WorldWideScience

Sample records for healthcare interventions explanation

  1. Theory-based explanation as intervention.

    Science.gov (United States)

    Weisman, Kara; Markman, Ellen M

    2017-10-01

    Cogent explanations are an indispensable means of providing new information and an essential component of effective education. Beyond this, we argue that there is tremendous untapped potential in using explanations to motivate behavior change. In this article we focus on health interventions. We review four case studies that used carefully tailored explanations to address gaps and misconceptions in people's intuitive theories, providing participants with a conceptual framework for understanding how and why some recommended behavior is an effective way of achieving a health goal. These case studies targeted a variety of health-promoting behaviors: (1) children washing their hands to prevent viral epidemics; (2) parents vaccinating their children to stem the resurgence of infectious diseases; (3) adults completing the full course of an antibiotic prescription to reduce antibiotic resistance; and (4) children eating a variety of healthy foods to improve unhealthy diets. Simply telling people to engage in these behaviors has been largely ineffective-if anything, concern about these issues is mounting. But in each case, teaching participants coherent explanatory frameworks for understanding health recommendations has shown great promise, with such theory-based explanations outperforming state-of-the-art interventions from national health authorities. We contrast theory-based explanations both with simply listing facts, information, and advice and with providing a full-blown educational curriculum, and argue for providing the minimum amount of information required to understand the causal link between a target behavior and a health outcome. We argue that such theory-based explanations lend people the motivation and confidence to act on their new understanding.

  2. Etiological explanation, treatability and preventability of childhood autism: a survey of Nigerian healthcare workers' opinion

    Directory of Open Access Journals (Sweden)

    Okonkwo Kevin O

    2009-02-01

    Full Text Available Abstract Background Because of their peculiar sociocultural background, healthcare workers in sub-Saharan African subcultures may have various conceptions on different aspects of autism spectrum disorders (ASD, such as etiology, treatment and issues of prognosis. These various conceptions, if different from current knowledge in literature about ASD, may negatively influence help-seeking behavior of parents of children with ASD who seek advice and information from the healthcare workers. This study assessed the opinions of healthcare workers in Nigeria on aspects of etiology, treatability and preventability of childhood autism, and relates their opinions to the sociodemographic variables. Methods Healthcare workers working in four tertiary healthcare facilities located in the south-east and south-south regions of Nigeria were interviewed with a sociodemographic questionnaire, personal opinion on etiology, treatability and preventability of childhood autism (POETPCA questionnaire and knowledge about childhood autism among health workers (KCAHW questionnaire to assess their knowledge and opinions on various aspects of childhood autism. Results A total of 134 healthcare workers participated in the study. In all, 78 (58.2%, 19 (14.2% and 36 (26.9% of the healthcare workers were of the opinion that the etiology of childhood autism can be explained by natural, preternatural and supernatural causes, respectively. One (0.7% of the healthcare workers was unsure of the explanation of the etiology. Knowledge about childhood autism as measured by scores on the KCAHW questionnaire was the only factor significantly associated with the opinions of the healthcare workers on etiology of childhood autism. In all, 73 (54.5% and 43 (32.1%, of the healthcare workers subscribed to the opinion that childhood autism is treatable and preventable respectively. Previous involvement with managing children with ASD significantly influenced the opinion of the healthcare

  3. Psychological explanations and interventions for indifference to greening hospitals.

    Science.gov (United States)

    Topf, Margaret

    2005-01-01

    Attention has increasingly been given to "greening" the environment, that is, to engaging in environmentally responsible behavior. Applied to hospitals, greening is collective interdisciplinary organizational behavior that reduces environmental hazards and overconsumption. An environmental crisis in hospitals is described. A number of individual and group psychological phenomena are detailed to explain the current absence of widespread greening in hospitals. Social and environmental psychology concepts for behavior change are combined to provide a model consisting of hospital administration and staff interventions to green this setting. Successful examples of these interventions are provided.

  4. Ethics interventions for healthcare professionals and students: A systematic review.

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    Stolt, Minna; Leino-Kilpi, Helena; Ruokonen, Minka; Repo, Hanna; Suhonen, Riitta

    2018-03-01

    The ethics and value bases in healthcare are widely acknowledged. There is a need to improve and raise awareness of ethics in complex systems and in line with competing needs, different stakeholders and patients' rights. Evidence-based strategies and interventions for the development of procedures and practice have been used to improve care and services. However, it is not known whether and to what extent ethics can be developed using interventions. To examine ethics interventions conducted on healthcare professionals and healthcare students to achieve ethics-related outcomes. A systematic review. Five electronic databases were searched: CINAHL, the Cochrane Library, Philosopher's Index, PubMed and PsycINFO. We searched for published articles written in English without a time limit using the keywords: ethic* OR moral* AND intervention OR program OR pre-post OR quasi-experimental OR rct OR experimental AND nurse OR nursing OR health care. In the four-phased retrieval process, 23 full texts out of 4675 citations were included in the review. Data were analysed using conventional content analysis. Ethical consideration: This systematic review was conducted following good scientific practice in every phase. It is possible to affect the ethics of healthcare practices through professionals and students. All the interventions were educational in type. Many of the interventions were related to the ethical or moral sensitivity of the professionals, such as moral courage and empowerment. A few of the interventions focused on identifying ethical problems or research ethics. Patient-related outcomes followed by organisational outcomes can be improved by ethics interventions targeting professionals. Such outcomes are promising in developing ethical safety for healthcare patients and professionals.

  5. AHRQ series on complex intervention systematic reviews-paper 7: PRISMA-CI elaboration and explanation.

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    Guise, Jeanne-Marie; Butler, Mary; Chang, Christine; Viswanathan, Meera; Pigott, Terri; Tugwell, Peter

    2017-10-01

    Complex interventions are widely used in health care, public health, education, criminology, social work, business, and welfare. They have increasingly become the subject of systematic reviews and are challenging to effectively report. The Complex Interventions Methods Workgroup developed an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Complex Interventions (PRISMA-CI). Following the EQUATOR Network guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions, this Explanation and Elaboration (EE) document accompanies the PRISMA-CI checklist to promote consistency in reporting of systematic reviews of complex interventions. The EE document explains the meaning and rationale for each unique PRISMA-CI checklist item and provides examples to assist systematic review authors in operationalizing PRISMA-CI guidance. The Complex Interventions Workgroup developed PRISMA-CI as an important start toward increased consistency in reporting of systematic reviews of complex interventions. Because the field is rapidly expanding, the Complex Interventions Methods Workgroup plans to re-evaluate periodically for the need to add increasing specificity and examples as the field matures. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  6. Do reviews of healthcare interventions teach us how to improve healthcare systems?

    Science.gov (United States)

    Pawson, Ray; Greenhalgh, Joanne; Brennan, Cathy; Glidewell, Elizabeth

    2014-08-01

    Planners, managers and policy makers in modern health services are not without ingenuity - they will always try, try and try again. They face deep-seated or 'wicked' problems, which have complex roots in the labyrinthine structures though which healthcare is delivered. Accordingly, the interventions devised to deal with such stubborn problems usually come in the plural. Many different reforms are devised to deal with a particular stumbling block, which may be implemented sequentially, simultaneously or whenever policy fashion or funding dictates. This paper examines this predicament from the perspective of evidence based policy. How might researchers go about reviewing the evidence when they are faced with multiple or indeed competing interventions addressing the same problem? In the face of this plight a rather unheralded form of research synthesis has emerged, namely the 'typological review'. We critically review the fortunes of this strategy. Separating the putative reforms into series of subtypes and producing a scorecard of their outcomes has the unintended effect of divorcing them all from an understanding of how organisations change. A more fruitful approach may lie in a 'theory-driven review' underpinned by an understanding of dynamics of social change in complex organisations. We test this thesis by examining the primary and secondary research on the many interventions designed to tackle a particularly wicked problem, namely the inexorable rise in demand for healthcare. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. Value of information and pricing new healthcare interventions.

    Science.gov (United States)

    Willan, Andrew R; Eckermann, Simon

    2012-06-01

    Previous application of value-of-information methods to optimal clinical trial design have predominantly taken a societal decision-making perspective, implicitly assuming that healthcare costs are covered through public expenditure and trial research is funded by government or donation-based philanthropic agencies. In this paper, we consider the interaction between interrelated perspectives of a societal decision maker (e.g. the National Institute for Health and Clinical Excellence [NICE] in the UK) charged with the responsibility for approving new health interventions for reimbursement and the company that holds the patent for a new intervention. We establish optimal decision making from societal and company perspectives, allowing for trade-offs between the value and cost of research and the price of the new intervention. Given the current level of evidence, there exists a maximum (threshold) price acceptable to the decision maker. Submission for approval with prices above this threshold will be refused. Given the current level of evidence and the decision maker's threshold price, there exists a minimum (threshold) price acceptable to the company. If the decision maker's threshold price exceeds the company's, then current evidence is sufficient since any price between the thresholds is acceptable to both. On the other hand, if the decision maker's threshold price is lower than the company's, then no price is acceptable to both and the company's optimal strategy is to commission additional research. The methods are illustrated using a recent example from the literature.

  8. An evaluation of a community dietetics intervention on the management of malnutrition for healthcare professionals.

    LENUS (Irish Health Repository)

    Kennelly, S

    2010-12-01

    Healthcare professionals working in the community setting have limited knowledge of the evidence-based management of malnutrition. The present study aimed to evaluate a community dietetics intervention, which included an education programme for healthcare professionals in conjunction with the introduction of a community dietetics service for patients \\'at risk\\' of malnutrition. Changes in nutritional knowledge and the reported management of malnourished patients were investigated and the acceptability of the intervention was explored.

