jones, Matthew; Butterworth, Richard; Willmot, Mark; Hayton, Tom; Lunn, Michael; Nicholl, David

    2015-01-01

    We aimed to establish whether recall of elements of the neurological examination can be improved by use of a simple patient assessment score. In a previous study we demonstrated that in-patients referred to neurology at two United Kingdom (UK) hospitals were not fully examined prior to referral; we therefore designed a larger quality improvement report with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention. In-patients referred to neurology over a four month period (in hospitals in the UK (10), Jordan (1), Sweden (2), and the United Arab Emirates (1)) were asked whether they recalled being examined with a tendon hammer (T), ophthalmoscope (O), and stethoscope (S) since admission. The results were disseminated to local medical teams using various techniques (including Grand Round presentations, email, posters, discounted equipment). Data were then collected for a further four month period post-intervention. Pre-intervention and post-intervention data were available for 11 centres with 407 & 391 patients in each arm respectively. Median age of patients was 51 (range 13-100) and 49 (range 16-95) years respectively, with 44.72% and 44.76% being male in each group. 264 patients (64.86%) recalled being examined with a tendon hammer in the pre-intervention arm, which significantly improved to 298 (76.21%) (pneurology referral yet a simple assessment score and educational intervention can improve recall of elements of the neurological examination and thus the likelihood of patients being examined neurologically. This is the largest and - to our knowledge - only study to assess this issue. This has implications for national neurological educators.

  16. Observation and measurement of hand hygiene and patient identification improve compliance with patient safety practices.

    Science.gov (United States)

    Rosenthal, Tom; Erbeznik, Mary; Padilla, Tony; Zaroda, Teresa; Nguyen, Daniel H; Rodriguez, Marcela

    2009-12-01

    Measurement, a crucial step in any quality improvement activity, is difficult in two important patient safety processes: hand hygiene and patient identification. This study describes a program at the UCLA Medical Center, called Measure to Achieve Patient Safety (MAPS), which uses undergraduate student volunteers to carry out observations in the hospital. This program has been an important part of UCLA's efforts for quality improvement in patient safety efforts. Since 2004, approximately 20 students per year plus two student leaders have been selected to participate in the MAPS program. They were trained in techniques of measuring and observation and in professional behavior. They participated in weekly and monthly meetings with program leadership, received continuing education from the UCLA patient safety staff, and were trained in observational measurement. The students' observational results have been systematically reported to clinicians and departmental and hospital leadership. Handwashing increased from 50% to 93%, and nurses' checking of two identifiers at the time of medication administration increased from 50% to 95%. Compliance with proper patient identification at the time of nurse-to-transporter handoffs of patients for procedures increased to >90%. This unique program has made a significant contribution to UCLA's quality, safety, and service programs. MAPS has been widely accepted by the clinical staff and has also been valuable to the student volunteers. Such an approach is easily adaptable to other academic medical centers.

  17. Icodextrin decreases technique failure and improves patient survival in peritoneal dialysis patients.

    Science.gov (United States)

    Wang, I-Kuan; Li, Yu-Fen; Chen, Jin-Hua; Liang, Chih-Chia; Liu, Yao-Lung; Lin, Hsin-Hung; Chang, Chiz-Tzung; Tsai, Wen-Chen; Yen, Tzung-Hai; Huang, Chiu-Ching

    2015-03-01

    It remains unclear whether long-term daily icodextrin use can decrease technique failure and improve survival in peritoneal dialysis (PD) patients. The aim of the present study was to investigate whether icodextrin use, once daily, can decrease technique failure and prolong patient survival in incident PD patients. Incident PD patients who survived more than 90 days were recruited from the China Medical University Hospital, Taiwan, between 1 January 2007 and 31 December 2011. All patients were followed until transfer to haemodialysis (HD), renal transplantation, transfer to another centre, death, or 31 December 2011. A total of 306 incident PD patients (89 icodextrin users, 217 icodextrin non-users) were recruited during the study period. Icodextrin users were more likely to have hypertension, diabetes and high or high-average peritoneal transport compared with non-users. During the follow-up period, 43 patients were transferred to HD: seven (7.87%) of the icodextrin group, and 36 (16.59%) of the non-icodextrin group. Thirty-two patients died during the follow-up period: five (5.62%) of the icodextrin group, and 27 (12.44%) of the non-icodextrin group. Icodextrin use was significantly associated with a better prognosis, in terms of technique failure (adjusted HR = 0.32; 95% CI = 0.14-0.72). With regard to patient survival, icodextrin use (adjusted HR = 0.33; 95% CI = 0.12-0.87) was associated with a significantly lower risk of death. The use of icodextrin once daily may decrease technique failure and improve survival in incident PD patients. © 2014 Asian Pacific Society of Nephrology.

  18. Patient safety oriented to improve patient retention in oral health services

    Directory of Open Access Journals (Sweden)

    Tri Erri Astoeti

    2009-03-01

    Full Text Available Background: Oral health service systems should be designed to promote patient health, protection, and must be in compliance with Indonesian laws that help protect patients from misuse of personal information. Patient safety is a new healthcare discipline that emphasizes the reporting, analysis, and prevention of medical or dental error that often lead to adverse healthcare events. Purpose: To describe correlation that patient safety would improve patent retention in oral health. Patient safety is an essential component of quality oral health care and dentist is encouraged to consider thoughtfully the environment in which they deliver dental care, while at the same time services and to implement practices that decrease a patient’s risk of injury or harm during the delivery of care. Reviews: Designing oral health care systems that focus on preventing errors is critical to assure patient safety. Some possible sources of error in oral health services are miscommunication, failure to review the patient’s medical history, and lack of standardized records, abbreviations, and processes. Conclusion: Patient safety would support patient satisfaction; therefore oral health services can increase patient retention.

  19. Melatonin acts as antioxidant and improves sleep in MS patients.

    Science.gov (United States)

    Adamczyk-Sowa, Monika; Pierzchala, Krystyna; Sowa, Pawel; Mucha, Sebastian; Sadowska-Bartosz, Izabela; Adamczyk, Jowita; Hartel, Marcin

    2014-08-01

    The relationship between the prevalence of multiple sclerosis (MS) and sunlight's ultraviolet radiation was proved. Oxidative stress plays a role in the pathogenic traits of MS. Melatonin possesses antioxidative properties and regulates circadian rhythms. Sleep disturbances in MS patients are common and contribute to daytime fatigue. The aim of study was to evaluate 5 mg daily melatonin supplementation over 90 days on serum total oxidant status (TOS), total antioxidant capacity (TAC) and its influence on sleep quality and depression level of MS patients. A case-control prospective study was performed on 102 MS patients and 20 controls matched for age and sex. The Kurtzke's Expanded Disability Status Scale, magnetic resonance imaging examinations, Athens Insomnia Scale (AIS), Beck Depression Inventory questionnaires were completed. Serum TOS and TAC levels were measured. We observed higher serum levels of TOS in all MS groups, while after melatonin treatment the TOS levels significantly decreased. The TAC level was significantly lower only in mitoxantrone-treated group and it increased after melatonin supplementation. A strong positive correlation between T1Gd(+) number lesions and TAC level in interferon-beta-1A group was observed. AIS group mean score above 6 defining insomnia were observed in interferon-beta-1B-group, glatiramer acetate-group and mitoxantrone-group: 6.62 ± 2.88, 8.45 ± 2.07, 11.1 ± 3.25, respectively. After melatonin treatment the AIS mean scores decrease in glatiramer acetate-group and mitoxantrone-group achieving 5.25 ± 1.14 and 7.08 ± 2.39, respectively (p melatonin can act as an antioxidant and improves reduced sleep quality in MS patients.

  20. A Case of Cardboard Boxes Likely Facilitating the Biting of a Patient by Trypanosoma cruzi-Infected Triatomine Bugs

    Science.gov (United States)

    Dolhun, Eduardo P.; Antes, Andrew W.

    2016-01-01

    Chagas disease is a vector-borne and potentially fatal parasitic disease that is transmitted by the triatomine bug, a nocturnal feeding, flying arthropod, often referred to by its colloquial name, the “kissing bug.” Vector-borne transmission is considered the most important means of spreading Chagas disease in endemic and nonendemic areas. Corrugated cardboard boxes may accelerate the spread of these insect vectors to nonendemic areas through their ability to harbor and transport small terrestrial arthropods such as silverfish, termites, and cockroaches. We report the case of a patient living in northern California who presented to a community clinic 6 weeks after being bitten by a positively identified triatomine bug. A local pest control company identified a total of eight adult Triatoma protracta, nine nymphs, and two eggs; all within the patient's bedding. No bugs were found outside of the patient's bedroom. The Centers for Disease Control and Prevention confirmed one adult female was positive for Trypanosoma cruzi via polymerase chain reaction. The patient's bedroom doubled as an office and regularly received and stored corrugated cardboard shipping boxes. Corrugated cardboard boxes have been used to trap and study the triatomine bug. This is the first documented case that provides circumstantial evidence that corrugated cardboard boxes may be an inadvertent and unrecognized factor in the spread of Chagas disease. PMID:27601526

  1. Rearrangements of MYC gene facilitate risk stratification in diffuse large B-cell lymphoma patients treated with rituximab-CHOP

    DEFF Research Database (Denmark)

    Tzankov, Alexandar; Xu-Monette, Zijun Y; Gerhard, Marc;

    2014-01-01

    In order to address the debatable prognostic role of MYC rearrangements in diffuse large B-cell lymphoma patients treated with rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone, we evaluated MYC rearrangements by fluorescence in situ hybridization in 563 cases using br...

  2. Perceptions of inhibitors and facilitators for adhering to hypertension treatment among insured patients in rural Nigeria: a qualitative study

    NARCIS (Netherlands)

    Odusola, A.O.; Hendriks, M.; Schultsz, C.; Bolarinwa, O.A.; Akande, T.; Osibogun, A.; Agyemang, C.; Ogedegbe, G.; Agbede, K.; Adenusi, P.; Lange, J.; van Weert, H.; Stronks, K.; Haafkens, J.A.

    2014-01-01

    Background: Universal health care coverage has been identified as a promising strategy for improving hypertension treatment and control rates in sub Saharan Africa (SSA). Yet, even when quality care is accessible, poor adherence can compromise treatment outcomes. To provide information for adherence

  3. Improving bariatric patient transport and care with simulation.

    Science.gov (United States)

    Gable, Brad D; Gardner, Aimee K; Celik, Dan H; Bhalla, Mary Colleen; Ahmed, Rami A

    2014-03-01

    Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics' knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes. Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree) to 5 (strongly agree) on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p ≤0.05. Proportions and 95% confidence

  4. Improving Bariatric Patient Transport and Care with Simulation

    Directory of Open Access Journals (Sweden)

    Brad D. Gable

    2014-03-01

    Full Text Available Introduction: Obesity is prevalent in the United States. Obese patients have physiologic differences from non-obese individuals. Not only does transport and maintenance of these patients require use of specialized equipment, but it also requires a distinct skill set and knowledge base. To date, there is no literature investigating simulation as a model for educating pre-hospital providers in the care of bariatric patients. The purpose of this study was to determine if a 3-hour educational course with simulation could improve paramedics’ knowledge and confidence of bariatric procedures and transport. This study also examined if prior experience with bariatric transport affected training outcomes. Methods: Our study took place in August 2012 during paramedic training sessions. Paramedics completed a pre- and post-test that assessed confidence and knowledge and provided information on previous experience. They had a 30-minute didactic and participated in 2 20-minute hands-on skills portions that reviewed procedural issues in bariatric patients, including airway procedures, peripheral venous and intraosseous access, and cardiopulmonary resuscitation. Study participants took part in one of two simulated patient encounters. Paramedics were challenged with treating emergent traumatic and/or medical conditions, as well as extricating and transporting bariatric patients. Each group underwent a debriefing of the scenario immediately following their case. We measured confidence using a 5-point Likert-type response scale ranging from 1 (strongly disagree to 5 (strongly agree on a 7-item questionnaire. We assessed knowledge with 12 multiple choice questions. Paired-sample t-tests were used to compare pre- and post-simulation confidence and knowledge with a significance level of p≤0.05. We used analysis of covariance to examine the effect of previous experiences on pre-and post-educational activity confidence and knowledge with a significance level of p

  5. Gene expression in uninvolved oral mucosa of OSCC patients facilitates identification of markers predictive of OSCC outcomes.

    Science.gov (United States)

    Lohavanichbutr, Pawadee; Houck, John; Doody, David R; Wang, Pei; Mendez, Eduardo; Futran, Neal; Upton, Melissa P; Holsinger, F Christopher; Schwartz, Stephen M; Chen, Chu

    2012-01-01

    Oral and oropharyngeal squamous cell carcinomas (OSCC) are among the most common cancers worldwide, with approximately 60% 5-yr survival rate. To identify potential markers for disease progression, we used Affymetrix U133 plus 2.0 arrays to examine the gene expression profiles of 167 primary tumor samples from OSCC patients, 58 uninvolved oral mucosae from OSCC patients and 45 normal oral mucosae from patients without oral cancer, all enrolled at one of the three University of Washington-affiliated medical centers between 2003 to 2008. We found 2,596 probe sets differentially expressed between 167 tumor samples and 45 normal samples. Among 2,596 probe sets, 71 were significantly and consistently up- or down-regulated in the comparison between normal samples and uninvolved oral samples and between uninvolved oral samples and tumor samples. Cox regression analyses showed that 20 of the 71 probe sets were significantly associated with progression-free survival. The risk score for each patient was calculated from coefficients of a Cox model incorporating these 20 probe sets. The hazard ratio (HR) associated with each unit change in the risk score adjusting for age, gender, tumor stage, and high-risk HPV status was 2.7 (95% CI: 2.0-3.8, p = 8.8E-10). The risk scores in an independent dataset of 74 OSCC patients from the MD Anderson Cancer Center was also significantly associated with progression-free survival independent of age, gender, and tumor stage (HR 1.6, 95% CI: 1.1-2.2, p = 0.008). Gene Set Enrichment Analysis showed that the most prominent biological pathway represented by the 71 probe sets was the Integrin cell surface interactions pathway. In conclusion, we identified 71 probe sets in which dysregulation occurred in both uninvolved oral mucosal and cancer samples. Dysregulation of 20 of the 71 probe sets was associated with progression-free survival and was validated in an independent dataset.

  6. A pilot study of omalizumab to facilitate rapid oral desensitization in high-risk peanut allergic patients

    Science.gov (United States)

    Schneider, Lynda C.; Rachid, Rima; LeBovidge, Jennifer; Blood, Emily; Mittal, Mudita; Umetsu, Dale T.

    2015-01-01

    Background Peanut allergy is a major public health problem that affects 1% of the population and has no effective therapy. Objective To examine the safety and efficacy of oraldesensitization in peanut allergic children in combination with a brief course of anti-IgE monoclonal antibody (omalizumab, Xolair). Methods We performed oral peanut desensitization in peanut allergic children at high risk for developing significant peanut-induced allergic reactions. Omalizumab was administered prior to and during oral peanut desensitization. Results We enrolled 13 children (median age, 10 years), with a median peanut-specific IgE of 229 kUA/L and a median total serum IgE of 621 kU/L, who failed an initial double-blind placebo controlled food challenge at doses 100 mg peanut flour. After pre-treatment with omalizumab, all subjects tolerated the initial 11 desensitization doses given on the first day, including the maximum dose of 500 mg peanut flour (cumulative dose, 992 mg, equivalent to >2 peanuts), requiring minimal or no rescue therapy. 12 subjects then reached the maximum maintenance dose of 4,000 mg peanut flour/day in a median time of 8 weeks, at which point omalizumab was discontinued. All 12 subjects continued on 4,000 mg peanut flour/day and subsequently tolerated a challenge with 8,000 mg peanut flour (equivalent to about 20 peanuts), or 160 to 400 times the dose tolerated before desensitization. During the study, 6 of the 13 subjects experienced mild or no allergic reactions; 6 subjects had Grade 2, and 2 subjects Grade 3 reactions, all of which responded rapidly to treatment. Conclusions Among children with high-risk peanut allergy, treatment with omalizumab may facilitate rapid oral desensitization, and qualitativelyimprove the desensitization process. PMID:24176117

  7. Impact of time from symptom onset to drug administration on outcome in patients undergoing glycoprotein IIb-IIIa facilitated primary angioplasty (from the EGYPT cooperation).

    Science.gov (United States)

    De Luca, Giuseppe; Van't Hof, Arnoud W J; Gibson, C Michael; Cutlip, Donald; Zeymer, Uwe; Noc, Marko; Maioli, Mauro; Zorman, Simona; Gabriel, H Mesquita; Emre, Ayse; Rakowski, Tomasz; Gyongyosi, Maryann; Huber, Kurt; Bellandi, Francesco; Dudek, Dariusz

    2015-03-15

    Contrasting data have been so far reported on facilitation with glycoprotein IIb-IIIa inhibitors (GpIIbIIIa) in patients who underwent primary percutaneous coronary intervention. However, it has been demonstrated a time-dependent composition of coronary thrombus in ST-segment elevation myocardial infarction, with more platelets in the first hours. Subsequently, the benefits of early administration of GpIIbIIIa may be affected by the time from symptoms onset to GpIIbIIIa, that therefore is the aim of this study. Our population is represented by 814 patients who underwent GpIIbIIIa facilitated primary angioplasty included in the Early glycoprotein IIb-IIIa inhibitors in primary angioplasty database. Patients were divided according to quartiles of time from symptom onset to GpIIbIIIa administration (≤65 minutes; 65 to 100 minutes; 101 to 178 minutes; and >178 minutes). Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Time from symptoms onset to GpIIbIIIa was linearly associated with hypertension, diabetes, hypercholesterolemia, and previous myocardial infarction but inversely associated with smoking. Abciximab was more often administrated later from symptoms onset. Time from symptoms onset to GpIIbIIIa was significantly associated with the rate of preprocedural recanalization (thrombolysis in myocardial infarction [TIMI] 2 to 3; p Time to GpIIbIIIa had a significant impact on mortality (hazard ratio [95% confidence interval] 1.46 [1.11 to 1.92], p = 0.007) that was confirmed after correction for baseline confounding factors (adjusted hazard ratio [95% confidence interval] 1.41 [1.02 to 2.21], p = 0.042). In conclusion, this study showed that in patients who underwent primary angioplasty with upstream GpIIbIIIa, time from symptoms onset to GpIIbIIIa strongly impacts on preprocedural recanalization, distal embolization, myocardial perfusion, and long-term survival.

  8. Pre-ablative high-resolution MRA facilitates electrophysiologic pulmonary vein ablation and reduces fluoroscopy time in patients with paroxysmal atrial fibrillation

    Science.gov (United States)

    Collins, Jeremy D.; Pereles, F. S.; Bello, David; Betts, Timothy; Zachariah, Anish; Kaliney, Ryan; Song, Gina K.; Shors, Stephanie M.; Carr, James C.; Finn, John P.

    2003-05-01

    Pulmonary MRA generates high-resolution images of the pulmonary veins (PV) and left atrium (LA), permitting characterization of complex PV anatomy, which is useful in electrophysiologic PV catheter ablation, a proven technique for the treatment of paroxysmal atrial fibrillation (PAF). The purpose of this study was to determine if pre-ablative pulmonary MRA with intra-ablative viewing facilitates ablation by reducing fluoroscopy time. We studied the morphology of the LA and PV at 1.5T (Magnetom Sonata, Siemens Medical Solutions, Erlangen Germany) with breath-held gadolinium-enhanced 3D MRA in 7 patients with PAF undergoing PV ablation. Data was volume rendered (VR) on a stereoscopic workstation. PV ostial diameter and cross-sectional area measurements were obtained on multi-planar reformatted (MPR) images. VR datasets were converted into digital movies and were viewed on a laptop computer adjacent to real-time fluoroscopic images. Fluoroscopy times for patients undergoing pre-ablative MPA mapping were compared with a cohort of 22 consecutive patients diagnosed with PAF who underwent catheter ablation without pre-ablative MRA planning. Mean PV ablation fluoroscopic time with MRA planning versus fluoroscopic imaging alone were 84+/-20 minutes and 114+/-20 minutes respectively. Pre-ablative MRA planning resulted in a significant mean fluoroscopy time savings of 26% (p<0.05). In patients with PAF undergoing PV ablation, analysis of MRA datasets depicting PV anatomy confirms that there is great variability in anatomy between veins. Pre-ablative 3D PV mapping by MRA greatly facilitates fluoroscopic identification of individual veins and significantly reduces fluoroscopic radiation time.

  9. Improving stroke patients' care: a patient held record is not enough

    Directory of Open Access Journals (Sweden)

    Lampe Fiona

    2001-03-01

    after discharge from hospital. Conclusions Stroke patients received poor information and explanations regardless of whether they received a PHR. A PHR did not appear to improve patient satisfaction or discharge planning, and may have reduced opportunities for communication and explanation.

  10. Application of Bow-tie methodology to improve patient safety.

    Science.gov (United States)

    Abdi, Zhaleh; Ravaghi, Hamid; Abbasi, Mohsen; Delgoshaei, Bahram; Esfandiari, Somayeh

    2016-05-09

    Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

  11. Effective colonoscopy training techniques: strategies to improve patient outcomes.

    Science.gov (United States)

    Papanikolaou, Ioannis S; Karatzas, Pantelis S; Varytimiadis, Lazaros T; Tsigaridas, Athanasios; Galanopoulos, Michail; Viazis, Nikos; Karamanolis, Dimitrios G

    2016-01-01

    Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists.

  12. Effective colonoscopy training techniques: strategies to improve patient outcomes

    Directory of Open Access Journals (Sweden)

    Papanikolaou IS

    2016-03-01

    Full Text Available Ioannis S Papanikolaou,1 Pantelis S Karatzas,2 Lazaros T Varytimiadis,2 Athanasios Tsigaridas,2 Michail Galanopoulos,2 Nikos Viazis,2 Dimitrios G Karamanolis21Hepato-gastroenterology Unit, 2nd Department of Internal Medicine, Attikon University General Hospital, University of Athens, 2Gastroenterology Department, Evangelismos Hospital, Athens, GreeceAbstract: Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists.Keywords: endoscopy, colonoscopy, teaching techniques, simulator, endoscopists, colon, polyps

  13. Improving a newly developed patient-reported outcome for thyroid patients, using cognitive interviewing

    DEFF Research Database (Denmark)

    Watt, Torquil; Rasmussen, Ase Krogh; Groenvold, Mogens;

    2008-01-01

    was within the set of problems involving attribution. Conclusion The cognitive interview methodology was effective in identifying and reducing problems within the questionnaire responding process. Patients tended to selectively report problems they considered to be caused by their thyroid disease even when......Objective To improve a newly developed patient-reported outcome measure for thyroid patients using cognitive interviewing. Methods Thirty-one interviews using immediate retrospective and expansive probing were conducted among patients with non-toxic goiter (n = 4), nodular toxic goiter (n = 5.......e. whether or not to report only issues considered of thyroid causality. Within each round of interviews, the number of problems declined from an initial average of six per interview to two, mainly due to a reduction in the number of problems associated with comprehension. The least amount of reduction...

  14. Improvement of tactile roughness discrimination acuity correlates with perception of improved hand function in patients after hand surgery.

    Science.gov (United States)

    Fujimoto, Shuhei; Kon, Noriko

    2016-04-01

    [Purpose] The purpose of this study was to elucidate how well patients' perceptions related to the improvements in their hand function during hospitalization. [Subjects] Sixteen patients who were hospitalized after hand surgery. [Methods] Using the Japanese Society for Surgery of the Hand edition of the Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire; tactile roughness discrimination acuity, motor imagery, motor function, sensory function, and pain of the upper limb were assessed at admission and discharge. Spearman's rank-order correlation coefficients were calculated using the differences in all assessment items at admission and discharge. A multiple regression analysis (stepwise method) was performed to investigate factors that correlated with improvements in Quick-Disabilities of the Arm, Shoulder, and Hand scores. [Results] The improvement of tactile roughness discrimination acuity was significantly associated with patient perception of improved hand function. [Conclusion] The results suggest that an improvement in tactile roughness discrimination acuity was most strongly correlated with patient perception of improved hand function.

  15. CLINICAL AUDIT AND RECORD KEEPING GUIDE FOR IMPROVING PATIENT CARE

    Directory of Open Access Journals (Sweden)

    Abhishek Motimath

    2017-04-01

    Full Text Available BACKGROUND Maintaining records and documentation of all aspects of patient’s dental care is considered as the legal responsibility and professional duty of the dental surgeon. Complete dental records consist of documents pertaining to history of present illness, clinical examination, diagnosis, treatment plan, treatment provided and prognosis. Record maintenance helps in all the aspects of practice whether providing appropriate treatment or medicolegal defence. MATERIALS AND METHODS We conducted thorough research of documents pertaining to patients who reported to the Department of Oral and Maxillofacial Surgery, KLES V.K. Institute of Dental Sciences, Karnataka, India, between 2015-2016.Their records were maintained in the prescribed format followed by entry in a register about the records, diagnosis, treatment which was crosschecked by a consultant daily.The record consist of several different elements, which include written notes, radiographs, study models, referral letters, consultants reports, clinical photographs, results of special investigations, drug prescriptions, laboratory prescriptions, patient identification information and a comprehensive medical history. Timely auditing was done to evaluate the quality of care provided with constant refinement of the protocols RESULTS The audit of the records done in our department showed the common mistakes in recording history by the trainees. We recorded common postoperative complications seen with different procedures and treatment protocols.Wherever required protocols and follow ups were changed to minimise them. With the help of this audit, we were able to compare new treatment modalities and were able to provide best possible care which was also cost effective. CONCLUSION This article highlights the importance of dental records and how it helps in improving patient care, especially in developing countries where this habit is to be inculcated from roots now. It gives an insight into the

  16. Organizational interventions to implement improvements in patient care: a structured review of reviews.

    NARCIS (Netherlands)

    Wensing, M.J.P.; Wollersheim, H.C.H.; Grol, R.P.T.M.