  9. Healthcare professionals and managers' participation in developing an intervention: A pre-intervention study in the elderly care context

    Directory of Open Access Journals (Sweden)

    Bergman Howard

    2009-04-01

    Full Text Available Abstract Background In order to increase the chances of success in new interventions in healthcare, it is generally recommended to tailor the intervention to the target setting and the target professionals. Nonetheless, pre-intervention studies are rarely conducted or are very limited in scope. Moreover, little is known about how to integrate the results of a pre-intervention study into an intervention. As part of a project to develop an intervention aimed at improving care for the elderly in France, a pre-intervention study was conducted to systematically gather data on the current practices, issues, and expectations of healthcare professionals and managers in order to determine the defining features of a successful intervention. Methods A qualitative study was carried out from 2004 to 2006 using a grounded theory approach and involving a purposeful sample of 56 healthcare professionals and managers in Paris, France. Four sources of evidence were used: interviews, focus groups, observation, and documentation. Results The stepwise approach comprised three phases, and each provided specific results. In the first step of the pre-intervention study, we gathered data on practices, perceived issues, and expectations of healthcare professionals and managers. The second step involved holding focus groups in order to define the characteristics of a tailor-made intervention. The third step allowed validation of the findings. Using this approach, we were able to design and develop an intervention in elderly care that met the professionals' and managers' expectations. Conclusion This article reports on an in-depth pre-intervention study that led to the design and development of an intervention in partnership with local healthcare professionals and managers. The stepwise approach represents an innovative strategy for developing tailored interventions, particularly in complex domains such as chronic care. It highlights the usefulness of seeking out the

  10. Health Professionals' Explanations of Suicidal Behaviour: Effects of Professional Group, Theoretical Intervention Model, and Patient Suicide Experience.

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    Rothes, Inês Areal; Henriques, Margarida Rangel

    2017-12-01

    In a help relation with a suicidal person, the theoretical models of suicidality can be essential to guide the health professional's comprehension of the client/patient. The objectives of this study were to identify health professionals' explanations of suicidal behaviors and to study the effects of professional group, theoretical intervention models, and patient suicide experience in professionals' representations. Two hundred and forty-two health professionals filled out a self-report questionnaire. Exploratory principal components analysis was used. Five explanatory models were identified: psychological suffering, affective cognitive, sociocommunicational, adverse life events, and psychopathological. Results indicated that the psychological suffering and psychopathological models were the most valued by the professionals, while the sociocommunicational was seen as the least likely to explain suicidal behavior. Differences between professional groups were found. We concluded that training and reflection on theoretical models in general and in communicative issues in particular are needed in the education of health professionals.

  11. A systematic review of team-building interventions in non-acute healthcare settings.

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    Miller, Christopher J; Kim, Bo; Silverman, Allie; Bauer, Mark S

    2018-03-01

    Healthcare is increasingly delivered in a team-based format emphasizing interdisciplinary coordination. While recent reviews have investigated team-building interventions primarily in acute healthcare settings (e.g. emergency or surgery departments), we aimed to systematically review the evidence base for team-building interventions in non-acute settings (e.g. primary care or rehabilitation clinics). We conducted a systematic review in PubMed and Embase to identify team-building interventions, and conducted follow-up literature searches to identify articles describing empirical studies of those interventions. This process identified 14 team-building interventions for non-acute healthcare settings, and 25 manuscripts describing empirical studies of these interventions. We evaluated outcomes in four domains: trainee evaluations, teamwork attitudes/knowledge, team functioning, and patient impact. Trainee evaluations for team-building interventions were generally positive, but only one study associated team-building with statistically significant improvement in teamwork attitudes/knowledge. Similarly mixed results emerged for team functioning and patient impact. The evidence base for healthcare team-building interventions in non-acute healthcare settings is much less developed than the parallel literature for short-term team function in acute care settings. Only one intervention we identified has been tested in multiple non-acute settings by distinct research teams. Positive findings regarding the utility of team-building interventions are tempered by a lack of control conditions, inconsistency in outcome measures, and high probability of bias. Considering these results alongside the well-recognized costs of poor healthcare teamwork suggests that additional research is sorely needed to develop the evidence base for team-building in non-acute settings.

  12. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework.

    Science.gov (United States)

    Sekhon, Mandeep; Cartwright, Martin; Francis, Jill J

    2017-01-26

    It is increasingly acknowledged that 'acceptability' should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. The purpose of this study was to develop a multi-construct theoretical framework of acceptability of healthcare interventions that can be applied to assess prospective (i.e. anticipated) and retrospective (i.e. experienced) acceptability from the perspective of intervention delivers and recipients. Two methods were used to select the component constructs of acceptability. 1) An overview of reviews was conducted to identify systematic reviews that claim to define, theorise or measure acceptability of healthcare interventions. 2) Principles of inductive and deductive reasoning were applied to theorise the concept of acceptability and develop a theoretical framework. Steps included (1) defining acceptability; (2) describing its properties and scope and (3) identifying component constructs and empirical indicators. From the 43 reviews included in the overview, none explicitly theorised or defined acceptability. Measures used to assess acceptability focused on behaviour (e.g. dropout rates) (23 reviews), affect (i.e. feelings) (5 reviews), cognition (i.e. perceptions) (7 reviews) or a combination of these (8 reviews). From the methods described above we propose a definition: Acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. The theoretical framework of acceptability (TFA) consists of seven component constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Despite frequent claims that healthcare interventions have assessed acceptability, it is

  13. Key factors of case management interventions for frequent users of healthcare services: a thematic analysis review.

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    Hudon, Catherine; Chouinard, Maud-Christine; Lambert, Mireille; Diadiou, Fatoumata; Bouliane, Danielle; Beaudin, Jérémie

    2017-10-22

    The aim of this paper was to identify the key factors of case management (CM) interventions among frequent users of healthcare services found in empirical studies of effectiveness. Thematic analysis review of CM studies. We built on a previously published review that aimed to report the effectiveness of CM interventions for frequent users of healthcare services, using the Medline, Scopus and CINAHL databases covering the January 2004-December 2015 period, then updated to July 2017, with the keywords 'CM' and 'frequent use'. We extracted factors of successful (n=7) and unsuccessful (n=6) CM interventions and conducted a mixed thematic analysis to synthesise findings. Chaudoir's implementation of health innovations framework was used to organise results into four broad levels of factors: (1) ,environmental/organisational level, (2) practitioner level, (3) patient level and (4) programme level. Access to, and close partnerships with, healthcare providers and community services resources were key factors of successful CM interventions that should target patients with the greatest needs and promote frequent contacts with the healthcare team. The selection and training of the case manager was also an important factor to foster patient engagement in CM. Coordination of care, self-management support and assistance with care navigation were key CM activities. The main issues reported by unsuccessful CM interventions were problems with case finding or lack of care integration. CM interventions for frequent users of healthcare services should ensure adequate case finding processes, rigorous selection and training of the case manager, sufficient intensity of the intervention, as well as good care integration among all partners. Other studies could further evaluate the influence of contextual factors on intervention impacts. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted

  14. iLead-a transformational leadership intervention to train healthcare managers' implementation leadership.

    Science.gov (United States)

    Richter, Anne; von Thiele Schwarz, Ulrica; Lornudd, Caroline; Lundmark, Robert; Mosson, Rebecca; Hasson, Henna

    2016-07-29

    Leadership is a key feature in implementation efforts, which is highlighted in most implementation frameworks. However, in studying leadership and implementation, only few studies rely on established leadership theory, which makes it difficult to draw conclusions regarding what kinds of leadership managers should perform and under what circumstances. In industrial and organizational psychology, transformational leadership and contingent reward have been identified as effective leadership styles for facilitating change processes, and these styles map well onto the behaviors identified in implementation research. However, it has been questioned whether these general leadership styles are sufficient to foster specific results; it has therefore been suggested that the leadership should be specific to the domain of interest, e.g., implementation. To this end, an intervention specifically involving leadership, which we call implementation leadership, is developed and tested in this project. The aim of the intervention is to increase healthcare managers' generic implementation leadership skills, which they can use for any implementation efforts in the future. The intervention is conducted in healthcare in Stockholm County, Sweden, where first- and second-line managers were invited to participate. Two intervention groups are included, including 52 managers. Intervention group 1 consists of individual managers, and group 2 of managers from one division. A control group of 39 managers is additionally included. The intervention consists of five half-day workshops aiming at increasing the managers' implementation leadership, which is the primary outcome of this intervention. The intervention will be evaluated through a mixed-methods approach. A pre- and post-design applying questionnaires at three time points (pre-, directly after the intervention, and 6 months post-intervention) will be used, in addition to process evaluation questionnaires related to each workshop. In

  15. Healthcare

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  16. Linking Environmental Sustainability and Healthcare: The Effects of an Energy Saving Intervention in Two Hospitals

    OpenAIRE

    Danae Manika; Diana Gregory-Smith; Victoria K. Wells; Lee Comerford; Lucy Aldrich-Smith

    2017-01-01

    Set in a real organisational setting, this study examines the challenges of implementing environmentally sustainable behaviour in healthcare. It evaluates the success of a real energy saving behaviour change intervention, based on social marketing principles, which targeted the employees of two National Health Service (NHS) hospitals. It also explores the intervention benefits for three key stakeholders: the organisation/hospitals, hospital employees and patients. A rich secondary dataset con...