    2006-01-01

    BACKGROUND: Changing the organization of patient care should contribute to improved patient outcomes as functioning of clinical teams and organizational structures are important enablers for improvement. OBJECTIVE: To provide an overview of the research evidence on effects of organizational strategi

  17. Robot-assisted intersphincteric resection facilitates an efficient sphincter-saving in patients with low rectal cancer.

    Science.gov (United States)

    Kim, Jin Cheon; Lee, Jong Lyul; Alotaibi, Abdulrahman Muaod; Yoon, Yong Sik; Kim, Chan Wook; Park, In Ja

    2017-08-01

    Few investigations of robot-assisted intersphincteric resection (ISR) are presently available to support this procedure as a safe and efficient procedure. We aimed to evaluate the utility of robot-assisted ISR by comparison between ISR and abdominoperineal resection (APR) using both robot-assisted and open approaches. The 558 patients with lower rectal cancer (LRC) who underwent curative operation was enrolled between July 2010 and June 2015 to perform either by robot-assisted (ISR vs. APR = 310 vs. 34) or open approaches (144 vs. 70). Perioperative and functional outcomes including urogenital and anorectal dysfunctions were measured. Recurrence and survival were examined in 216 patients in which >3 years had elapsed after the operation. The robot-assisted approach was the most significant parameter to determine ISR achievement among potent parameters (OR = 3.467, 95% CI = 2.095-5.738, p robot-assisted ISR at 12 and 24 months, respectively (p robot-assisted ISR replaced a significant portion of APR to achieve successful SSO via mostly transabdominal approach and double-stapled anastomosis. The robot-assisted ISR with minimal invasiveness might be a help to reduce anorectal and urogenital dysfunctions.

  18. Dipeptidyl Peptidase 4 Inhibition May Facilitate Healing of Chronic Foot Ulcers in Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Raffaele Marfella

    2012-01-01

    Full Text Available The pathophysiology of chronic diabetic ulcers is complex and still incompletely understood, both micro- and macroangiopathy strongly contribute to the development and delayed healing of diabetic wounds, through an impaired tissue feeding and response to ischemia. With adequate treatment, some ulcers may last only weeks; however, many ulcers are difficult to treat and may last months, in certain cases years; 19–35% of ulcers are reported as nonhealing. As no efficient therapy is available, it is a high priority to develop new strategies for treatment of this devastating complication. Because experimental and pathological studies suggest that incretin hormone glucagon-like peptide-1 may improves VEGF generation and promote the upregulation of HIF-1α through a reduction of oxidative stress, the study evaluated the effect of the augmentation of GLP-1, by inhibitors of the dipeptidyl peptidase-4, such as vildagliptin, on angiogenesis process and wound healing in diabetic chronic ulcers. Although elucidation of the pathophysiologic importance of these aspects awaits further confirmations, the present study evidences an additional aspect of how DPP-4 inhibition might contribute to improved ulcer outcome.

  19. Dipeptidyl peptidase 4 inhibition may facilitate healing of chronic foot ulcers in patients with type 2 diabetes.

    Science.gov (United States)

    Marfella, Raffaele; Sasso, Ferdinando Carlo; Rizzo, Maria Rosaria; Paolisso, Pasquale; Barbieri, Michelangela; Padovano, Vincenzo; Carbonara, Ornella; Gualdiero, Pasquale; Petronella, Pasquale; Ferraraccio, Franca; Petrella, Antonello; Canonico, Raffaele; Campitiello, Ferdinando; Della Corte, Angela; Paolisso, Giuseppe; Canonico, Silvestro

    2012-01-01

    The pathophysiology of chronic diabetic ulcers is complex and still incompletely understood, both micro- and macroangiopathy strongly contribute to the development and delayed healing of diabetic wounds, through an impaired tissue feeding and response to ischemia. With adequate treatment, some ulcers may last only weeks; however, many ulcers are difficult to treat and may last months, in certain cases years; 19-35% of ulcers are reported as nonhealing. As no efficient therapy is available, it is a high priority to develop new strategies for treatment of this devastating complication. Because experimental and pathological studies suggest that incretin hormone glucagon-like peptide-1 may improves VEGF generation and promote the upregulation of HIF-1α through a reduction of oxidative stress, the study evaluated the effect of the augmentation of GLP-1, by inhibitors of the dipeptidyl peptidase-4, such as vildagliptin, on angiogenesis process and wound healing in diabetic chronic ulcers. Although elucidation of the pathophysiologic importance of these aspects awaits further confirmations, the present study evidences an additional aspect of how DPP-4 inhibition might contribute to improved ulcer outcome.

  20. The Facilitative Effect of Transcranial Direct Current Stimulation on Visuospatial Working Memory in Patients with Diabetic Polyneuropathy: A Pre-post Sham-Controlled Study.

    Science.gov (United States)

    Wu, Yi-Jen; Tseng, Philip; Huang, Han-Wei; Hu, Jon-Fan; Juan, Chi-Hung; Hsu, Kuei-Sen; Lin, Chou-Ching

    2016-01-01

    Diabetes mellitus can lead to diabetic polyneuropathy (DPN) and cognitive deficits that manifest as peripheral and central neuropathy, respectively. In this study we investigated the relationship between visuospatial working memory (VSWM) capacity and DPN severity, and attempted to improve VSWM in DPN patients via the use of transcranial direct current stimulation (tDCS). Sixteen DPN patients and 16 age- and education-matched healthy control subjects received Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Montreal Cognitive Assessment (MOCA) for baseline cognitive assessment. A forward- and backward-recall computerized Corsi block tapping task (CBT), both with and without a concurrent motor interference task was used to measure VSWM capacity. Each DPN patient underwent a pre-treatment CBT, followed by tDCS or sham treatment, then a post-treatment CBT on two separate days. We found that although patients with severe DPN (Dyck's grade 2a or 2b) showed comparable general intelligence scores on WAIS-IV as their age- and education-matched healthy counterparts, they nonetheless showed mild cognitive impairment (MCI) on MOCA and working memory deficit on digit-span test of WAIS-IV. Furthermore, patients' peripheral nerve conduction velocity (NCV) was positively correlated with their VSWM span in the most difficult CBT condition that involved backward-recall with motor interference such that patients with worse NCV also had lower VSWM span. Most importantly, anodal tDCS over the right DLPFC was able to improve low-performing patients' VSWM span to be on par with the high-performers, thereby eliminating the correlation between NCV and VSWM. In summary, these findings suggest that (1) MCI and severe peripheral neuropathy can coexist with unequal severity in diabetic patients, (2) the positive correlation of VSWM and NCV suggests a link between peripheral and central neuropathies, and (3) anodal tDCS over the right DLPFC can improve DPN patients' VSWM

  1. Enhanced patient support services improve patient persistence with multiple sclerosis treatment

    Directory of Open Access Journals (Sweden)

    Roche J

    2014-06-01

    Full Text Available Jane Roche,1 Yvonne McCarry,2 Karen Mellors31Beaumont Hospital, Dublin, 2Quintiles Ireland Ltd, Fairview, Dublin, Ireland; 3Merck Serono Ltd, Feltham, UKBackground: Subcutaneous interferon beta-1a (sc IFN β-1a therapy (44 µg or 22 µg, three times weekly improves relapse rates and disability progression in patients with relapsing multiple sclerosis (MS. While early treatment with disease-modifying drugs may maximize therapeutic benefit, patients with low adherence or long treatment gaps are at increased risk of relapse. MySupport is an industry-sponsored program that provides support to patients with MS who have been prescribed sc IFN β-1a in the UK or Republic of Ireland (ROI, via telephone and text messaging, website access, and (in some cases face-to-face support from a dedicated MySupport Nurse. The aim of this audit was to assess if the MySupport program in the ROI could improve persistence to sc IFN β-1a therapy.Methods: Anonymized data were supplied retrospectively from the MySupport program, for ROI patients who were registered in January 2010 to receive sc IFN β-1a three times weekly. Patients were recorded as “new” at their first drug delivery; “active”, if they continued to receive scheduled deliveries; “interrupted”, if their medication delivery was halted; or “stopped”, if no deliveries were made for 12 months. The number of “active” patients was recorded monthly for 24 months. Results were compared with data from UK patients with MS, who were receiving National Health Service (NHS support only, or this support plus MySupport.Results: A greater proportion of ROI patients receiving MySupport (compared against UK patients receiving NHS support only were on treatment at 12 months (87.8% versus 79.3% and at 24 months (76.2% versus 61.8%. The odds of being on treatment were significantly greater, at all time points, for ROI patients receiving MySupport, versus UK patients receiving NHS support only (P<0

  2. Barriers and Facilitators for the Practice of Physical Exercise in Patients With Spondyloarthritis: Qualitative Study of Focus Groups (EJES-3D).

    Science.gov (United States)

    Curbelo Rodríguez, Rafael; Zarco Montejo, Pedro; Almodóvar González, Raquel; Flórez García, Mariano; Carmona Ortells, Loreto

    To explore barriers to exercise of patients with spondyloarthritis (SpA) and to propose facilitators. Analysis of the speech of focus groups. It included the identification the elements that shape the studied reality, description of the relationship between them and synthesis through: 1) Thematic segmentation, 2) Categorization according to situations, relationships, opinions, feelings or others, 3) Coding of the various categories and 4) Interpretation of results. Two focus groups of one hour each with 11 patients recruited from associations and social networks in Madrid and surrounding provinces took place (64% men, 72% between 40 and 60 years, 57% with disease duration longer than 10 years, 80% performed some type of exercise or physical activity). The following were identified: 1) barriers to exercise, among which the following pointed out: disinformation, fear, pain, distrust, and prior negative experiences with exercise; 2) facilitators to exercise: the complementary to barriers plus regularity and social and professional support; 3) items that could influence in either way, negative or positively; and 4) four phases of coping with exercise or physical activity in SpA. Apart from recognizing the existence of some modifiable personal factors, patients generally demand: more knowledge and education on exercise, including the pros and cons in the context of their disease, and coherence of messages received, together with better monitors that accompany them in their coping with disease and exercise. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  3. A comparative study of art therapy in cancer patients receiving chemotherapy and improvement in quality of life by watercolor painting.

    Science.gov (United States)

    Bozcuk, H; Ozcan, K; Erdogan, C; Mutlu, H; Demir, M; Coskun, S

    2017-02-01

    There is limited data on the role of art therapy used in cancer patients. We wanted to test the effect of painting art therapy provided by a dedicated professional painting artist on quality of life and anxiety and depression levels in patients having chemotherapy. Cancer patients having chemotherapy in the day unit of a medical oncology department of a university hospital were offered to take part in a painting art therapy program (PATP). This program consisted of a professional painting artist facilitating and helping patients to perform painting during their chemotherapy sessions while they were in the day unit, as well as supplying them painting material for home practice. The changes in quality of life domains of EORTC-QLQ-C30 questionnaire and in Hospital Anxiety and Depression Scores (HADS) were assessed before and after the PATP. These results were contrasted with a reference group of cancer patients on chemotherapy but not taking part in the PATP. In order to adjust for multiple comparisons of quality of life parameters between patient groups, we utilized the Bonferroni correction. A total of 48 patients, of which 26 patients did and 22 did not have prior exposure to PATP, were enrolled in the PATP. A control group of 24 patients who did not have any PATP activity during the study period also took part in the study. With PATP, there was significant improvement in global quality of life (F=7.87, P=0.001), and depression scores (F=7.80, P=0.001). To our knowledge, this is the largest comparative PATP experience in cancer patients on chemotherapy and show that PATP is feasible in the clinics. Our results confirm that art therapy in the form of painting improves quality of life and depression in cancer patients having chemotherapy. This effect was more pronounced in patients without any previous experience of PATP. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. An exploratory study of knowledge brokering in hospital settings: facilitating knowledge sharing and learning for patient safety?

    Science.gov (United States)

    Waring, Justin; Currie, Graeme; Crompton, Amanda; Bishop, Simon

    2013-12-01

    This paper reports on an exploratory study of intra-organisational knowledge brokers working within three large acute hospitals in the English National Health Services. Knowledge brokering is promoted as a strategy for supporting knowledge sharing and learning in healthcare, especially in the diffusion of research evidence into practice. Less attention has been given to brokers who support knowledge sharing and learning within healthcare organisations. With specific reference to the need for learning around patient safety, this paper focuses on the structural position and role of four types of intra-organisational brokers. Through ethnographic research it examines how variations in formal role, location and relationships shape how they share and support the use of knowledge across organisational and occupational boundaries. It suggests those occupying hybrid organisational roles, such as clinical-managers, are often best positioned to support knowledge sharing and learning because of their 'ambassadorial' type position and legitimacy to participate in multiple communities through dual-directed relationships.