  17. Interventions to improve teamwork and communications among healthcare staff.

    Science.gov (United States)

    McCulloch, P; Rathbone, J; Catchpole, K

    2011-04-01

    Concern over the frequency of unintended harm to patients has focused attention on the importance of teamwork and communication in avoiding errors. This has led to experiments with teamwork training programmes for clinical staff, mostly based on aviation models. These are widely assumed to be effective in improving patient safety, but the extent to which this assumption is justified by evidence remains unclear. A systematic literature review on the effects of teamwork training for clinical staff was performed. Information was sought on outcomes including staff attitudes, teamwork skills, technical performance, efficiency and clinical outcomes. Of 1036 relevant abstracts identified, 14 articles were analysed in detail: four randomized trials and ten non-randomized studies. Overall study quality was poor, with particular problems over blinding, subjective measures and Hawthorne effects. Few studies reported on every outcome category. Most reported improved staff attitudes, and six of eight reported significantly better teamwork after training. Five of eight studies reported improved technical performance, improved efficiency or reduced errors. Three studies reported evidence of clinical benefit, but this was modest or of borderline significance in each case. Studies with a stronger intervention were more likely to report benefits than those providing less training. None of the randomized trials found evidence of technical or clinical benefit. The evidence for technical or clinical benefit from teamwork training in medicine is weak. There is some evidence of benefit from studies with more intensive training programmes, but better quality research and cost-benefit analysis are needed. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  18. Employee wellness coaching as an interpersonal communication intervention: exploring intervention effects on healthcare costs, risks, and behaviors

    OpenAIRE

    Fedesco, Heather Noel

    2015-01-01

    In order to address the rise in healthcare expenditures, employers are turning to wellness programs as a means to potentially curtail costs. One newly implemented program is wellness coaching, which takes a communicative and holistic approach to helping others make improvements to their health. Wellness coaching is a behavioral health intervention whereby coaches work with clients to help them attain wellness-promoting goals in order to change lifestyle-related behaviors across a range of are...

  19. Decision Making for Healthcare Resource Allocation: Joint v. Separate Decisions on Interacting Interventions.

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    Dakin, Helen; Gray, Alastair

    2018-05-01

    Standard guidance for allocating healthcare resources based on cost-effectiveness recommends using different decision rules for independent and mutually exclusive alternatives, although there is some confusion around the definition of "mutually exclusive." This paper reviews the definitions used in the literature and shows that interactions (i.e., non-additive effects, whereby the effect of giving 2 interventions simultaneously does not equal the sum of their individual effects) are the defining feature of mutually exclusive alternatives: treatments cannot be considered independent if the costs and/or benefits of one treatment are affected by the other treatment. The paper then identifies and categorizes the situations in which interventions are likely to have non-additive effects, including interventions targeting the same goal or clinical event, or life-saving interventions given to overlapping populations. We demonstrate that making separate decisions on interventions that have non-additive effects can prevent us from maximizing health gained from the healthcare budget. In contrast, treating combinations of independent options as though they were "mutually exclusive" makes the analysis more complicated but does not affect the conclusions. Although interactions are considered by the World Health Organization, other decision makers, such as the National Institute for Health and Care Excellence (NICE), currently make independent decisions on treatments likely to have non-additive effects. We propose a framework by which interactions could be considered when selecting, prioritizing, and appraising healthcare technologies to ensure efficient, evidence-based decision making.

  20. The use of music intervention in healthcare research: a narrative review of the literature.

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    Tang, Hsin-Yi Jean; Vezeau, Toni

    2010-09-01

    Although music has been widely used in healthcare, there has been scant review of literature analyzing the use of music as an intervention in healthcare research. The purpose of this article was to provide a narrative review of the literature to explore how "music therapy" has been used in healthcare research to promote healing in adult populations. The following five questions were addressed: (a) In what populations and under what conditions has music intervention been studied? (b) What specific kinds of music have been used for study intervention? (c) How has the music intervention been operationalized? (d) What metrics have been used as outcome measures? (e) Have music interventions been effective? Articles were retrieved from several scientific databases (PubMed, CINAHL, and PsycINFO) using the following search parameters: MeSH search terms "music therapy" in the title field with the search limit to "adults 19 years and older," "humans," "clinical randomized controlled studies," and "English." A total of 33 clinical randomized controlled studies that met the search criteria were reviewed. (a) In the reviewed studies (studied articles), subjects with dementia were the most commonly studied population group, and the predominant aim of the study was to alleviate anxiety. (b) Employed music interventions may be categorized as one of two types: passive (receptive) and active. The passive (receptive) music intervention commonly involved subjects in a resting position listening to music, whereas the active music intervention is usually carried out in a group format in which subjects are actively involved in the music intervention. (c) Intervention frequency, dosing, and duration were highly variable across the reviewed studies. Very few studies described the intervention setting, which made evaluation of these studies difficult. Direct supervision seemed to be an influential factor for adherence. (d) Outcome measures in retrieved articles involved two types

  1. Healthcare interventions for the prevention and control of gestational diabetes mellitus in China: a scoping review.

    Science.gov (United States)

    Xu, Tingting; He, Yasheng; Dainelli, Livia; Yu, Kai; Detzel, Patrick; Silva-Zolezzi, Irma; Volger, Sheri; Fang, Hai

    2017-06-05

    Gestational Diabetes Mellitus (GDM) is a type of diabetes which occurs during pregnancy. Women with GDM are at greater risk of complications during pregnancy and delivery, while babies born from mothers with GDM are at greater risk of post-natal complications. Using the most updated diagnosis criteria, the GDM prevalence is estimated at 9.3-25.5% worldwide and 9.3-18.9% in China. Our objective was to identify healthcare interventions aimed at GDM prevention and control in China. A best-evidence synthesis was performed based on a systematic search of literature published between 1997 and October 2015 in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wan-fang databases using keywords "Gestational Diabetes Mellitus", "GDM", "Intervention" "Medical Intervention" "Early Medical Intervention", "Dietary Intervention", "Exercise Intervention", "Lifestyle Intervention", "Therapy", "Treatment" and "China". Inclusion criteria were studies conducted in China, reporting GDM healthcare interventions, and published in either Chinese or English. Two reviewers independently assessed eligibility and quality of the studies and extracted the data. Treatment efficacy was examined with weighted pooled odds ratio (OR) meta-analyses. The search resulted in 5961 articles (published in 276 different Chinese language journals and 6 English language journals), of which 802 were included in this synthesis. While 39.4% (n = 316) failed to report the GDM diagnostic criteria used, the remaining studies classified GDM with various international (n = 5) or Chinese (n = 7) diagnostic standards. Treatment interventions were categorized into 6 types: dietary (18.6%), exercise (1.6%), medication (20.7%), health education (9.0%), psychological (2.6%) and combination (47.4%). No interventions aimed at GDM prevention were identified. Meta-analyses demonstrated a statistically significant overall benefit of GDM treatment strategies in reducing the odds of maternal and

  2. Understanding Teen Dating Violence: Practical screening and intervention strategies for pediatric and adolescent healthcare providers

    Science.gov (United States)

    Cutter-Wilson, Elizabeth; Richmond, Tracy

    2012-01-01

    Purpose of Review Teen Dating Violence (TDV) is a serious and potentially lethal form of relationship violence in adolescence. TDV is highly correlated with several outcomes related to poor physical and mental health. Although incidence and prevalence data indicates high rates of exposure to TDV among adolescents throughout the United States, significant confusion remains in healthcare communities concerning the definition and implications of TDV. Additionally, healthcare providers are uncertain about effective screening and intervention methods. The article will review the definition and epidemiology of TDV and discuss possible screening and intervention strategies. Recent Findings TDV research is a relatively new addition to the field of relationship violence. Although some confusion remains, the definition and epidemiology of TDV is better understood which has greatly lead to effective ways in which to screen and intervene when such violence is detected. Universal screening with a focus on high risk subgroups combined with referrals to local and national support services are key steps in reducing both primary and secondary exposure. Summary TDV is a widespread public health crisis with serious short and long-term implications. It is necessary for pediatric and adolescent healthcare providers to be aware of TDV, its potential repercussions, as well as possible methods for screening and intervention. More research is needed to better understand TDV as well as to further define effective screening and intervention protocol for the clinical environment. PMID:21670679

  3. Interventions for sustained healthcare professional behaviour change: a protocol for an overview of reviews.

    Science.gov (United States)

    Dombrowski, Stephan U; Campbell, Pauline; Frost, Helen; Pollock, Alex; McLellan, Julie; MacGillivray, Steve; Gavine, Anna; Maxwell, Margaret; O'Carroll, Ronan; Cheyne, Helen; Presseau, Justin; Williams, Brian

    2016-10-13

    Failure to successfully implement and sustain change over the long term continues to be a major problem in health and social care. Translating evidence into routine clinical practice is notoriously complex, and it is recognised that to implement new evidence-based interventions and sustain them over time, professional behaviour needs to change accordingly. A number of theories and frameworks have been developed to support behaviour change among health and social care professionals, and models of sustainability are emerging, but few have translated into valid and reliable interventions. The long-term success of healthcare professional behavioural change interventions is variable, and the characteristics of successful interventions unclear. Previous reviews have synthesised the evidence for behaviour change, but none have focused on sustainability. In addition, multiple overlapping reviews have reported inconsistent results, which do not aid translation of evidence into practice. Overviews of reviews can provide accessible succinct summaries of evidence and address barriers to evidence-based practice. We aim to compile an overview of reviews, identifying, appraising and synthesising evidence relating to sustained social and healthcare professional behaviour change. We will conduct a systematic review of Cochrane reviews (an Overview). We plan to systematically search the Cochrane Database of Systematic Reviews. We will include all systematic reviews of randomised controlled trials comparing a healthcare professional targeted behaviour change intervention to a standard care or no intervention control group. Two reviewers will independently assess the eligibility of the reviews and the methodological quality of included reviews using the ROBIS tool. The quality of evidence within each comparison in each review will be judged based on the GRADE criteria. Disagreements will be resolved through discussion. Effects of interventions will be systematically tabulated and the

  4. Informed consent to healthcare interventions in people with learning disabilities--an integrative review.

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    Goldsmith, Lesley; Skirton, Heather; Webb, Christine

    2008-12-01

    This paper is a report of an integrative review of informed consent to healthcare interventions in people with learning disabilities. Consent to treatment lies at the heart of the relationship between patient and healthcare professional. In order for people with learning disabilities to have equity of access to health care, they need to be able to give informed consent to health interventions--or be assessed as incompetent to give consent. The British Nursing Index (BNI), CINAHL, MEDLINE, Social Care Online, ERIC and ASSIA and PsycINFO databases were searched using the search terms: Consent or informed choice or capacity or consent to treat* or consent to examin* AND Learning disab* or intellectual* disab* or mental* retard* or learning difficult* or mental* handicap*. The search was limited to papers published in English from January 1990 to March 2007. An integrative review was conducted and the data analysed thematically. Twenty-two studies were reviewed. The main themes identified were: life experience, interaction between healthcare professionals and participants, ability to consent, and psychometric variables. A consensus seemed to emerge that capacity to consent is greater in people with higher cognitive ability and verbal skills, but that the attitudes and behaviour of healthcare professionals was also a crucial factor. The findings support use of the functional approach to assessing mental capacity for the purpose of obtaining informed consent. Future research into informed consent in people with learning disabilities is needed using real life situations rather than hypothetical vignettes.

  5. Sustainability of knowledge translation interventions in healthcare decision-making: protocol for a scoping review.

    Science.gov (United States)

    Tricco, Andrea C; Cogo, Elise; Ashoor, Huda; Perrier, Laure; McKibbon, K Ann; Grimshaw, Jeremy M; Straus, Sharon E

    2013-05-14

    Knowledge translation (KT also known as research utilisation, translational medicine and implementation science) is a dynamic and iterative process that includes the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health. After the implementation of KT interventions, their impact on relevant outcomes should be monitored. The objectives of this scoping review are to: (1) conduct a systematic search of the literature to identify the impact on healthcare outcomes beyond 1 year, or beyond the termination of funding of the initiative of KT interventions targeting chronic disease management for end-users including patients, clinicians, public health officials, health services managers and policy-makers; (2) identify factors that influence sustainability of effective KT interventions; (3) identify how sustained change from KT interventions should be measured; and (4) develop a framework for assessing sustainability of KT interventions. Comprehensive searches of relevant electronic databases (eg, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials), websites of funding agencies and websites of healthcare provider organisations will be conducted to identify relevant material. We will include experimental, quasi-experimental and observational studies providing information on the sustainability of KT interventions targeting chronic disease management in adults and focusing on end-users including patients, clinicians, public health officials, health services managers and policy-makers. Two reviewers will pilot-test the screening criteria and data abstraction form. They will then screen all citations, full articles and abstract data in duplicate independently. The results of the scoping review will be synthesised descriptively and used to develop a framework to assess the sustainability of KT interventions. Our results will help inform end-users (ie, patients, clinicians, public health officials, health services managers

  6. Lean interventions in healthcare: do they actually work? A systematic literature review.

    Science.gov (United States)

    Moraros, John; Lemstra, Mark; Nwankwo, Chijioke

    2016-04-01

    Lean is a widely used quality improvement methodology initially developed and used in the automotive and manufacturing industries but recently expanded to the healthcare sector. This systematic literature review seeks to independently assess the effect of Lean or Lean interventions on worker and patient satisfaction, health and process outcomes, and financial costs. We conducted a systematic literature review of Medline, PubMed, Cochrane Library, CINAHL, Web of Science, ABI/Inform, ERIC, EMBASE and SCOPUS. Peer reviewed articles were included if they examined a Lean intervention and included quantitative data. Methodological quality was assessed using validated critical appraisal checklists. Publically available data collected by the Saskatchewan Health Quality Council and the Saskatchewan Union of Nurses were also analysed and reported separately. Data on design, methods, interventions and key outcomes were extracted and collated. Our electronic search identified 22 articles that passed methodological quality review. Among the accepted studies, 4 were exclusively concerned with health outcomes, 3 included both health and process outcomes and 15 included process outcomes. Our study found that Lean interventions have: (i) no statistically significant association with patient satisfaction and health outcomes; (ii) a negative association with financial costs and worker satisfaction and (iii) potential, yet inconsistent, benefits on process outcomes like patient flow and safety. While some may strongly believe that Lean interventions lead to quality improvements in healthcare, the evidence to date simply does not support this claim. More rigorous, higher quality and better conducted scientific research is required to definitively ascertain the impact and effectiveness of Lean in healthcare settings. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care.

  7. The efficiency frontier approach to economic evaluation of health-care interventions.

    Science.gov (United States)

    Caro, J Jaime; Nord, Erik; Siebert, Uwe; McGuire, Alistair; McGregor, Maurice; Henry, David; de Pouvourville, Gérard; Atella, Vincenzo; Kolominsky-Rabas, Peter

    2010-10-01

    IQWiG commissioned an international panel of experts to develop methods for the assessment of the relation of benefits to costs in the German statutory health-care system. The panel recommended that IQWiG inform German decision makers of the net costs and value of additional benefits of an intervention in the context of relevant other interventions in that indication. To facilitate guidance regarding maximum reimbursement, this information is presented in an efficiency plot with costs on the horizontal axis and value of benefits on the vertical. The efficiency frontier links the interventions that are not dominated and provides guidance. A technology that places on the frontier or to the left is reasonably efficient, while one falling to the right requires further justification for reimbursement at that price. This information does not automatically give the maximum reimbursement, as other considerations may be relevant. Given that the estimates are for a specific indication, they do not address priority setting across the health-care system. This approach informs decision makers about efficiency of interventions, conforms to the mandate and is consistent with basic economic principles. Empirical testing of its feasibility and usefulness is required.

  8. Assessment of Fidelity in Interventions to Improve Hand Hygiene of Healthcare Workers: A Systematic Review

    Science.gov (United States)

    Musuuza, Jackson S.; Barker, Anna; Ngam, Caitlyn; Vellardita, Lia; Safdar, Nasia

    2016-01-01

    OBJECTIVE Compliance with hand hygiene in healthcare workers is fundamental to infection prevention yet remains a challenge to sustain. We examined fidelity reporting in interventions to improve hand hygiene compliance, and we assessed 5 measures of intervention fidelity: (1) adherence, (2) exposure or dose, (3) quality of intervention delivery, (4) participant responsiveness, and (5) program differentiation. DESIGN Systematic review METHODS A librarian performed searches of the literature in PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, and Web of Science of material published prior to June 19, 2015. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews, and assessment of study quality was conducted for each study reviewed. RESULTS A total of 100 studies met the inclusion criteria. Only 8 of these 100 studies reported all 5 measures of intervention fidelity. In addition, 39 of 100 (39%) failed to include at least 3 fidelity measures; 20 of 100 (20%) failed to include 4 measures; 17 of 100 (17%) failed to include 2 measures, while 16 of 100 (16%) of the studies failed to include at least 1 measure of fidelity. Participant responsiveness and adherence to the intervention were the most frequently unreported fidelity measures, while quality of the delivery was the most frequently reported measure. CONCLUSIONS Almost all hand hygiene intervention studies failed to report at least 1 fidelity measurement. To facilitate replication and effective implementation, reporting fidelity should be standard practice when describing results of complex behavioral interventions such as hand hygiene. PMID:26861117

  9. Impact of intervention on healthcare waste management practices in a tertiary care governmental hospital of Nepal.

    Science.gov (United States)

    Sapkota, Binaya; Gupta, Gopal Kumar; Mainali, Dhiraj

    2014-09-26

    Healthcare waste is produced from various therapeutic procedures performed in hospitals, such as chemotherapy, dialysis, surgery, delivery, resection of gangrenous organs, autopsy, biopsy, injections, etc. These result in the production of non-hazardous waste (75-95%) and hazardous waste (10-25%), such as sharps, infectious, chemical, pharmaceutical, radioactive waste, and pressurized containers (e.g., inhaler cans). Improper healthcare waste management may lead to the transmission of hepatitis B, Staphylococcus aureus and Pseudomonas aeruginosa. This evaluation of waste management practices was carried out at gynaecology, obstetrics, paediatrics, medicine and orthopaedics wards at Government of Nepal Civil Service Hospital, Kathmandu from February 12 to October 15, 2013, with the permission from healthcare waste management committee at the hospital. The Individualized Rapid Assessment tool (IRAT), developed by the United Nations Development Program Global Environment Facility project, was used to collect pre-interventional and post-interventional performance scores concerning waste management. The healthcare waste management committee was formed of representing various departments. The study included responses from focal nurses and physicians from the gynaecology, obstetrics, paediatrics, medicine and orthopaedics wards, and waste handlers during the study period. Data included average scores from 40 responders. Scores were based on compliance with the IRAT. The waste management policy and standard operating procedure were developed after interventions, and they were consistent with the national and international laws and regulations. The committee developed a plan for recycling or waste minimization. Health professionals, such as doctors, nurses and waste handlers, were trained on waste management practices. The programs included segregation, collection, handling, transportation, treatment and disposal of waste, as well as occupational health and safety issues

  10. Linking Environmental Sustainability and Healthcare: The Effects of an Energy Saving Intervention in Two Hospitals

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    Danae Manika

    2017-03-01

    Full Text Available Set in a real organisational setting, this study examines the challenges of implementing environmentally sustainable behaviour in healthcare. It evaluates the success of a real energy saving behaviour change intervention, based on social marketing principles, which targeted the employees of two National Health Service (NHS hospitals. It also explores the intervention benefits for three key stakeholders: the organisation/hospitals, hospital employees and patients. A rich secondary dataset containing actual workplace behaviour measures (collected via observations and self-reported data from employee interviews and patient questionnaires is used for this purpose. The intervention encouraged three employee energy saving actions (called TLC actions: (1 Turn off machines, (2 Lights out when not needed, and (3 Close doors when possible; which led to energy savings and carbon reduction for the two hospitals. Hospital employees reported a greater level of work efficiency as a result of engaging in TLC actions, which increased the 'quiet time' periods in both hospitals. Indirectly, employees' TLC actions also improved patients' quality of sleep (which in turn is positively associated with greater patient hospital experience satisfaction. These findings shed light on the benefits of social marketing interventions targeting energy saving behaviour change for multiple stakeholders in healthcare organisations. They also illustrate connections between environmental sustainability and social and political pillars of corporate social responsibility. Additionally, organisational culture was highlighted as a key challenge in changing practices. To encourage long-term sustainable behaviour, this study recommends a pre-intervention assessment of infrastructure and equipment, the communication of expected benefits to motivate higher involvement of employees, the need for internal green champions and the dissemination of post-intervention feedback on various energy