  5. Factors facilitating and hindering the intention to promote pulmonary rehabilitation for patients with COPD among respiratory therapists

    Directory of Open Access Journals (Sweden)

    Chen YJ

    2017-09-01

    Full Text Available Yun-Ju Chen,1 Jun-Yu Fan,2 Su-Er Guo,2–4 Su-Lun Hwang,2,3 Tsung-Ming Yang4 1Division of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan, Republic of China; 2Graduate Institute of Nursing, College of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China; 3Chronic Diseases and Health Promotion Research Centre, Chang Gung University of Science and Technology, Chiayi, Taiwan, Republic of China; 4Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Chang Gung Medical Foundation, Chiayi, Taiwan, Republic of China Purpose: Pulmonary rehabilitation (PR is recognized as the chief non-pharmacologic management approach for patients with COPD, but is clinically under-utilized. In Taiwan, respiratory therapists (RTs are one of the first-line health care providers who spend vast amounts of time with COPD patients in PR programs. To better enhance patients’ knowledge of and participation in PR, it is necessary to understand how PR is viewed by RTs, as well as how these views influence their behavioral intentions toward promoting PR. This study applied the Theory of Planned Behavior (TPB to investigate both the behavioral intentions and the influential factors surrounding PR in RTs.Patients and methods: This cross-sectional study used structured self-administered questionnaires at a national symposium for RTs to collect data on their knowledge, attitudes, subjective norms, perceived behavioral controls, and behavioral intentions with regard to promoting PR. Multiple linear regression analysis was used to identify significant factors affecting the intended promotion of PR by RTs.Results: The response rate after excluding respondents with incomplete data was 88.1% (n=379. A majority of the participants were college graduates, aged over 30 years, and women. The respective percentage scores derived from questionnaires gauging the

  6. 78 FR 55257 - Patient Safety and Quality Improvement: Civil Money Penalty Inflation Adjustment

    Science.gov (United States)

    2013-09-10

    ... HUMAN SERVICES Patient Safety and Quality Improvement: Civil Money Penalty Inflation Adjustment AGENCY... provisions of the Patient Safety and Quality Improvement Rule is not required at this time. FOR FURTHER... and Quality and Improvement Act of 2005 (Patient Safety Act), 42 U.S.C. 299b-21 to 299b-26, amended...

  7. Stakeholders' Recommendations to Improve Patient-centered "LGBTQ" Primary Care in Rural and Multicultural Practices.

    Science.gov (United States)

    Kano, Miria; Silva-Bañuelos, Alma Rosa; Sturm, Robert; Willging, Cathleen E

    2016-01-01

    Individuals among gender/sexual minorities share experiences of stigma and discrimination, yet have distinctive health care needs influenced by ethnic/racial minority and rural realities. We collected qualitative data from lesbian/gay/bisexual/transgender (LGBT) and queer persons across the largely rural, multicultural state of New Mexico, particularly those from understudied ethnic groups, regarding factors facilitating or impeding patient-centered primary care. The themes identified formed the basis for a statewide summit on LGBT health care guidelines and strategies for decreasing treatment gaps. Three to 15 individuals, ages 18 to 75 years, volunteered for 1 of 4 town hall dialogues (n = 32), and 175 people took part in the summit. Participants acknowledged health care gaps pertinent to LGBT youth, elders, American Indians, and Latinos/Latinas, expressing specific concern for rural residents. This preliminary research emphasizes the need to improve primary care practices that treat rural and ethnic-minority LGBT people and offers patient-driven recommendations to enhance care delivery while clinic-level transformations are implemented. © Copyright 2016 by the American Board of Family Medicine.

  8. Facilitering som styringsredskab

    OpenAIRE

    Jørgensen, Karen Overgaard

    2006-01-01

    #This thesis surveys facilitation as a new tool of steering within the public sector in Denmark. It is explored how facilitation is articulated and practiced among facilitators from the public, private and voluntary sector. Furthermore, the facilitator’s challenges by using facilitation are examined. The thesis is based on the presumption that facilitation is articulated by rationalities, which influence how facilitation is practiced and performed. Also, a facilitator is seen as a performer a...

  9. High-quality chronic care delivery improves experiences of chronically ill patients receiving care

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)

    2013-01-01

    markdownabstract__Abstract__ Objective. Investigate whether high-quality chronic care delivery improved the experiences of patients. Design. This study had a longitudinal design. Setting and Participants. We surveyed professionals and patients in 17 disease management programs targeting patients wi

  10. Impact Of Patient Counseling And Education Of Diabetic Patients In Improving Their Quality Of Life

    Directory of Open Access Journals (Sweden)

    Nalini Pais

    2010-12-01

    Full Text Available Objectives: The current study which is randomized comparative intervention (concurrent control attempts to study the effect of counseling and education provided by clinical pharmacist regarding the disease and related issues to achieve glycemic control and ultimately better quality of life of Diabetic patients; which was carried out for a period of 6months in the out-patient medicine department of St.Martha’sHospital, Bangalore.Materials and Method: A total of 98 (53 intervention, 45control patients were randomized into intervention and control group by chit method. Intervention group received counseling and education along with the information leaflet;follow up was done at intervals of 2nd, 4th & 6th month after baseline. Pre-validated questionnaires for KAP & QoL were administered at the baseline and last follow up. In a group of25 patients HbA1c was recorded at baseline & last follow-up.All the parameters (FBS, PPBS, HbA1c and scores were compared between intervention & control group postcounseling. Significant improvement (P<0.05 was observed inthe intervention group in terms of glycemic control and HbA1cvalues in comparison with the control group.Results: In the intervention group; Knowledge about the disease improved (P<0.05 along with better compliance to diet, however change in attitude towards need for exercise and regular checkups could not be achieved but significant improvement (p<0.05 in Quality of Life (QoL was achieved with education and counseling.Conclusion: The findings revealed that the clinical pharmacist can contribute to the better management of diabetes through patient education and counseling.

  11. Adapting the human-computer interface for reading literacy and computer skill to facilitate collection of information directly from patients.

    Science.gov (United States)

    Lobach, David F; Arbanas, Jennifer M; Mishra, Dharani D; Campbell, Marci; Wildemuth, Barbara M

    2004-01-01

    Clinical information collected directly from patients is critical to the practice of medicine. Past efforts to collect this information using computers have had limited utility because these efforts required users to be facile with the computerized information collecting system. In this paper we describe the design, development, and function of a computer system that uses recent technology to overcome the limitations of previous computer-based data collection tools by adapting the human-computer interface to the native language, reading literacy, and computer skills of the user. Specifically, our system uses a numerical representation of question content, multimedia, and touch screen technology to adapt the computer interface to the native language, reading literacy, and computer literacy of the user. In addition, the system supports health literacy needs throughout the data collection session and provides contextually relevant disease-specific education to users based on their responses to the questions. The system has been successfully used in an academically affiliated family medicine clinic and in an indigent adult medicine clinic.

  12. Monocarboxylate transporter 4 facilitates cell proliferation and migration and is associated with poor prognosis in oral squamous cell carcinoma patients.

    Directory of Open Access Journals (Sweden)

    Jiang Zhu

    Full Text Available Monocarboxylate transporter 4 (MCT4 is a cell membrane transporter of lactate. Recent studies have shown that MCT4 is over-expressed in various cancers; however, its role in cancer maintenance and aggressiveness has not been fully demonstrated. This study investigated the role of MCT4 in oral squamous cell carcinoma (OSCC, and found that it is highly expressed in OSCC patients by using immunohistochemistry. Moreover, this over-expression of MCT4 was closely associated with tumor size, TNM classification, lymphatic metastasis, distant metastasis and tumor recurrence, and also poor prognosis. To further study mechanisms of MCT4 in vitro, we used small-interfering RNA to silence its expression in OSCC cell lines. The results showed that knock-down of MCT4 decreased cell proliferation, migration, and invasion. The inhibition of proliferation was associated with down-regulation of p-AKT and p-ERK1/2, while decreased cell migration and invasion may be caused by down-regulation of integrin β4-SRC-FAK and MEK-ERK signaling. Together, these findings provide new insight into the critical role of MCT4 in cell proliferation and metastasis in OSCC.

  13. Splitting in-patient and out-patient responsibility does not improve patient care.

    Science.gov (United States)

    Burns, Tom; Baggaley, Martin

    2017-01-01

    Over the past 15 years there has been a move away from consultants having responsibility for the care of patients both in the community and when in hospital towards a functional split in responsibility. In this article Tom Burns and Martin Baggaley debate the merits or otherwise of the split, identifying leadership, expertise and continuity of care as key issues; both recognise that this move is not evidence based.

  14. Benefits of global partnerships to facilitate access to medicines in developing countries: a multi-country analysis of patients and patient outcomes in GIPAP

    Directory of Open Access Journals (Sweden)

    Vandoros Sotiris

    2009-12-01

    Full Text Available Abstract Background Access to medicines in developing countries continues to be a significant problem due to lack of insurance and lack of affordability. Chronic Myeloid Leukemia (CML, a rare disease, can be treated effectively, but the pharmaceutical treatment available (imatinib is costly and unaffordable by most patients. GIPAP, is a programme set up between a manufacturer and an NGO to provide free treatment to eligible CML patients in 80 countries worldwide. Objectives To discuss the socio-economic and demographic characteristics of patients participating in GIPAP; to research the impact GIPAP is having on health outcomes (survival of assistance-eligible CML patients; and to discuss the determinants of such outcomes and whether there are any variations according to socio-economic, demographic, or geographical criteria. Methods Data for 13,568 patients across 15 countries, available quarterly, were analysed over the 2005-2007 period. Ordered Probit panel data analysis was used to analyze the determinants of a patient's progress in terms of participation in the programme. Four waves of patients entering quarterly in 2005 were used to evaluate patient survival over the sample period. Results All patients in the sample are eligible to receive treatment provided they report to a facility quarterly. 62.3% of patients were male and 37.7% female. The majority (84.4% entered during the chronic phase of the disease and their average age was 38.4 years. Having controlled for age, location and occupation, the analysis showed that patients were significantly much more likely to move towards a better health state after receiving treatment irrespective of their disease stage at the point of entry to the program (OR = 30.5, α = 1%; and that the larger the gap between diagnosis and approval for participation in the program, the more likely it is that patients' condition deteriorates (OR = 0.995, α = 1%, due to absence of treatment. Regressions to account

  15. Protocol guided bleeding management improves cardiac surgery patient outcomes.

    Science.gov (United States)

    Pearse, B L; Smith, I; Faulke, D; Wall, D; Fraser, J F; Ryan, E G; Drake, L; Rapchuk, I L; Tesar, P; Ziegenfuss, M; Fung, Y L

    2015-10-01

    Excessive bleeding is a risk associated with cardiac surgery. Treatment invariably requires transfusion of blood products; however, the transfusion itself may contribute to postoperative sequelae. Our objective was to analyse a quality initiative designed to provide an evidenced-based approach to bleeding management. A retrospective analysis compared blood product transfusion and patient outcomes 15 months before and after implementation of a bleeding management protocol. The protocol incorporated point-of-care coagulation testing (POCCT) with ROTEM and Multiplate to diagnose the cause of bleeding and monitor treatment. Use of the protocol led to decreases in the incidence of transfusion of PRBCs (47·3% vs. 32·4%; P bleeding (5·6% vs. 3·4; P = 0·01), superficial chest wound (3·3% vs. 1·4%; P = 0·002), leg wound infection (4·6% vs. 2·0%; P bleeding management protocol supported by POCCT in a cardiac surgery programme was associated with significant reductions in the transfusion of allogeneic blood products, improved outcomes and reduced cost. © 2015 International Society of Blood Transfusion.

  16. [Human factors and crisis resource management: improving patient safety].

    Science.gov (United States)

    Rall, M; Oberfrank, S

    2013-10-01

    A continuing high number of patients suffer harm from medical treatment. In 60-70% of the cases the sources of harm can be attributed to the field of human factors (HFs) and teamwork; nevertheless, those topics are still neither part of medical education nor of basic and advanced training even though it has been known for many years and it has meanwhile also been demonstrated for surgical specialties that training in human factors and teamwork considerably reduces surgical mortality.Besides the medical field, the concept of crisis resource management (CRM) has already proven its worth in many other industries by improving teamwork and reducing errors in the domain of human factors. One of the best ways to learn about CRM and HFs is realistic simulation team training with well-trained instructors in CRM and HF. The educational concept of the HOTT (hand over team training) courses for trauma room training offered by the DGU integrates these elements based on the current state of science. It is time to establish such training for all medical teams in emergency medicine and operative care. Accompanying safety measures, such as the development of a positive culture of safety in every department and the use of effective critical incident reporting systems (CIRs) should be pursued.

  17. Anti-citrullinated protein antibodies suppress let-7a expression in monocytes from patients with rheumatoid arthritis and facilitate the inflammatory responses in rheumatoid arthritis.