  11. Sustainability of knowledge translation interventions in healthcare decision-making: a scoping review.

    Science.gov (United States)

    Tricco, Andrea C; Ashoor, Huda M; Cardoso, Roberta; MacDonald, Heather; Cogo, Elise; Kastner, Monika; Perrier, Laure; McKibbon, Ann; Grimshaw, Jeremy M; Straus, Sharon E

    2016-04-21

    Knowledge translation (KT, also known as research utilization, and sometimes referring to implementation science) is a dynamic and iterative process that includes the synthesis, dissemination, exchange, and ethically sound application of knowledge to improve health. A KT intervention is one which facilitates the uptake of research. The long-term sustainability of KT interventions is unclear. We aimed to characterize KT interventions to manage chronic diseases that have been used for healthcare outcomes beyond 1 year or beyond the termination of initial grant funding. We conducted a scoping review by searching MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Campbell from inception until February 2013. We included experimental, quasi-experimental, and observational studies providing information on the sustainability of KT interventions for managing chronic diseases in adults and focusing on end-users including patients, clinicians, public health officials, health service managers, and policy-makers. Articles were screened and abstracted by two reviewers, independently. The data were charted and results described narratively. We included 62 studies reported in 103 publications (total 260,688 patients) plus 41 companion reports after screening 12,328 titles and abstracts and 464 full-text articles. More than half of the studies were randomized controlled trials (RCTs). The duration of the KT intervention ranged from 61 to 522 weeks. Nine chronic conditions were examined across the studies, such as diabetes (34 %), cardiovascular disease (28 %), and hypertension (16 %). Thirteen KT interventions were reported across the studies. Patient education was the most commonly examined (20 %), followed by self-management (17 %). Most studies (61 %) focused on patient-level outcomes (e.g. disease severity), while 31 % included system-level outcomes (e.g. number of eye examinations

  12. Healthcare provider-led interventions to support medication adherence following ACS: a meta-analysis.

    Science.gov (United States)

    Crawshaw, Jacob; Auyeung, Vivian; Ashworth, Lucy; Norton, Sam; Weinman, John

    2017-01-01

    We conducted a systematic review and meta-analysis to determine the effectiveness of healthcare provider-led (HCPs) interventions to support medication adherence in patients with acute coronary syndrome (ACS). A systematic search of Cochrane Library, Medline, EMBASE, PsycINFO, Web of Science, IPA, CINAHL, ASSIA, OpenGrey, EthOS, WorldCat and PQDT was undertaken. Interventions were deemed eligible if they included adult ACS patients, were HCP-led, measured medication adherence and randomised participants to parallel groups. Intervention content was coded using the Behaviour Change Technique (BCT) Taxonomy and data were pooled for analysis using random-effects models. Our search identified 8870 records, of which 27 were eligible (23 primary studies). A meta-analysis (n=9735) revealed HCP-led interventions increased the odds of medication adherence by 54% compared to control interventions (k=23, OR 1.54, 95% CI 1.26 to 1.88, I 2 =57.5%). After removing outliers, there was a 41% increase in the odds of medication adherence with moderate heterogeneity (k=21, OR 1.41, 95% CI 1.21 to 1.65, I 2 =35.3%). Interventions that included phone contact yielded (k=12, OR 1.63, 95% CI 1.25 to 2.12, I 2 =32.0%) a larger effect compared to those delivered exclusively in person. A total of 32/93 BCTs were identified across interventions (mean=4.7, SD=2.2) with 'information about health consequences' (BCT 5.1) (19/23) the most common. HCP-led interventions for ACS patients appear to have a small positive impact on medication adherence. While we were able to identify BCTs among interventions, data were insufficient to determine the impact of particular BCTs on study effectiveness. CRD42016037706.

  13. Novel Interventions in Children's Healthcare for Youth Hospitalized for Chronic Pain.

    Science.gov (United States)

    Harris, Michael A; Wagner, David V; Wilson, Anna C; Spiro, Kim; Heywood, Matthew; Hoehn, Dana

    2015-03-01

    The purpose of this study was to pilot the implementation of the Novel Interventions in Children's Healthcare (NICH) program for youth with chronic pain who utilized a disproportionate amount of health care. Three youth (2 males and 1 female, aged 11 to 15 years) participated. The intervention consisted of a combination of family-based problem-solving, care coordination, and case management, with the inclusion of technology-assisted treatment delivery (e.g., text messages, video chat) to reduce costs. Both objective (i.e., hospitalization records) and subjective (e.g., interventionist reports) outcomes were examined to assess changes over the course of treatment. Two of the three youth demonstrated reductions in the number of days hospitalized and associated costs. In addition, interventionist reports indicated improved quality of life for family and youth served. Although further research is needed, NICH appears to be a promising intervention for youth with chronic pain and high health care utilization and shows the potential to result in improved youth health and reduced monetary costs for families, providers, and the healthcare system.

  14. Factors affecting pain relief in response to physical exercise interventions among healthcare workers.

    Science.gov (United States)

    Jakobsen, M D; Sundstrup, E; Brandt, M; Andersen, L L

    2017-12-01

    The aim of this study is to identify factors associated with musculo-skeletal pain reduction during workplace-based or home-based physical exercise interventions among healthcare workers. Two hundred female healthcare workers (age: 42.0, BMI: 24.1, average pain intensity: 3.1 on a scale of 0-10) from three hospitals participated. Participants were randomly allocated at the cluster level (18 departments) to 10 weeks of (i) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to five group-based coaching sessions on motivation for regular physical exercise, or (ii) home-based physical exercise (HOME) performed alone during leisure-time for 5 × 10 minutes per week. Linear mixed models accounting for cluster identified factors affecting pain reduction. On average 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions were performed per week in WORK and HOME, respectively. The multi-adjusted analysis showed a significant effect on pain reduction of both training adherence (P=.04) and intervention group (P=.04) with participants in WORK experiencing greater reductions compared with HOME. Obesity at baseline was associated with better outcome. Leisure-time exercise, daily patient transfer, age, and chronic pain did not affect the changes in pain. In conclusion, even when adjusted for training adherence, performing physical exercise at the workplace is more effective than home-based exercise in reducing musculo-skeletal pain in healthcare workers. Noteworthy, obese individuals may especially benefit from physical exercise interventions targeting musculo-skeletal pain. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. Does a Consumer-Targeted Deprescribing Intervention Compromise Patient-Healthcare Provider Trust?

    Science.gov (United States)

    Zhang, Yi Zhi; Turner, Justin P; Martin, Philippe; Tannenbaum, Cara

    2018-04-16

    One in four community-dwelling older adults is prescribed an inappropriate medication. Educational interventions aimed at patients to reduce inappropriate medications may cause patients to question their prescriber’s judgment. The objective of this study was to determine whether a patient-focused deprescribing intervention compromised trust between older adults and their healthcare providers. An educational brochure was distributed to community-dwelling older adults by community pharmacists in order to trigger deprescribing conversations. At baseline and 6-months post-intervention, participants completed the Primary Care Assessment Survey, which measures patient trust in doctors and pharmacists. Changes in trust were ascertained post-intervention. Proportions with 95% confidence intervals (CI), and logistic regression were used to determine a shift in trust and associated predictors. 352 participants responded to the questionnaire at both time points. The majority of participants had no change or gained trust in their doctors for items related to the choice of medical care (78.5%, 95% CI = 74.2–82.8), communication transparency (75.4%, 95% CI = 70.7–79.8), and overall trust (81.9%, 95% CI = 77.9–86.0). Similar results were obtained for participants’ perceptions of their pharmacists, with trust remaining intact for items related to the choice of medical care (79.4%, 95% CI = 75.3–83.9), transparency in communicating (82.0%, 95% CI = 78.0–86.1), and overall trust (81.6%, 95% CI = 77.5–85.7). Neither age, sex nor the medication class targeted for deprescribing was associated with a loss of trust. Overall, the results indicate that patient-focused deprescribing interventions do not shift patients’ trust in their healthcare providers in a negative direction.

  16. Does a Consumer-Targeted Deprescribing Intervention Compromise Patient-Healthcare Provider Trust?

    Directory of Open Access Journals (Sweden)

    Yi Zhi Zhang

    2018-04-01

    Full Text Available One in four community-dwelling older adults is prescribed an inappropriate medication. Educational interventions aimed at patients to reduce inappropriate medications may cause patients to question their prescriber’s judgment. The objective of this study was to determine whether a patient-focused deprescribing intervention compromised trust between older adults and their healthcare providers. An educational brochure was distributed to community-dwelling older adults by community pharmacists in order to trigger deprescribing conversations. At baseline and 6-months post-intervention, participants completed the Primary Care Assessment Survey, which measures patient trust in doctors and pharmacists. Changes in trust were ascertained post-intervention. Proportions with 95% confidence intervals (CI, and logistic regression were used to determine a shift in trust and associated predictors. 352 participants responded to the questionnaire at both time points. The majority of participants had no change or gained trust in their doctors for items related to the choice of medical care (78.5%, 95% CI = 74.2–82.8, communication transparency (75.4%, 95% CI = 70.7–79.8, and overall trust (81.9%, 95% CI = 77.9–86.0. Similar results were obtained for participants’ perceptions of their pharmacists, with trust remaining intact for items related to the choice of medical care (79.4%, 95% CI = 75.3–83.9, transparency in communicating (82.0%, 95% CI = 78.0–86.1, and overall trust (81.6%, 95% CI = 77.5–85.7. Neither age, sex nor the medication class targeted for deprescribing was associated with a loss of trust. Overall, the results indicate that patient-focused deprescribing interventions do not shift patients’ trust in their healthcare providers in a negative direction.