    Science.gov (United States)

    Lai, Ning-Sheng; Yu, Hui-Chun; Yu, Chia-Li; Koo, Malcolm; Huang, Hsien-Bin; Lu, Ming-Chi

    2015-12-01

    We hypothesized that anti-citrullinated protein antibodies (ACPAs) could affect the expression of miRNAs in monocytes and contribute to the inflammatory responses in rheumatoid arthritis (RA). The expression profiles of 270 human miRNAs, co-cultured with ACPAs or human immunoglobulin G (IgG), were analyzed using real-time polymerase chain reaction. Ten miRNAs exhibited differential expression in U937 cells after co-cultured with ACPAs compared with human IgG. The expression levels of these miRNAs were investigated in monocytes from 21 ACPA-positive RA patients and 13 controls. Among these miRNAs, the expression levels of let-7a was decreased in monocytes from ACPA-positive RA patients. The expression levels of let-7a showed a negative correlation with positivity of rheumatoid factor in patients sampled. We found that transfection of U937 cells with let-7a mimic suppressed K-Ras protein expression. In the ACPA-mediated signaling pathway, transfection of U937 cells with let-7a mimic suppressed the ACPA-enhanced phosphorylation of c-Jun N-terminal kinase (JNK), extracellular signal-regulated kinase 1/2 (ERK1/2), and the expression and secretion of interleukin (IL)-1β. In conclusion, ACPA-mediated decreased let-7a expression in monocytes from ACPA-positive RA patients. Decreased let-7a expression was associated with the positivity of RF in ACPA-positive RA patients. The decreased expression of let-7a could facilitate the inflammatory pathway via enhanced ACPA-mediated phosphorylation of ERK1/2 and JNK and increased expression of IL-1β through an increase in the expression of Ras proteins.

  18. An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study

    Directory of Open Access Journals (Sweden)

    Kostrowski Shannon

    2011-10-01

    Full Text Available Abstract Background A small percentage of high-risk patients accounts for a large proportion of Medicaid spending in the United States, which has become an urgent policy issue. Our objective was to pilot a novel patient-centered intervention for high-risk patients with frequent hospital admissions to determine its potential to improve care and reduce costs. Methods Community and hospital-based care management and coordination intervention with pre-post analysis of health care utilization. We enrolled Medicaid fee-for-service patients aged 18-64 who were admitted to an urban public hospital and identified as being at high risk for hospital readmission by a validated predictive algorithm. Enrolled patients were evaluated using qualitative and quantitative interview techniques to identify needs such as transportation to/advocacy during medical appointments, mental health/substance use treatment, and home visits. A community housing partner initiated housing applications in-hospital for homeless patients. Care managers facilitated appropriate discharge plans then worked closely with patients in the community using a harm reduction approach. Results Nineteen patients were enrolled; all were male, 18/19 were substance users, and 17/19 were homeless. Patients had a total of 64 inpatient admissions in the 12 months before the intervention, versus 40 in the following 12 months, a 37.5% reduction. Most patients (73.3% had fewer inpatient admissions in the year after the intervention compared to the prior year. Overall ED visits also decreased after study enrollment, while outpatient clinic visits increased. Yearly study hospital Medicaid reimbursements fell an average of $16,383 per patient. Conclusions A pilot intervention for high-cost patients shows promising results for health services usage. We are currently expanding our model to serve more patients at additional hospitals to see if the pilot's success can be replicated. Trial registration

  19. The Facilitative Effect of Transcranial Direct Current Stimulation on Visuospatial Working Memory in Patients with Diabetic Polyneuropathy: A Pre–post Sham-Controlled Study

    Science.gov (United States)

    Wu, Yi-Jen; Tseng, Philip; Huang, Han-Wei; Hu, Jon-Fan; Juan, Chi-Hung; Hsu, Kuei-Sen; Lin, Chou-Ching

    2016-01-01

    Diabetes mellitus can lead to diabetic polyneuropathy (DPN) and cognitive deficits that manifest as peripheral and central neuropathy, respectively. In this study we investigated the relationship between visuospatial working memory (VSWM) capacity and DPN severity, and attempted to improve VSWM in DPN patients via the use of transcranial direct current stimulation (tDCS). Sixteen DPN patients and 16 age- and education-matched healthy control subjects received Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Montreal Cognitive Assessment (MOCA) for baseline cognitive assessment. A forward- and backward-recall computerized Corsi block tapping task (CBT), both with and without a concurrent motor interference task was used to measure VSWM capacity. Each DPN patient underwent a pre-treatment CBT, followed by tDCS or sham treatment, then a post-treatment CBT on two separate days. We found that although patients with severe DPN (Dyck’s grade 2a or 2b) showed comparable general intelligence scores on WAIS-IV as their age- and education-matched healthy counterparts, they nonetheless showed mild cognitive impairment (MCI) on MOCA and working memory deficit on digit-span test of WAIS-IV. Furthermore, patients’ peripheral nerve conduction velocity (NCV) was positively correlated with their VSWM span in the most difficult CBT condition that involved backward-recall with motor interference such that patients with worse NCV also had lower VSWM span. Most importantly, anodal tDCS over the right DLPFC was able to improve low-performing patients’ VSWM span to be on par with the high-performers, thereby eliminating the correlation between NCV and VSWM. In summary, these findings suggest that (1) MCI and severe peripheral neuropathy can coexist with unequal severity in diabetic patients, (2) the positive correlation of VSWM and NCV suggests a link between peripheral and central neuropathies, and (3) anodal tDCS over the right DLPFC can improve DPN patients’ VSWM

  20. Bevacizumab improves survival for patients with advanced cervical cancer

    Science.gov (United States)

    Patients with advanced, recurrent, or persistent cervical cancer that was not curable with standard treatment who received the drug bevacizumab (Avastin) lived 3.7 months longer than patients who did not receive the drug, according to an interim analysis

  1. Improving communication with patients with a hearing impairment

    OpenAIRE

    Seema Rupani Shah; Newton, Valerie E

    2013-01-01

    The main barrier to communication for people who are hearing impaired is the lack of consideration by others. These patients can face prolonged or unnecessary illnesses due to inadequate communication with their health care providers. However, by being prepared, and by preparing the patient, health workers can ensure good communication, thereby giving patients access to appropriate and effective health care. Please note that patients with both visual and hearing impairments require even more ...

  2. Improving communication with patients with a hearing impairment

    Directory of Open Access Journals (Sweden)

    Seema Rupani Shah

    2013-05-01

    Full Text Available The main barrier to communication for people who are hearing impaired is the lack of consideration by others. These patients can face prolonged or unnecessary illnesses due to inadequate communication with their health care providers. However, by being prepared, and by preparing the patient, health workers can ensure good communication, thereby giving patients access to appropriate and effective health care. Please note that patients with both visual and hearing impairments require even more consideration!

  3. Beneficent persuasion: techniques and ethical guidelines to improve patients' decisions.

    Science.gov (United States)

    Swindell, J S; McGuire, Amy L; Halpern, Scott D

    2010-01-01

    Physicians frequently encounter patients who make decisions that contravene their long-term goals. Behavioral economists have shown that irrationalities and self-thwarting tendencies pervade human decision making, and they have identified a number of specific heuristics (rules of thumb) and biases that help explain why patients sometimes make such counterproductive decisions. In this essay, we use clinical examples to describe the many ways in which these heuristics and biases influence patients' decisions. We argue that physicians should develop their understanding of these potentially counterproductive decisional biases and, in many cases, use this knowledge to rebias their patients in ways that promote patients' health or other values. Using knowledge of decision-making psychology to persuade patients to engage in healthy behaviors or to make treatment decisions that foster their long-term goals is ethically justified by physicians' duties to promote their patients' interests and will often enhance, rather than limit, their patients' autonomy. We describe techniques that physicians may use to frame health decisions to patients in ways that are more likely to motivate patients to make choices that are less biased and more conducive to their long-term goals. Marketers have been using these methods for decades to get patients to engage in unhealthy behaviors; employers and policy makers are beginning to consider the use of similar approaches to influence healthy choices. It is time for clinicians also to make use of behavioral psychology in their interactions with patients.

  4. Improved patient-reported health impact of multiple sclerosis

    DEFF Research Database (Denmark)

    Macdonell, Richard; Nagels, Guy; Laplaud, David-Axel

    2016-01-01

    BACKGROUND: Multiple sclerosis (MS) is a debilitating disease that negatively impacts patients' lives. OBJECTIVE: ENABLE assessed the effect of long-term prolonged-release (PR) fampridine (dalfampridine extended release in the United States) treatment on patient-perceived health impact in patients...

  5. Barriers and facilitators to patient and public engagement and recruitment to digital health interventions: protocol of a systematic review of qualitative studies.

    Science.gov (United States)

    O'Connor, Siobhan; Hanlon, Peter; O'Donnell, Catherine A; Garcia, Sonia; Glanville, Julie; Mair, Frances S

    2016-09-02

    Patients and the public are beginning to use digital health tools to assist in managing chronic illness, support independent living and self-care, and remain connected to health and care providers. However, engaging with and enrolling in digital health interventions, such as telehealth systems, mobile health applications, patient portals and personal health records, in order to use them varies considerably. Many factors affect people's ability to engage with and sign up to digital health platforms. The primary aim is to identify the barriers and facilitators patients and the public experience to engagement and recruitment to digital health interventions. The secondary aim is to identify engagement and enrolment strategies, leading if possible to a taxonomy of such approaches, and a conceptual framework of digital health engagement and recruitment processes. A systematic review of qualitative studies will be conducted by searching six databases: MEDLINE, CINAHL, PubMed, EMBASE, Scopus and the ACM Digital Library for papers published between 2000 and 2015. Titles and abstracts along with full-text papers will be screened by two independent reviewers against predetermined inclusion and exclusion criteria. A data extraction form will be used to provide details of the included studies. Quality assessment will be conducted using the Consolidated Criteria for Reporting Qualitative Research checklist. Any disagreements will be resolved through discussion with an independent third reviewer. Analysis will be guided by framework synthesis and informed by normalization process theory and burden of treatment theory, to aid conceptualisation of digital health engagement and recruitment processes. This systematic review of qualitative studies will explore factors affecting engagement and enrolment in digital health interventions. It will advance our understanding of readiness for digital health by examining the complex factors that affect patients' and the public's ability to

  6. At Your Request((R)) room service dining improves patient satisfaction, maintains nutritional status, and offers opportunities to improve intake

    NARCIS (Netherlands)

    Doorduijn, A.S.; Gameren, Y. van; Vasse, E.; Roos, N.M. de

    2016-01-01

    BACKGROUND: Malnutrition in hospitals may be combatted by improving the meal service. AIM: To evaluate whether At Your Request((R)), a meal service concept by Sodexo with a restaurant style menu card and room service, improved patient satisfaction, nutritional status, and food intake compared to the

  7. Icodextrin improves metabolic and fluid management in high and high-average transport diabetic patients.

    Science.gov (United States)

    Paniagua, Ramón; Ventura, María-de-Jesús; Avila-Díaz, Marcela; Cisneros, Alejandra; Vicenté-Martínez, Marlén; Furlong, María-Del-Carmen; García-González, Zuzel; Villanueva, Diana; Orihuela, Oscar; Prado-Uribe, María-Del-Carmen; Alcántara, Guadalupe; Amato, Dante

    2009-01-01

    Icodextrin-based solutions (ICO) have clinical and theoretical advantages over glucose-based solutions (GLU) in fluid and metabolic management of diabetic peritoneal dialysis (PD) patients; however, these advantages have not yet been tested in a randomized fashion. To analyze the effects of ICO on metabolic and fluid control in high and high-average transport diabetic patients on continuous ambulatory PD (CAPD). A 12-month, multicenter, open-label, randomized controlled trial was conducted to compare ICO (n = 30) versus GLU (n = 29) in diabetic CAPD patients with high-average and high peritoneal transport characteristics. The basic daily schedule was 3 x 2 L GLU (1.5%) and either 1 x 2 L ICO (7.5%) or 1 x 2 L GLU (2.5%) for the long-dwell exchange, with substitution of 2.5% or 4.25% for 1.5% GLU being allowed when clinically necessary. Variables related to metabolic and fluid control were measured each month. Groups were similar at baseline in all measured variables. More than 66% of the patients using GLU, but only 9% using ICO, needed prescriptions of higher glucose concentration solutions. Ultrafiltration (UF) was higher (198 +/- 101 mL/day, p ICO group than in the GLU group over time. Changes from baseline were more pronounced in the ICO group than in the GLU group for extracellular fluid volume (0.23 +/- 1.38 vs -1.0 +/- 1.48 L, p ICO group had better metabolic control than those in the GLU group: glucose absorption was more reduced (-17 +/- 44 vs -64 +/- 35 g/day) as were insulin needs (3.6 +/- 3.4 vs - 9.1 +/- 4.7 U/day, p ICO group had fewer adverse events related to fluid and glucose control than patients in the GLU group. Icodextrin represents a significant advantage in the management of high transport diabetic patients on PD, improving peritoneal UF and fluid control and reducing the burden of glucose overexposure, thereby facilitating metabolic control.

  8. Long-term survival in advanced melanoma patients using repeated therapies: successive immunomodulation improving the odds?