  17. Using Co-Design to Develop a Collective Leadership Intervention for Healthcare Teams to Improve Safety Culture

    Directory of Open Access Journals (Sweden)

    Marie E. Ward

    2018-06-01

    Full Text Available While co-design methods are becoming more popular in healthcare; there is a gap within the peer-reviewed literature on how to do co-design in practice. This paper addresses this gap by delineating the approach taken in the co-design of a collective leadership intervention to improve healthcare team performance and patient safety culture. Over the course of six workshops healthcare staff, patient representatives and advocates, and health systems researchers collaboratively co-designed the intervention. The inputs to the process, exercises and activities that took place during the workshops and the outputs of the workshops are described. The co-design method, while challenging at times, had many benefits including grounding the intervention in the real-world experiences of healthcare teams. Implications of the method for health systems research are discussed.

  18. Drawing on healthcare professionals' ethnicity: lessons learned from a Danish community pharmacy intervention for ethnic minorities.

    Science.gov (United States)

    Mygind, Anna; Nørgaard, Lotte Stig; Traulsen, Janine M; El-Souri, Mira; Kristiansen, Maria

    2017-05-01

    To present and discuss implementation experiences regarding the involvement of community pharmacists with ethnic minority backgrounds in a medication review intervention for ethnic minority poly-pharmacy patients in Denmark. Data sources include 1) reflection notes from an introductory seminar with pharmacists and the cross-disciplinary research team and 2) five individual interviews and one focus group interview with pharmacists. Data were thematically coded and synthesised to identify underlying rationales and challenges encountered when involving professionals with ethnic minority backgrounds in interventions for ethnic minorities. Informants perceived the need for interventions targeted at ethnic minority poly-pharmacy patients, and highlighted the potential of involving professionals with diverse ethnic backgrounds in such interventions. However, implementation created challenges, because the professional identity of the pharmacists reduced their options for serving as peers with the same ethnic background. Furthermore, issues related to organisational difficulties and overcoming language barriers in the intervention impacted on the potential of involving professionals with ethnic minority backgrounds. Involving healthcare professionals with ethnic minority backgrounds in encounters with ethnic minorities holds potential for the adaptation of services to ethnically diverse populations, thus improving access to and quality of care. However, it is important to ensure sufficient personal and organisational support and to acknowledge the delicate balance between simultaneously serving as a peer and as a professional.

  19. Healthcare Work and Organizational Interventions to Prevent Work-related Stress in Brindisi, Italy.

    Science.gov (United States)

    d'Ettorre, Gabriele; Greco, Mariarita

    2015-03-01

    Organizational changes that involve healthcare hospital departments and care services of health districts, and ongoing technological innovations and developments in society increasingly expose healthcare workers (HCWs) to work-related stress (WRS). Minimizing occupational exposure to stress requires effective risk stress assessment and management programs. The authors conducted an integrated analysis of stress sentinel indicators, an integrated analysis of objective stress factors of occupational context and content areas, and an integrated analysis between nurses and physicians of hospital departments and care services of health districts in accordance with a multidimensional validated tool developed in Italy by the National Network for the Prevention of Work-Related Psychosocial Disorders. The purpose of this retrospective observational study was to detect and analyze in different work settings the level of WRS resulting from organizational changes implemented by hospital healthcare departments and care services of health districts in a sample of their employees. The findings of the study showed that hospital HCWs seemed to incur a medium level risk of WRS that was principally the result of work context factors. The implementation of improvement interventions focused on team development, safety training programs, and adopting an ethics code for HCWs, and it effectively and significantly reduced the level of WRS risk in the workplace. In this study HCW resulted to be exposed to occupational stress factors susceptible to reduction. Stress management programs aimed to improve work context factors associated with occupational stress are required to minimize the impact of WRS on workers.

  20. A healthcare utilization cost comparison between employees receiving a worksite mindfulness or a diet/exercise lifestyle intervention to matched controls 5 years post intervention.

    Science.gov (United States)

    Klatt, Maryanna D; Sieck, Cynthia; Gascon, Gregg; Malarkey, William; Huerta, Timothy

    2016-08-01

    To compare healthcare costs and utilization among participants in a study of two active lifestyle interventions implemented in the workplace and designed to foster awareness of and attention to health with a propensity score matched control group. We retrospectively compared changes in healthcare (HC) utilization among participants in the mindfulness intervention (n=84) and the diet/exercise intervention (n=86) to a retrospectively matched control group (n=258) drawn for this study. The control group was matched from the non-participant population on age, gender, relative risk score, and HC expenditures in the 9 month preceding the study. Measures included number of primary care visits, number and cost of pharmacy prescriptions, number of hospital admissions, and overall healthcare costs tracked for 5 years after the intervention. Significantly fewer primary care visits (porganization health cost savings that such programs can generate. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Improving Maternal and Child Healthcare Programme Using Community-Participatory Interventions in Ebonyi State Nigeria

    Directory of Open Access Journals (Sweden)

    Chigozie Jesse Uneke

    2014-10-01

    Full Text Available In Nigeria, the government is implementing the Free Maternal and Child Health Care Programme (FMCHCP. The policy is premised on the notion that financial barriers are one of the most important constraints to equitable access and use of skilled maternal and child healthcare. In Ebonyi State, Southeastern Nigeria the FMCHCP is experiencing implementation challenges including: inadequate human resource for health, inadequate funding, out of stock syndrome, inadequate infrastructure, and poor staff remuneration. Furthermore, there is less emphasis on community involvement in the programme implementation. In this policy brief, we recommend policy options that emphasize the implementation of community-based participatory interventions to strengthen the government’s FMCHCP as follows: Option 1: Training community women on prenatal care, life-saving skills in case of emergency, reproductive health, care of the newborn and family planning. Option 2: Sensitizing the community women towards behavioural change, to understand what quality services that respond to their needs are but also to seek and demand for such. Option 3: Implementation packages that provide technical skills to women of childbearing age as well as mothers’ groups, and traditional birth attendants for better home-based maternal and child healthcare. The effectiveness of this approach has been demonstrated in a number of community-based participatory interventions, building on the idea that if community members take part in decision-making and bring local knowledge, experiences and problems to the fore, they are more likely to own and sustain solutions to improve their communities’ health.

  2. Art and Healthcare - Healing Potential of Artistic Interventions in Medical Settings

    Science.gov (United States)

    Awtuch, Anna; Gębczyńska-Janowicz, Agnieszka

    2017-10-01

    The stereotype of a machine for healing seems to be well rooted in common thinking and social perception of hospital buildings. The technological aspect of healthcare architecture has been influenced for several years by three major factors. The first is linked to the necessity of providing safety and security in the environment of elevated epidemiological risk. The second concerns the need for incorporating advanced technology required for medical equipment and building infrastructure. Finally, the third relates to Cartesian dualism in medical sciences. Fortunately, healthcare architecture of 21st-century is in the process of dynamic transformations resulting from the change in approach to patients. The holistic perspective gradually enters into medical sciences, and as a result a patient is perceived as a human being whose needs are discussed on three equally important dimensions: biological, social and psychological. The new trend has influenced the design process of contemporary hospitals. One can observe a turn from the primacy of medical technology over environmental conditions towards the balance between medical requirements and psychological and social needs of hospital users. The research on the impact of hospital environment on therapeutic process gave rise to a new trend of incorporating arts into the space and form of medical facilities. Both architecture and interior design details are more carefully negotiated in terms of aesthetics. Designers expand the possibilities of exhibiting visual art in functional and spatial arrangement. The initiatives introducing artistic objects, installations and activities into medical spaces aim at increasing the efficiency of medical services, transforming the image of sterile hospital architecture and introducing high quality public space. These interventions generate the impact both on micro and macro scales and they concern several fields of activity and forms of art. The paper presents the scope of possibilities

  3. Burden of disease and economic evaluation of healthcare interventions: are we investigating what really matters?

    Science.gov (United States)

    Catalá-López, Ferrán; García-Altés, Anna; Alvarez-Martín, Elena; Gènova-Maleras, Ricard; Morant-Ginestar, Consuelo; Parada, Antoni

    2011-04-13

    The allocation of limited available healthcare resources demands an agreed rational allocation principle and the consequent priority setting. We assessed the association between economic evaluations of healthcare interventions published in Spain (1983-2008) and the disease burden in the population. Electronic databases (e.g., PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME, IBECS) and reports from health technology assessment agencies were systematically reviewed. For each article, multiple variables were recorded such as: year and journal of publication, type of study, health intervention targetted, perspective of analysis, type of costs and sources of information, first author's affiliation, explicit recommendations aimed at decision-making, and the main disease cause to which the intervention was addressed. The following disease burden measures were calculated: years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), and mortality by cause. Correlation and linear regression models were fitted. Four hundred and seventy-seven economic evaluations were identified. Cardiovascular diseases (15.7%), infectious diseases (15.3%), malignant neoplasms (13.2%), and neuropsychiatric diseases (9.6%) were the conditions most commonly addressed. Accidents and injuries, congenital anomalies, oral conditions, nutritional deficiencies and other neoplasms were the categories with a lowest number of studies (0.6% for each of them). For the main disease categories (n = 20), a correlation was seen with: mortality 0.67 (p = 0.001), DALYs 0.63 (p = 0.003), YLLs 0.54 (p = 0.014), and YLDs 0.51 (p = 0.018). By disease sub-categories (n = 51), the correlations were generally low and non statistically significant. Examining discrepancies between economic evaluations in particular diseases and the overall burden of disease helps shed light on whether there are potentially over- and under-investigated areas. The approach taken could help

  4. Motivated Explanation

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    Richard ePatterson

    2015-10-01

    Full Text Available Although motivation is a well-established field of study in its own right, and has been fruitfully studied in connection with attribution theory and belief formation under the heading of motivated thinking, its powerful and pervasive influence on explanatory processes is less well explored. Where one has a strong motivation to understand some event correctly, one is thereby motivated to adhere as best one can to normative or epistemic criteria for correct or accurate explanation, even if one does not consciously formulate or apply such criteria. By contrast, many of our motivations to explain introduce bias into the processes involved in generating, evaluating, or giving of explanations. Non-epistemic explanatory motivations, or (following Kunda’s usage, directional motivations, include self-justification, resolution of cognitive dissonance, deliberate deception, teaching, and many more. Some of these motivations lead to the relaxation or violation of epistemic norms, combined with an effort to preserve the appearance of accuracy; others enhance epistemic motivation, so that one engages in more careful and thorough generational and evaluative processes. In short, real life explanatory processes are often constrained by multiple goals, epistemic and directional, where these goals may mutually reinforce one another or may conflict, and where our explanations emerge as a matter of weighing and satisfying those goals. Our proposals are largely programmatic, although we do review a good deal of relevant behavioral and neurological evidence. Specifically, we recognize five generative processes, some of which cover further sub-processes, and six evaluative processes. All of these are potential points of entry for the influence of motivation. We then suggest in some detail how specific sorts of explanatory motivation interact with specific explanatory processes.