    Directory of Open Access Journals (Sweden)

    Coventry BJ

    2015-04-01

    Full Text Available Brendon J Coventry, Dominique Baume, Carrie Lilly Discipline of Surgery, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia Background: Patients with advanced metastatic melanoma are often confronted with little prospect of medium- to longer-term survival by any currently available therapeutic means. However, most clinicians are aware of exceptional cases where survival defies the notion of futility. Prolonged survival from immunotherapies, including interleukin-2, vaccines and antibodies to cytotoxic lymphocyte antigen-4, and programmed death-1 receptor inhibitory monoclonal antibody, implies a role for immune system modulation. We aimed to identify cases where exceptional survival from advanced melanoma occurred prior to recent novel therapies to facilitate better understanding of this phenomenon. Methods: Cases of long-term survival of ≥3 years' duration (from diagnosis of metastatic disease were identified from the database of one clinician; these cases were treated before the availability of newer immunotherapies, and they were documented and examined. A literature search for reported outcome measures from published studies using older and recent therapies for advanced melanoma was conducted to enable the comparison of data. Results: Eighteen cases were identified that identified survival of ≥3 years' duration from metastatic disease (12 American Joint Committee on Cancer [AJCC] Stage IV cases; six AJCC III cases diagnosis. These were assessed and reported to detail the clinical course. Standard clinical prognostication methods predicted high risk of early mortality in those patients. No identifiable differences could be detected between these and other patients with similar patterns of disease. At evaluation, 17 patients (94% had survived ≥5 years, and eleven patients (61% had survived ≥10 years (range: 3–15 years. The median survival duration with metastatic disease was 11 years; 15 remained alive and three

  9. Novel use of an exchange catheter to facilitate intubation with an Aintree catheter in a tall patient with a predicted difficult airway: a case report

    Directory of Open Access Journals (Sweden)

    Gruenbaum Shaun E

    2012-04-01

    Full Text Available Abstract Introduction The Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA has been shown to successfully facilitate difficult intubations when other methods have failed. The Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA has a fixed length of 56 cm, and it has been suggested in the literature that it may be too short for safe use in patients who are tall. Case presentation We present the case of a 32-year-old, 180 cm tall Caucasian woman with a predicted difficult airway who presented to our facility for an emergency cesarean section. After several failed intubation attempts via direct laryngoscopy, an airway was established with a laryngeal mask airway. After delivery of a healthy baby, our patient's condition necessitated tracheal intubation. A fiber-optic bronchoscope loaded with an Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA was passed through the laryngeal mask airway into the trachea until just above the carina, but was too short to safely allow for the passage of an endotracheal tube. Conclusions We present a novel technique in which the Aintree intubating catheter (Cook® Medical Inc., Bloomington, IN, USA was replaced with a longer (100 cm exchange catheter, over which an endotracheal tube was passed successfully into the trachea.

  10. Potential barriers and facilitators for implementation of an integrated care pathway for hearing-impaired persons: an exploratory survey among patients and professionals

    Directory of Open Access Journals (Sweden)

    Verschuure Hans

    2007-04-01

    Full Text Available Abstract Background Because of the increasing costs and anticipated shortage of Ear Nose and Throat (ENT specialists in the care for hearing-impaired persons, an integrated care pathway that includes direct hearing aid provision was developed. While this direct pathway is still under investigation, in a survey we examined expectations and potential barriers and facilitators towards this direct pathway, of patients and professionals involved in the pathway. Methods Two study populations were assessed: members of the health professions involved in the care pathway for hearing-impaired persons (general practitioners (GPs, hearing aid dispensers, ENT-specialists and clinical audiologists and persons with hearing complaints. We developed a comprehensive semi-structured questionnaire for the professionals, regarding expectations, barriers, facilitators and conditions for implementation. We developed two questionnaires for persons with hearing complaints, both regarding evaluations and preferences, and administered them after they had experienced two key elements of the direct pathway: the triage and the hearing aid fitting. Results On average GPs and hearing aid dispensers had positive expectations towards the direct pathway, while ENT-specialists and clinical audiologists had negative expectations. Professionals stated both barriers and facilitators towards the direct pathway. Most professionals either supported implementation of the direct pathway, provided that a number of conditions were satisfied, or did not support implementation, unless roughly the same conditions were satisfied. Professionals generally agreed on which conditions need to be satisfied. Persons with hearing complaints evaluated the present referral pathway and the new direct pathway equally. Many, especially older, participants stated however that they would still visit the GP and ENT-specialist, even when this would not be necessary for reimbursement of the hearing aid, and

  11. Use of a graphics processing unit (GPU) to facilitate real-time 3D graphic presentation of the patient skin-dose distribution during fluoroscopic interventional procedures.

    Science.gov (United States)

    Rana, Vijay; Rudin, Stephen; Bednarek, Daniel R

    2012-02-23

    We have developed a dose-tracking system (DTS) that calculates the radiation dose to the patient's skin in real-time by acquiring exposure parameters and imaging-system-geometry from the digital bus on a Toshiba Infinix C-arm unit. The cumulative dose values are then displayed as a color map on an OpenGL-based 3D graphic of the patient for immediate feedback to the interventionalist. Determination of those elements on the surface of the patient 3D-graphic that intersect the beam and calculation of the dose for these elements in real time demands fast computation. Reducing the size of the elements results in more computation load on the computer processor and therefore a tradeoff occurs between the resolution of the patient graphic and the real-time performance of the DTS. The speed of the DTS for calculating dose to the skin is limited by the central processing unit (CPU) and can be improved by using the parallel processing power of a graphics processing unit (GPU). Here, we compare the performance speed of GPU-based DTS software to that of the current CPU-based software as a function of the resolution of the patient graphics. Results show a tremendous improvement in speed using the GPU. While an increase in the spatial resolution of the patient graphics resulted in slowing down the computational speed of the DTS on the CPU, the speed of the GPU-based DTS was hardly affected. This GPU-based DTS can be a powerful tool for providing accurate, real-time feedback about patient skin-dose to physicians while performing interventional procedures.

  12. Use of a graphics processing unit (GPU) to facilitate real-time 3D graphic presentation of the patient skin-dose distribution during fluoroscopic interventional procedures

    Science.gov (United States)

    Rana, Vijay; Rudin, Stephen; Bednarek, Daniel R.

    2012-03-01

    We have developed a dose-tracking system (DTS) that calculates the radiation dose to the patient's skin in realtime by acquiring exposure parameters and imaging-system-geometry from the digital bus on a Toshiba Infinix C-arm unit. The cumulative dose values are then displayed as a color map on an OpenGL-based 3D graphic of the patient for immediate feedback to the interventionalist. Determination of those elements on the surface of the patient 3D-graphic that intersect the beam and calculation of the dose for these elements in real time demands fast computation. Reducing the size of the elements results in more computation load on the computer processor and therefore a tradeoff occurs between the resolution of the patient graphic and the real-time performance of the DTS. The speed of the DTS for calculating dose to the skin is limited by the central processing unit (CPU) and can be improved by using the parallel processing power of a graphics processing unit (GPU). Here, we compare the performance speed of GPU-based DTS software to that of the current CPU-based software as a function of the resolution of the patient graphics. Results show a tremendous improvement in speed using the GPU. While an increase in the spatial resolution of the patient graphics resulted in slowing down the computational speed of the DTS on the CPU, the speed of the GPU-based DTS was hardly affected. This GPU-based DTS can be a powerful tool for providing accurate, real-time feedback about patient skin-dose to physicians while performing interventional procedures.

  13. The perspectives of Aboriginal patients and their health care providers on improving the quality of hemodialysis services: a qualitative study.

    Science.gov (United States)

    Rix, Elizabeth F; Barclay, Lesley; Stirling, Janelle; Tong, Allison; Wilson, Shawn

    2015-01-01

    Chronic kidney disease has a higher prevalence in Indigenous populations globally. The incidence of end-stage kidney disease in Australian Aboriginal people is eight times higher than non-Aboriginal Australians. Providing services to rural and remote Aboriginal people with chronic disease is challenging because of access and cultural differences. This study aims to describe and analyze the perspectives of Aboriginal patients' and health care providers' experience of renal services, to inform service improvement for rural Aboriginal hemodialysis patients. We conducted a thematic analysis of interviews with Aboriginal patients (n = 18) receiving hemodialysis in rural Australia and health care providers involved in their care (n = 29). An overarching theme of avoiding the "costly" crisis encompassed four subthemes: (1) Engaging patients earlier (prevent late diagnosis, slow disease progression); (2) flexible family-focused care (early engagement of family, flexibility to facilitate family and cultural obligations); (3) managing fear of mainstream services (originating in family dialysis experiences and previous racism when engaging with government organizations); (4) service provision shaped by culture (increased home dialysis, Aboriginal support and Aboriginal-led cultural education). Patients and health care providers believe service redesign is required to meet the needs of Aboriginal hemodialysis patients. Participants identified early screening and improving the relationship of Aboriginal people with health systems would reduce crisis entry to hemodialysis. These strategies alongside improving the cultural competence of staff would reduce patients' fear of mainstream services, decrease the current emotional and family costs of care, and increase efficiency of health expenditure on a challenging and increasingly unsustainable treatment system.

  14. Implementation of the Kids-CAT in clinical settings: a newly developed computer-adaptive test to facilitate the assessment of patient-reported outcomes of children and adolescents in clinical practice in Germany.

    Science.gov (United States)

    Barthel, D; Fischer, K I; Nolte, S; Otto, C; Meyrose, A-K; Reisinger, S; Dabs, M; Thyen, U; Klein, M; Muehlan, H; Ankermann, T; Walter, O; Rose, M; Ravens-Sieberer, U

    2016-03-01

    To describe the implementation process of a computer-adaptive test (CAT) for measuring health-related quality of life (HRQoL) of children and adolescents in two pediatric clinics in Germany. The study focuses on the feasibility and user experience with the Kids-CAT, particularly the patients' experience with the tool and the pediatricians' experience with the Kids-CAT Report. The Kids-CAT was completed by 312 children and adolescents with asthma, diabetes or rheumatoid arthritis. The test was applied during four clinical visits over a 1-year period. A feedback report with the test results was made available to the pediatricians. To assess both feasibility and acceptability, a multimethod research design was used. To assess the patients' experience with the tool, the children and adolescents completed a questionnaire. To assess the clinicians' experience, two focus groups were conducted with eight pediatricians. The children and adolescents indicated that the Kids-CAT was easy to complete. All pediatricians reported that the Kids-CAT was straightforward and easy to understand and integrate into clinical practice; they also expressed that routine implementation of the tool would be desirable and that the report was a valuable source of information, facilitating the assessment of self-reported HRQoL of their patients. The Kids-CAT was considered an efficient and valuable tool for assessing HRQoL in children and adolescents. The Kids-CAT Report promises to be a useful adjunct to standard clinical care with the potential to improve patient-physician communication, enabling pediatricians to evaluate and monitor their young patients' self-reported HRQoL.

  15. Facilitating safe care: a qualitative study of Iranian nurse leaders.

    Science.gov (United States)

    Vaismoradi, Mojtaba; Bondas, Terese; Salsali, Mahvash; Jasper, Melanie; Turunen, Hannele

    2014-01-01

    Aim  The purpose of this study was to explore and describe how nurse leaders facilitate safe care from the perspectives of both nurses and nurse leaders. Background  The health-care system's success in improving patient safety pivots on nursing leadership. However, there is a lack of knowledge in the international literature about how nurse leaders facilitate provision of safe care and reaching the goal of a safe health-care system. Method  A qualitative design using a content analysis approach was applied for data gathering and analysis. In this study, 20 nurses (16 nurses and four head nurses) working in a referral teaching hospital in Tehran, Iran, were recruited through purposive sampling. Semi-structured interviews and 10 hours of structured observations were conducted to collect data. Results  The data analysis resulted in three main themes: 'providing environmental prerequisites for safe nursing practice', 'uniting and integrating health-care providers', and 'creating an atmosphere of safe care'. Conclusion  The results indicate that to facilitate providing safe care, nurse leaders should improve nurses' working conditions, develop the nurses' practical competencies, assign duties to nurses according to their skills and capabilities, administer appropriate supervision, improve health-care providers' professional relationships and encourage their collaboration, empower nurses and reward their safe practice. Implications for nursing management  Approaching the challenge of patient safety requires the health-care system to combine its efforts and strategies with nursing leadership in its vital role of facilitating safe care and improving patient safety. © 2012 John Wiley & Sons Ltd.

  16. Can audio recording of outpatient consultations improve patient outcome?

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    different departments: Orthopedics, Urology, Internal Medicine and Pediatrics. A total of 5,460 patients will be included from the outpatient clinics. All patients randomized to an intervention group are offered audio recording of their consultation. An Interactive Voice Response platform enables an audio......Introduction Information provided in an outpatient consultation concerns medication, diagnostic tests, treatment and rehabilitation which is crucial knowledge in regards of patient compliance, decision making and general patient satisfaction. Despite good communication skills among clinicians...... the communication is challenged by the fact that patients tend to forget or misunderstand a great deal of the information given. The primary objective of this study is to investigate the effects of providing patients with an audio recording of the consultation. Methods A randomized controlled trial involving four...

  17. Improving plan quality and consistency by standardization of dose constraints in prostate cancer patients treated with CyberKnife.

    Science.gov (United States)

    Descovich, Martina; Carrara, Mauro; Morlino, Sara; Pinnaduwage, Dilini S; Saltiel, Daniel; Pouliot, Jean; Nash, Marc B; Pignoli, Emanuele; Valdagni, Riccardo; Roach, Mack; Gottschalk, Alexander R

    2013-09-06

    Treatment plans for prostate cancer patients undergoing stereotactic body radiation therapy (SBRT) are often challenging due to the proximity of organs at risk. Today, there are no objective criteria to determine whether an optimal treatment plan has been achieved, and physicians rely on their personal experience to evaluate the plan's quality. In this study, we propose a method for determining rectal and bladder dose constraints achievable for a given patient's anatomy. We expect that this method will improve the overall plan quality and consistency, and facilitate comparison of clinical outcomes across different institutions. The 3D proximity of the organs at risk to the target is quantified by means of the expansion-intersection volume (EIV), which is defined as the intersection volume between the target and the organ at risk expanded by 5 mm. We determine a relationship between EIV and relevant dosimetric parameters, such as the volume of bladder and rectum receiving 75% of the prescription dose (V75%). This relationship can be used to establish institution-specific criteria to guide the treatment planning and evaluation process. A database of 25 prostate patients treated with CyberKnife SBRT is used to validate this approach. There is a linear correlation between EIV and V75% of bladder and rectum, confirming that the dose delivered to rectum and bladder increases with increasing extension and proximity of these organs to the target. This information can be used during the planning stage to facilitate the plan optimization process, and to standardize plan quality and consistency. We have developed a method for determining customized dose constraints for prostate patients treated with robotic SBRT. Although the results are technology specific and based on the experience of a single institution, we expect that the application of this method by other institutions will result in improved standardization of clinical practice.

  18. Methods to improve patient recruitment and retention in stroke trials

    DEFF Research Database (Denmark)

    Berge, Eivind; Stapf, Christian; Al-Shahi Salman, Rustam

    2016-01-01

    Background: The success of randomized-controlled stroke trials is dependent on the recruitment and retention of a sufficient number of patients, but fewer than half of all trials meet their target number of patients. Methods: We performed a search and review of the literature, and conducted......, reimbursement for new interventions only within a study, and monetary incentives to institutions taking part in research (for recruitment); and involvement of patient groups, remote and central follow-up, use of mobile devices, and reminders to patients about their consent to participate (for retention...

  19. Digital audio recordings improve the outcomes of patient consultations

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Holst, René

    2017-01-01

    OBJECTIVES: To investigate the effects on patients' outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL). METHODS: This is a three-armed randomised controlled cluster trial. One group of patients received standard care......, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires...

  20. Digital audio recordings improve the outcomes of patient consultations

    DEFF Research Database (Denmark)

    Wolderslund, Maiken; Kofoed, Poul-Erik; Axboe, Mette

    2016-01-01

    OBJECTIVES: To investigate the effects on patients' outcome of the consultations when provided with: a Digital Audio Recording (DAR) of the consultation and a Question Prompt List (QPL). METHODS: This is a three-armed randomised controlled cluster trial. One group of patients received standard care......, while the other two groups received either the QPL in combination with a recording of their consultation or only the recording. Patients from four outpatient clinics participated: Paediatric, Orthopaedic, Internal Medicine, and Urology. The effects were evaluated by patient-administered questionnaires...

  1. Three-dimensional virtual operations can facilitate complicated surgical planning for the treatment of patients with jaw deformities associated with facial asymmetry:a case report

    Institute of Scientific and Technical Information of China (English)

    Shingo Hara; Masaharu Mitsugi; Takahiro Kanno; Akihiko Nomachi; Takehiko Wajima; Yukihiro Tatemoto

    2013-01-01

    This article describes a case we experienced in which good postsurgical facial profiles were obtained for a patient with jaw deformities associated with facial asymmetry, by implementing surgical planning with SimPlant OMS. Using this method, we conducted LF1 osteotomy, intraoral vertical ramus osteotomy (IVRO), sagittal split ramus osteotomy (SSRO), mandibular constriction and mandibular border genioplasty. Not only did we obtain a class I occlusal relationship, but the complicated surgery also improved the asymmetry of the frontal view, as well as of the profile view, of the patient. The virtual operation using three-dimensional computed tomography (3D-CT) could be especially useful for the treatment of patients with jaw deformities associated with facial asymmetry.

  2. Expanding patient engagement in quality improvement and health system redesign: Three Canadian case studies.

    Science.gov (United States)

    Baker, G Ross; Fancott, Carol; Judd, Maria; O'Connor, Patricia

    2016-09-01

    Healthcare organizations face growing pressures to increase patient-centred care and to involve patients more in organizational decisions. Yet many providers worry that such involvement requires additional time and resources and do not see patients as capable of contributing meaningfully to decisions. This article discusses three efforts in four organizations to engage patients in quality improvement efforts. McGill University Health Centre, Saskatoon Health Region, and Vancouver Coastal and Fraser Health Regions all engaged patients in quality improvement and system redesign initiatives that were successful in improving care processes, outcomes, and patient experience measures. Patient involvement in redesigning care may provide a way to demonstrate the value of patients' experiences and inputs into problem-solving, building support for their involvement in other areas. Further study of these cases and a broader survey of organizational experiences with patient involvement may help elucidate the factors that support greater patient engagement. © 2016 The Canadian College of Health Leaders.

  3. Evaluation of a Tool to Categorize Patients by Reading Literacy and Computer Skill to Facilitate the Computer-Administered Patient Interview

    OpenAIRE

    Lobach, David F.; Hasselblad, Victor; Wildemuth, Barbara M.

    2003-01-01

    Past efforts to collect clinical information directly from patients using computers have had limited utility because these efforts required users to be literate and facile with the computerized information collecting system. In this paper we describe the creation and use of a computer-based tool designed to assess a user’s reading literacy and computer skill for the purpose of adapting the human-computer interface to fit the identified skill levels of the user. The tool is constructed from a ...

  4. Silver Ring Splints Improve Dexterity in Patients with Rheumatoid Arthritis.

    NARCIS (Netherlands)

    Zijlstra, Theo R.; Heijnsdijk-Rouwenhorst, Linda; Rasker, Hans J.

    2004-01-01

    Objective: To study the effect of Silver Ring Splints (SRSs) on hand function in patients with rheumatoid arthritis (RA). - Methods: RA patients with stable disease and finger deformities eligible for splinting received 1 or more SRSs. Primary outcome was dexterity, which was measured with the Seque

  5. Levetiracetam improves verbal memory in high-grade glioma patients

    NARCIS (Netherlands)

    de Groot, Marjolein; Douw, Linda; Sizoo, Eefje M; Bosma, Ingeborg; Froklage, Femke E; Heimans, Jan J; Postma, Tjeerd J; Klein, Martin; Reijneveld, Jaap C

    2013-01-01

    BACKGROUND: Treatment of high-grade glioma (HGG) patients with anti-epileptic drugs (AEDs) has met with various side effects, such as cognitive deterioration. The cognitive effects of both older and newer AEDs in HGG patients are largely unknown. The aim of this study was to determine the effect of

  6. Metabolic acidosis improves airway conductance in patients with asthma.

    NARCIS (Netherlands)

    Brijker, F.; Elshout, F.J.J. van den; Bosch, F.H.; Heijdra, Y.F.; Folgering, H.T.M.

    2009-01-01

    The objective was to investigate whether acute metabolic acidosis could cause bronchodilation in patients with asthma. Twelve patients with asthma (8 females, mean age 39 (+/- SD 12) years, forced expiratory volume in 1 second [FEV(1)] 93 [+/-9] % predicted, PC(20) 1.9 (+/-1.0) mg/mL) participated i

  7. [The TPE nurse improving the patient's quality of life].

    Science.gov (United States)

    Mira, Thierry

    The impact of interventions by therapeutic education nurses on compliance and the quality of life of patients with chronic diseases has been proven. These different perspectives of caregivers and patients highlight the specific case of the treatment of HIV. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. Levetiracetam improves verbal memory in high-grade glioma patients

    NARCIS (Netherlands)

    de Groot, Marjolein; Douw, Linda; Sizoo, Eefje M; Bosma, Ingeborg; Froklage, Femke E; Heimans, Jan J; Postma, Tjeerd J; Klein, Martin; Reijneveld, Jaap C

    BACKGROUND: Treatment of high-grade glioma (HGG) patients with anti-epileptic drugs (AEDs) has met with various side effects, such as cognitive deterioration. The cognitive effects of both older and newer AEDs in HGG patients are largely unknown. The aim of this study was to determine the effect of

  9. Theme: The Role of the Teacher in Facilitation of Learning.

    Science.gov (United States)

    Agricultural Education Magazine, 2003

    2003-01-01

    Contains 13 articles on facilitation in agricultural education that address improving student learning, teaching methods, the teacher's role as a facilitator, preparing students for the workplace, and the facilitator's role in student-centered classrooms. (JOW)

  10. Addressing the Issue of Microplastics in the Wake of the Microbead-Free Waters Act-A New Standard Can Facilitate Improved Policy.

    Science.gov (United States)

    McDevitt, Jason P; Criddle, Craig S; Morse, Molly; Hale, Robert C; Bott, Charles B; Rochman, Chelsea M

    2017-06-20

    The United States Microbead-Free Waters Act was signed into law in December 2015. It is a bipartisan agreement that will eliminate one preventable source of microplastic pollution in the United States. Still, the bill is criticized for being too limited in scope, and also for discouraging the development of biodegradable alternatives that ultimately are needed to solve the bigger issue of plastics in the environment. Due to a lack of an acknowledged, appropriate standard for environmentally safe microplastics, the bill banned all plastic microbeads in selected cosmetic products. Here, we review the history of the legislation and how it relates to the issue of microplastic pollution in general, and we suggest a framework for a standard (which we call "Ecocyclable") that includes relative requirements related to toxicity, bioaccumulation, and degradation/assimilation into the natural carbon cycle. We suggest that such a standard will facilitate future regulation and legislation to reduce pollution while also encouraging innovation of sustainable technologies.

  11. Hybrid Assistive Neuromuscular Dynamic Stimulation Therapy: A New Strategy for Improving Upper Extremity Function in Patients with Hemiparesis following Stroke

    Directory of Open Access Journals (Sweden)

    Toshiyuki Fujiwara

    2017-01-01

    Full Text Available Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS therapy is one of the neurorehabilitation therapeutic approaches that facilitates the use of the paretic upper extremity (UE in daily life by combining closed-loop electromyography- (EMG- controlled neuromuscular electrical stimulation (NMES with a wrist-hand splint. This closed-loop EMG-controlled NMES can change its stimulation intensity in direct proportion to the changes in voluntary generated EMG amplitudes recorded with surface electrodes placed on the target muscle. The stimulation was applied to the paretic finger extensors. Patients wore a wrist-hand splint and carried a portable stimulator in an arm holder for 8 hours during the daytime. The system was active for 8 hours, and patients were instructed to use their paretic hand as much as possible. HANDS therapy was conducted for 3 weeks. The patients were also instructed to practice bimanual activities in their daily lives. Paretic upper extremity motor function improved after 3 weeks of HANDS therapy. Functional improvement of upper extremity motor function and spasticity with HANDS therapy is based on the disinhibition of the affected hemisphere and modulation of reciprocal inhibition. HANDS therapy may offer a promising option for the management of the paretic UE in patients with stroke.

  12. Hybrid Assistive Neuromuscular Dynamic Stimulation Therapy: A New Strategy for Improving Upper Extremity Function in Patients with Hemiparesis following Stroke

    Science.gov (United States)

    Honaga, Kaoru; Tochikura, Michi; Abe, Kaoru

    2017-01-01

    Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) therapy is one of the neurorehabilitation therapeutic approaches that facilitates the use of the paretic upper extremity (UE) in daily life by combining closed-loop electromyography- (EMG-) controlled neuromuscular electrical stimulation (NMES) with a wrist-hand splint. This closed-loop EMG-controlled NMES can change its stimulation intensity in direct proportion to the changes in voluntary generated EMG amplitudes recorded with surface electrodes placed on the target muscle. The stimulation was applied to the paretic finger extensors. Patients wore a wrist-hand splint and carried a portable stimulator in an arm holder for 8 hours during the daytime. The system was active for 8 hours, and patients were instructed to use their paretic hand as much as possible. HANDS therapy was conducted for 3 weeks. The patients were also instructed to practice bimanual activities in their daily lives. Paretic upper extremity motor function improved after 3 weeks of HANDS therapy. Functional improvement of upper extremity motor function and spasticity with HANDS therapy is based on the disinhibition of the affected hemisphere and modulation of reciprocal inhibition. HANDS therapy may offer a promising option for the management of the paretic UE in patients with stroke. PMID:28191352

  13. Efficacy of interventions to improve sleep quality among patients with breast cancer : a systematic review

    OpenAIRE

    Li, Xueqi; 李雪琪

    2015-01-01

    Introduction: Breast cancer is the most common cancer in women. While advances in therapeutic approaches have improved the survival of breast cancer patients, it is important to improve the quality of life among the cancer survivors. Sleep disturbance is one of the most important problems for breast cancer patients that substantially reduced their quality of life. Many interventions have been developed for improving sleep quality for breast cancer patients. The aim of this review is firstly t...

  14. The eDL mobile app - Improving communication between hospitals, patients and community physicians

    NARCIS (Netherlands)

    Lezcano, Leonardo; Drachsler, Hendrik; Ternier, Stefaan; Kalz, Marco; Specht, Marcus

    2013-01-01

    Lezcano, L., Drachsler, H., Ternier, S., Kalz, M., & Specht, M. (2012, October). The eDL mobile app - Improving communication between hospitals, patients and community physicians. Presentation at the kickoff meeting of the Patient project, Heerlen, The Netherlands.