  5. Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: A systematic review.

    Science.gov (United States)

    Matvienko-Sikar, Karen; Toomey, Elaine; Delaney, Lisa; Harrington, Janas; Byrne, Molly; Kearney, Patricia M

    2018-04-01

    Childhood obesity is a global public health challenge. Parental feeding practices, such as responsive feeding, are implicated in the etiology of childhood obesity. This systematic review aimed to examine of effects of healthcare professional-delivered early feeding interventions, on parental feeding practices, dietary intake, and weight outcomes for children up to 2 years. The role of responsive feeding interventions was also specifically examined. Databases searched included: CINAHL, the Cochrane Library, EMBASE, Medline, PubMed, PsycINFO, and Maternity and Infant Care. participants are parents of children ≤2 years; intervention includes focus on early child feeding to prevent overweight and obesity; intervention delivered by healthcare professionals. Sixteen papers, representing 10 trials, met inclusion criteria for review. Six interventions included responsive feeding components. Interventions demonstrated inconsistent effects on feeding practices, dietary intake, and weight outcomes. Findings suggest some reductions in pressure to eat and infant consumption of non-core beverages. Responsive feeding based interventions demonstrate greater improvements in feeding approaches, and weight outcomes. The findings of this review highlight the importance of incorporating responsive feeding in healthcare professional delivered early feeding interventions to prevent childhood obesity. Observed inconsistencies across trials may be explained by methodological limitations. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Serious electronic games as behavioural change interventions in healthcare-associated infections and infection prevention and control: a scoping review of the literature and future directions.

    Science.gov (United States)

    Castro-Sánchez, Enrique; Kyratsis, Yiannis; Iwami, Michiyo; Rawson, Timothy M; Holmes, Alison H

    2016-01-01

    The uptake of improvement initiatives in infection prevention and control (IPC) has often proven challenging. Innovative interventions such as 'serious games' have been proposed in other areas to educate and help clinicians adopt optimal behaviours. There is limited evidence about the application and evaluation of serious games in IPC. The purposes of the study were: a) to synthesise research evidence on the use of serious games in IPC to support healthcare workers' behaviour change and best practice learning; and b) to identify gaps across the formulation and evaluation of serious games in IPC. A scoping study was conducted using the methodological framework developed by Arksey and O'Malley. We interrogated electronic databases (Ovid MEDLINE, Embase Classic + Embase, PsycINFO, Scopus, Cochrane, Google Scholar) in December 2015. Evidence from these studies was assessed against an analytic framework of intervention formulation and evaluation. Nine hundred sixty five unique papers were initially identified, 23 included for full-text review, and four finally selected. Studies focused on intervention inception and development rather than implementation. Expert involvement in game design was reported in 2/4 studies. Potential game users were not included in needs assessment and game development. Outcome variables such as fidelity or sustainability were scarcely reported. The growing interest in serious games for health has not been coupled with adequate evaluation of processes, outcomes and contexts involved. Explanations about the mechanisms by which game components may facilitate behaviour change are lacking, further hindering adoption.

  7. Brain science and illness beliefs: an unexpected explanation of the healing power of therapeutic conversations and the family interventions that matter.

    Science.gov (United States)

    Wright, Lorraine M

    2015-05-01

    Paradigm families and paradigm practice moments have shown me that therapeutic conversations between nurses and families can profoundly and positively change illness beliefs in family members and nurses and contribute to healing from serious illness. The integration of brain science into nursing practice offers further understanding of the importance of illness beliefs and the role they may play in helping individual and family healing. Brain science offers explanations that connect how certain family nursing interventions that soften suffering and challenge constraining illness beliefs may result in changes in brain structure and functioning. New illness beliefs may result in new neural pathways in the brain, and therefore, possibilities for a new way of being in relationship with illness and in relationship with others can also develop. Newly acquired practice skills and interventions that have emerged from an understanding of brain science plus the reemphasis of other interventions utilized in the Illness Beliefs Model are offered to enhance our care of families suffering with illness. © The Author(s) 2015.

  8. Sequential and simultaneous multiple explanation

    Directory of Open Access Journals (Sweden)

    Robert Litchfield

    2007-02-01

    Full Text Available This paper reports two experiments comparing variants of multiple explanation applied in the early stages of a judgment task (a case involving employee theft where participants are not given a menu of response options. Because prior research has focused on situations where response options are provided to judges, we identify relevant dependent variables that an intervention might affect when such options are not given. We use these variables to build a causal model of intervention that illustrates both the intended effects of multiple explanation and some potentially competing processes that it may trigger. Although multiple explanation clearly conveys some benefits (e.g., willingness to delay action to engage in information search, increased detail, quality and confidence in alternative explanations in the present experiments, we also found evidence that it may initiate or enhance processes that attenuate its advantages (e.g., feelings that one does not need more data if one has multiple good explanations.

  9. Burden of disease and economic evaluation of healthcare interventions: are we investigating what really matters?

    Directory of Open Access Journals (Sweden)

    Gènova-Maleras Ricard

    2011-04-01

    Full Text Available Abstract Background The allocation of limited available healthcare resources demands an agreed rational allocation principle and the consequent priority setting. We assessed the association between economic evaluations of healthcare interventions published in Spain (1983-2008 and the disease burden in the population. Methods Electronic databases (e.g., PubMed/MEDLINE, SCOPUS, ISI Web of Knowledge, CRD, IME, IBECS and reports from health technology assessment agencies were systematically reviewed. For each article, multiple variables were recorded such as: year and journal of publication, type of study, health intervention targetted, perspective of analysis, type of costs and sources of information, first author's affiliation, explicit recommendations aimed at decision-making, and the main disease cause to which the intervention was addressed. The following disease burden measures were calculated: years of life lost (YLLs, years lived with disability (YLDs, disability-adjusted life years (DALYs, and mortality by cause. Correlation and linear regression models were fitted. Results Four hundred and seventy-seven economic evaluations were identified. Cardiovascular diseases (15.7%, infectious diseases (15.3%, malignant neoplasms (13.2%, and neuropsychiatric diseases (9.6% were the conditions most commonly addressed. Accidents and injuries, congenital anomalies, oral conditions, nutritional deficiencies and other neoplasms were the categories with a lowest number of studies (0.6% for each of them. For the main disease categories (n = 20, a correlation was seen with: mortality 0.67 (p = 0.001, DALYs 0.63 (p = 0.003, YLLs 0.54 (p = 0.014, and YLDs 0.51 (p = 0.018. By disease sub-categories (n = 51, the correlations were generally low and non statistically significant. Conclusions Examining discrepancies between economic evaluations in particular diseases and the overall burden of disease helps shed light on whether there are potentially over- and under

  10. Educational interventions to train healthcare professionals in end-of-life communication: a systematic review and meta-analysis.

    Science.gov (United States)

    Chung, Han-Oh; Oczkowski, Simon J W; Hanvey, Louise; Mbuagbaw, Lawrence; You, John J

    2016-04-29

    Practicing healthcare professionals and graduates exiting training programs are often ill-equipped to facilitate important discussions about end-of-life care with patients and their families. We conducted a systematic review to evaluate the effectiveness of educational interventions aimed at providing healthcare professionals with training in end-of-life communication skills, compared to usual curriculum. We searched MEDLINE, Embase, CINAHL, ERIC and the Cochrane Central Register of Controlled Trials from the date of inception to July 2014 for randomized control trials (RCT) and prospective observational studies of educational training interventions to train healthcare professionals in end-of-life communication skills. To be eligible, interventions had to provide communication skills training related to end-of-life decision making; other interventions (e.g. breaking bad news, providing palliation) were excluded. Our primary outcomes were self-efficacy, knowledge and end-of-life communication scores with standardized patient encounters. Sufficiently similar studies were pooled in a meta-analysis. The quality of evidence was assessed using GRADE. Of 5727 candidate articles, 20 studies (6 RCTs, 14 Observational) were included in this review. Compared to usual teaching, educational interventions to train healthcare professionals in end-of-life communication skills were associated with greater self-efficacy (8 studies, standardized mean difference [SMD] 0.57;95% confidence interval [CI] 0.40-0.75; P communication scores (8 studies, SMD 0.69; 95% CI 0.41-0.96; p communication training may improve healthcare professionals' self-efficacy, knowledge, and EoL communication scores compared to usual teaching. Further studies comparing two active educational interventions are recommended with a continued focus on contextually relevant high-level outcomes. PROSPERO CRD42014012913.

  11. Group supervision for healthcare professionals within primary care for patients with psychosomatic health problems: a pilot intervention study.