  15. The Effect of Performance-Based Financial Incentives on Improving Patient Care Experiences: A Statewide Evaluation

    National Research Council Canada - National Science Library

    Rodriguez, Hector P; von Glahn, Ted; Elliott, Marc N; Rogers, William H; Safran, Dana Gelb

    2009-01-01

    Patient experience measures are central to many pay-for-performance (P4P) programs nationally, but the effect of performance-based financial incentives on improving patient care experiences has not been...

  16. Oxytocin improves compassion toward women among patients with PTSD.

    Science.gov (United States)

    Palgi, Sharon; Klein, Ehud; Shamay-Tsoory, Simone G

    2016-02-01

    Although impairments in social skills, including empathic abilities, are common in post-traumatic stress disorder (PTSD), the ability to feel compassion-a pro-social behavior that is based on empathy and drives us to help others-has never been assessed among these patients. The first aim of this study was to examine whether patients with PTSD suffer from deficits in compassion and to examine the association between the clusters of PTSD symptoms and these deficits. Furthermore, given that intranasal oxytocin (OT) has been suggested to possibly modulate social behaviors, the second aim of this study was to investigate whether intranasal OT may enhance compassion in these patients. Using a randomized, double-blind, placebo-controlled crossover design, we administered 24 IU of OT and placebo at a one-week interval to 32 patients with PTSD and to 30 matched healthy control participants. The results indicate that patients with PTSD exhibit deficits in compassion and that the numbing cluster emerged as the key predictor of those deficits. Moreover, the results indicate that a single intranasal dose of OT enhances compassion toward women (but not towards men), both in patients with PTSD and in controls. These results offer support for recent suggestions that intranasal OT may potentially be an effective pharmacological intervention for patients with PTSD.

  17. The facilitative effect of transcranial direct current stimulation on visuospatial working memory in patients with diabetic polyneuropathy: a pre-post sham-controlled study

    Directory of Open Access Journals (Sweden)

    YI-JEN WU

    2016-09-01

    Full Text Available Diabetes mellitus (DM can lead to diabetic polyneuropathy (DPN and cognitive deficits that manifest as peripheral and central neuropathy, respectively. In this study we investigated the relationship between visuospatial working memory (VSWM capacity and DPN severity, and attempted to improve VSWM in DPN patients via the use of transcranial direct current stimulation (tDCS. Sixteen DPN patients and sixteen age- and education-matched healthy control subjects received Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV and Montreal Cognitive Assessment (MOCA for baseline cognitive assessment. A forward- and backward-recall computerized Corsi block tapping task (CBT, both with and without a concurrent motor interference task was used to measure VSWM capacity. Each DPN patient underwent a pre-treatment CBT, followed by tDCS or sham treatment, then a post-treatment CBT on two separate days. We found that although patients with severe DPN (Dyck’s grade 2a or 2b showed comparable general intelligence scores on WAIS-IV as their age- and education-matched healthy counterparts, they nonetheless showed mild cognitive impairment on MOCA and working memory deficit on digit-span test of WAIS-IV. Furthermore, patients’ peripheral nerve conduction velocity (NCV was positively correlated with their VSWM span in the most difficult CBT condition that involved backward-recall with motor interference such that patients with worse NCV also had lower VSWM span. Most importantly, anodal tDCS over the right DLPFC was able to improve low-performing patients’ VSWM span to be on par with the high-performers, thereby eliminating the correlation between NCV and VSWM. In summary, these findings suggest that 1 mild cognitive impairment and severe peripheral neuropathy can coexist with unequal severity in diabetic patients, 2 the positive correlation of VSWM and NCV suggests a link between peripheral and central neuropathies and 3 anodal tDCS over the right DLPFC can

  18. Improving radionuclide therapy in prostate cancer patients with metastatic bone pain

    NARCIS (Netherlands)

    Lam, M.G.E.H.

    2009-01-01

    Bone seeking radiopharmaceuticals are indicated in cancer patients with multiple painful skeletal metastases. The majority of these patients are hormone-refractory prostate cancer patients in an advanced stage of their disease. Bone seeking radiopharmaceuticals relieve pain and improve the patients

  19. Using simulation modeling to improve patient flow at an outpatient orthopedic clinic.

    Science.gov (United States)

    Rohleder, Thomas R; Lewkonia, Peter; Bischak, Diane P; Duffy, Paul; Hendijani, Rosa

    2011-06-01

    We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced.

  20. The use of nationwide on-line prescription records improves the drug history in hospitalized patients

    DEFF Research Database (Denmark)

    Glintborg, Bente; Poulsen, Henrik E; Dalhoff, Kim P

    2008-01-01

    What is already known about this subject: Structured medication interviews improve the medication history upon hospitalization. Pharmacy records are valid lists of the prescribed medications available to individual patients. In Denmark, treating doctors now have access to their patients' pharmacy...... records through a real-time online electronic database What this study adds: Omission errors are frequent among hospitalized patients despite structured drug interviews and home visits. Pharmacy records may be used to minimize patients' recall bias and improve the medication lists....

  1. The use of nationwide on-line prescription records improves the drug history in hospitalized patients

    DEFF Research Database (Denmark)

    Glintborg, Bente; Poulsen, Henrik E; Dalhoff, Kim P

    2008-01-01

    records through a real-time online electronic database What this study adds: Omission errors are frequent among hospitalized patients despite structured drug interviews and home visits. Pharmacy records may be used to minimize patients' recall bias and improve the medication lists.......What is already known about this subject: Structured medication interviews improve the medication history upon hospitalization. Pharmacy records are valid lists of the prescribed medications available to individual patients. In Denmark, treating doctors now have access to their patients' pharmacy...

  2. Oxygen supplementation facilitating successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease following trans-tibial amputation: a case report

    Directory of Open Access Journals (Sweden)

    Sharma Sat

    2010-12-01

    Full Text Available Abstract Introduction Dysvascular amputations are increasingly performed in patients with underlying cardiac and pulmonary disorders. A limb prosthesis is rarely offered to patients with severe chronic obstructive pulmonary disease because of their inability to achieve the high energy expenditure required for prosthetic ambulation. We describe a case of successful prosthetic fitting and rehabilitation of a patient with severe chronic obstructive pulmonary disease with the aid of oxygen supplementation. Case presentation A 67-year-old aboriginal woman with severe chronic obstructive pulmonary disease and hypercapnic respiratory failure underwent right trans-tibial (below the knee amputation for severe foot gangrene. An aggressive rehabilitation program of conditioning exercises and gait training utilizing oxygen therapy was initiated. She was custom-fitted with a right trans-tibial prosthesis. A rehabilitation program improved her strength, endurance and stump contracture, and she was able to walk for short distances with the prosthesis. The motion analysis studies showed a cadence of 73.5 steps per minute, a velocity of 0.29 meters per second and no difference in right and left step time and step length. Conclusion This case report illustrates that patients with significant severe chronic obstructive pulmonary disease can be successfully fitted with limb prostheses and undergo rehabilitation using supplemental oxygen along with optimization of their underlying comorbidities. Despite the paucity of published information in this area, prosthesis fitting and rehabilitation should be considered in patients who have undergone amputation and have severe chronic obstructive disease.

  3. Improving the service for patients receiving extracorporeal photopheresis using Lean principles.

    Science.gov (United States)

    Rushton, Cherie; Robertson, Leeah; Taylor, Tracie; Taylor, Peter; Button, Paul; Alfred, Arun

    2016-09-08

    The photopheresis unit where the authors work has seen an increased demand both locally and as an outreach service. A Lean assessment of the unit was undertaken to improve processing time and productivity, which in turn would improve the availability of treatment and improve patient care. The assessment indicated that there were excellent nursing standards and patient care; however, patient waiting times and treatment times were prolonged in comparison with other units. The unit reviewed the patient pathway and identified where delays occurred and consequently changed patient scheduling.

  4. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, Peter Krogh; Husted, Steen; Damsgaard, Else Marie Skjøde

    2007-01-01

    INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have...... focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. AIMS: To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery......, length of stay in hospital and infectious complications. SUBJECTS AND METHODS: 89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months...

  5. Visitation by physicians did not improve triage in trauma patients

    DEFF Research Database (Denmark)

    Holm Burén, Lars Andreas; Daugaard, Morten; Larsen, Jens Rolighed

    2013-01-01

    Introduction: A formalized trauma response team is designed to optimize the quality and progress of patient care for severely injured patients in order to reduce mortality and morbidity. The goal of this study was to determine over- and undertriage and to evaluate if a physicianmanned pre......-hospital response (MD-EMS) would reduce overtriage. Overtriage was defined as the process of overestimating the level of injury sustained by an individual. Material and methods: This was a retrospective study. All patients admitted with trauma team activation (TTA) (n = 1,468) during a four-year period (2007......-2011) were included. Undertriage was estimated by assessing the fraction of major trauma patients (New Injury Severity Score (NISS) > 15) admitted to Viborg Regional Hospital in the project period without TTA. RESULTS : For each year, overtriage was 88.3% (2007), 89.9% (2008), 92.8% (2009) and 88.2% (2010...

  6. Improved nutritional status in elderly patients 6 months after stroke

    DEFF Research Database (Denmark)

    Brynningsen, P K; Damsgaard, Else Marie; Husted, Steen

    2007-01-01

    , length of stay in hospital and infectious complications. SUBJECTS AND METHODS: 89 patients with ischemic stroke consecutively admitted to a geriatric stroke rehabilitation unit had their nutritional status evaluated in the hospital at 1 week and 5 weeks after stroke, and in their own home at 3 months...... was 31 (35 %) at 1 week and was reduced to 20 (22 %) at 6 months. CONCLUSION: 35 % of elderly patients with ischemic stroke admitted to a geriatric rehabilitation unit were malnourished 1 week after stroke. Particularly serum proteins and body fat were affected. Follow-up of nutritional variables showed......INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have...

  7. Functional electrical stimulation improves brain perfusion in cranial trauma patients

    National Research Council Canada - National Science Library

    Amorim, Bárbara Juarez; Santos, Allan de Oliveira; Oberg, Telma Dagmar; Romanato, Juliana; Anjos, Dalton A; Lima, Mariana da Cunha Lopes de; Ramos, Celso Darío; Honorato, Donizete Cesar; Camargo, Edwaldo Eduardo; Etchebehere, Elba Cristina de Sá Camargo

    2011-01-01

    ...: cranial trauma and major vascular insults. All SPECT images were analyzed using SPM. RESULTS: There was a significant statistical difference between the two groups related to patient's ages and extent of hypoperfusion in the SPECT...

  8. Visitation by physicians did not improve triage in trauma patients

    DEFF Research Database (Denmark)

    Holm Burén, Lars Andreas; Daugaard, Morten; Larsen, Jens Rolighed

    2013-01-01

    Introduction: A formalized trauma response team is designed to optimize the quality and progress of patient care for severely injured patients in order to reduce mortality and morbidity. The goal of this study was to determine over- and undertriage and to evaluate if a physicianmanned pre......-hospital response (MD-EMS) would reduce overtriage. Overtriage was defined as the process of overestimating the level of injury sustained by an individual. Material and methods: This was a retrospective study. All patients admitted with trauma team activation (TTA) (n = 1,468) during a four-year period (2007......-2011) were included. Undertriage was estimated by assessing the fraction of major trauma patients (New Injury Severity Score (NISS) > 15) admitted to Viborg Regional Hospital in the project period without TTA. RESULTS : For each year, overtriage was 88.3% (2007), 89.9% (2008), 92.8% (2009) and 88.2% (2010...

  9. Training Surgeons and Anesthesiologists to Facilitate End-of-Life Conversations With Patients and Families: A Systematic Review of Existing Educational Models.

    Science.gov (United States)

    Bakke, Katherine E; Miranda, Stephen P; Castillo-Angeles, Manuel; Cauley, Christy E; Lilley, Elizabeth J; Bernacki, Rachelle; Bader, Angela M; Urman, Richard D; Cooper, Zara

    2017-09-19

    Despite caring for patients near the end-of-life (EOL), surgeons and anesthesiologists report low confidence in their ability to facilitate EOL conversations. This discrepancy exists despite competency requirements and professional medical society recommendations. The objective of this systematic review is to identify articles describing EOL communication training available to surgeons and anesthesiologists, and to assess their methodological rigor to inform future curricular design and evaluation. This PRISMA-concordant systematic review identified English-language articles from PubMed, EMBASE, and manual review. Eligible articles included viewpoint pieces, and observational, qualitative, or case studies that featured an educational intervention for surgeons or anesthesiologists on EOL communication skills. Data on the study objective, setting, design, participants, intervention, and results were extracted and analyzed. The Newcastle-Ottawa Scale was used to assess methodological quality. Database and manual search returned 2710 articles. A total of 2268 studies were screened by title and abstract, 46 reviewed in full-text, and 16 included in the final analysis. Fifteen studies were conducted exclusively in academic hospitals. Two studies included attending surgeons as participants; all others featured residents, fellows, or a mix thereof. Fifteen studies used simulated role-playing to teach and assess EOL communication skills. Measured outcomes included knowledge, attitudes, confidence, self-rated or observer-rated communication skills, and curriculum feedback; signifi