    Science.gov (United States)

    Bullington, Jennifer; Cronqvist, Agneta

    2018-03-01

    In primary health care, efficacious treatment strategies are lacking for these patients, although the most prominent symptoms accounting for consultation in primary care often cannot be related to any biological causes. The aim was to explore whether group supervision from a specific phenomenological theory of psychosomatics could provide healthcare professionals treating patients with psychosomatic health issues within primary care a deeper understanding of these conditions and stimulate profession-specific treatment strategies. Our research questions were as follows: (i) What is the healthcare professionals' understanding of psychosomatics before and after the intervention? (ii) What are the treatment strategies for this group of patients before and after the intervention? The study was an explorative qualitative intervention pilot study. The six participants from a primary healthcare setting in a medium-sized city in Sweden participated in the study. A supervision group was formed, based on a mix of professions, age, gender and years of clinical experience. Supervision consisted of one 75-minutes meeting every month during the course of 6 months. Participants were interviewed before and after the supervision intervention. The study showed two distinct categories emerged from the data. One category of healthcare professionals espoused a psycho-educative approach, while the other lacked a cohesive approach. The supervision improved the second category of healthcare professionals' understanding of psychosomatics. The psycho-educative group did not change their understanding of psychosomatics, although they felt strengthened in their approach by the supervision. Profession-specific strategies were not developed. This pilot study indicates that a relatively short supervision intervention can aid clinicians in their clinical encounters with these patients; however, further research is necessary to ascertain the value of the specific phenomenologically based

  12. Linking Environmental Sustainability and Healthcare: The Effects of an Energy Saving Intervention in Two Hospitals\\ud

    OpenAIRE

    Manika, D.; Gregory-Smith, D.; Wells, V.K.; Comerford, L.; Aldrich-Smith, L.

    2017-01-01

    Set in a real organisational setting, this study examines the challenges of implementing environmentally sustainable behaviour in healthcare. It evaluates the success of a real energy saving behaviour change intervention, based on social marketing principles, which targeted the employees of two National Health Service (NHS) hospitals. It also explores the intervention benefits for three key stakeholders: the organisation/hospitals, hospital employees and patients. A rich secondary dataset con...

  13. Supporting 3rd-grade students model-based explanations about groundwater: a quasi-experimental study of a curricular intervention

    Science.gov (United States)

    Zangori, Laura; Vo, Tina; Forbes, Cory T.; Schwarz, Christina V.

    2017-07-01

    Scientific modelling is a key practice in which K-12 students should engage to begin developing robust conceptual understanding of natural systems, including water. However, little past research has explored primary students' learning about groundwater, engagement in scientific modelling, and/or the ways in which teachers conceptualise and cultivate model-based science learning environments. We are engaged in a multi-year project designed to support 3rd-grade students' formulation of model-based explanations (MBE) for hydrologic phenomenon, including groundwater, through curricular and instructional support. In this quasi-experimental comparative study of five 3rd-grade classrooms, we present findings from analysis of students' MBE generated as part of experiencing a baseline curricular intervention (Year 1) and a modelling-enhanced curricular intervention (Year 2). Findings show that students experiencing the latter version of the unit made significant gains in both conceptual understanding and reasoning about groundwater, but that these gains varied by classroom. Overall, student gains from Year 1 to Year 2 were attributed to changes in two of the five classrooms in which students were provided additional instructional supports and scaffolds to enhance their MBE for groundwater. Within these two classrooms, the teachers enacted the Year 2 curriculum in unique ways that reflected their deeper understanding about the practices of modelling. Their enactments played a critical role in supporting students' MBE about groundwater. Study findings contribute to research on scientific modelling in elementary science learning environments and have important implications for teachers and curriculum developers.

  14. Retrospective chart review for obesity and associated interventions among rural Mexican-American adolescents accessing healthcare services.

    Science.gov (United States)

    Champion, Jane Dimmitt; Collins, Jennifer L

    2013-11-01

    To report a retrospective analysis of data routinely collected in the course of healthcare services at a rural health clinic and to assess obesity incidence and associated interventions among rural Mexican-American adolescents. Two hundred and twelve charts reviewed; 98 (46.2%) males and 114 (53.8%) females. Data extracted included Medicaid exams conducted at the clinic within 5 years. Equal overweight or obese (n = 105, 49.5%), versus normal BMI categorizations (n = 107, 50.5%) documented overall and by gender. Female obesity higher (25.4%) than national norms (17.4%); male rates (25.5%) were within national norm. Interventions provided by nurse practitioners (94%) for 34.8%-80% of overweight/obese had limited follow-up (4%). Obesity incidence markedly increased between 13 and 18 years of age without associated interventions; 51.4%-75.6% without interventions. Obesity is a healthcare problem among rural Mexican-American adolescents accessing care at the rural health clinic. Obesity intervention and follow-up was suboptimal within this setting. Rural and ethnic minority adolescents experience health disparities concerning obesity prevalence and remote healthcare access. Obesity prevention and treatment during adolescence is a national health priority given physiologic and psychological tolls on health and potential for obesity into adulthood. Obesity assessment and translation of evidence-based interventions for rural Mexican-American adolescents at rural health clinics is implicated. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  15. Assessing the value of healthcare interventions using multi-criteria decision analysis: a review of the literature.

    Science.gov (United States)

    Marsh, Kevin; Lanitis, Tereza; Neasham, David; Orfanos, Panagiotis; Caro, Jaime

    2014-04-01

    The objective of this study is to support those undertaking a multi-criteria decision analysis (MCDA) by reviewing the approaches adopted in healthcare MCDAs to date, how these varied with the objective of the study, and the lessons learned from this experience. Searches of EMBASE and MEDLINE identified 40 studies that provided 41 examples of MCDA in healthcare. Data were extracted on the objective of the study, methods employed, and decision makers' and study authors' reflections on the advantages and disadvantages of the methods. The recent interest in MCDA in healthcare is mirrored in an increase in the application of MCDA to evaluate healthcare interventions. Of the studies identified, the first was published in 1990, but more than half were published since 2011. They were undertaken in 18 different countries, and were designed to support investment (coverage and reimbursement), authorization, prescription, and research funding allocation decisions. Many intervention types were assessed: pharmaceuticals, public health interventions, screening, surgical interventions, and devices. Most used the value measurement approach and scored performance using predefined scales. Beyond these similarities, a diversity of different approaches were adopted, with only limited correspondence between the approach and the type of decision or product. Decision makers consulted as part of these studies, as well as the authors of the studies are positive about the potential of MCDA to improve decision making. Further work is required, however, to develop guidance for those undertaking MCDA.

  16. Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews.

    Science.gov (United States)

    Johnson, Mark J; May, Carl R

    2015-09-30

    Translating research evidence into routine clinical practice is notoriously difficult. Behavioural interventions are often used to change practice, although their success is variable and the characteristics of more successful interventions are unclear. We aimed to establish the characteristics of successful behaviour change interventions in healthcare. We carried out a systematic overview of systematic reviews on the effectiveness of behaviour change interventions with a theory-led analysis using the constructs of normalisation process theory (NPT). MEDLINE, CINAHL, PsychINFO and the Cochrane Library were searched electronically from inception to July 2015. Primary and secondary care. Participants were any patients and healthcare professionals in systematic reviews who met the inclusion criteria of having examined the effectiveness of professional interventions in improving professional practice and/or patient outcomes. Professional interventions as defined by the Cochrane Effective Practice and Organisation of Care Review Group. Success of each intervention in changing practice or patient outcomes, and their mechanisms of action. Reviews were coded as to the interventions included, how successful they had been and which NPT constructs its component interventions covered. Searches identified 4724 articles, 67 of which met the inclusion criteria. Interventions fell into three main categories: persuasive; educational and informational; and action and monitoring. Interventions focusing on action or education (eg, Audit and Feedback, Reminders, Educational Outreach) acted on the NPT constructs of Collective Action and Reflexive Monitoring, and reviews using them tended to report more positive outcomes. This theory-led analysis suggests that interventions which contribute to normative restructuring of practice, modifying peer group norms and expectations (eg, educational outreach) and relational restructuring, reinforcing modified peer group norms by emphasising the

  17. Interventions to increase tuberculosis case detection at primary healthcare or community-level services.

    Science.gov (United States)

    Mhimbira, Francis A; Cuevas, Luis E; Dacombe, Russell; Mkopi, Abdallah; Sinclair, David

    2017-11-28

    Pulmonary tuberculosis is usually diagnosed when symptomatic individuals seek care at healthcare facilities, and healthcare workers have a minimal role in promoting the health-seeking behaviour. However, some policy specialists believe the healthcare system could be more active in tuberculosis diagnosis to increase tuberculosis case detection. To evaluate the effectiveness of different strategies to increase tuberculosis case detection through improving access (geographical, financial, educational) to tuberculosis diagnosis at primary healthcare or community-level services. We searched the following databases for relevant studies up to 19 December 2016: the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library, Issue 12, 2016; MEDLINE; Embase; Science Citation Index Expanded, Social Sciences Citation Index; BIOSIS Previews; and Scopus. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, and the metaRegister of Controlled Trials (mRCT) for ongoing trials. Randomized and non-randomized controlled studies comparing any intervention that aims to improve access to a tuberculosis diagnosis, with no intervention or an alternative intervention. Two review authors independently assessed trials for eligibility and risk of bias, and extracted data. We compared interventions using risk ratios (RR) and 95% confidence intervals (CI). We assessed the certainty of the evidence using the GRADE approach. We included nine cluster-randomized trials, one individual randomized trial, and seven non-randomized controlled studies. Nine studies were conducted in sub-Saharan Africa (Ethiopia, Nigeria, South Africa, Zambia, and Zimbabwe), six in Asia (Bangladesh, Cambodia, India, Nepal, and Pakistan), and two in South America (Brazil and Colombia); which are all high tuberculosis prevalence areas.Tuberculosis outreach

  18. Tailoring Healthy Workplace Interventions to Local Healthcare Settings: A Complexity Theory-Informed Workplace of Well-Being Framework.

    Science.gov (United States)

    Brand, Sarah L; Fleming, Lora E; Wyatt, Katrina M

    2015-01-01

    Many healthy workplace interventions have been developed for healthcare settings to address the consistently low scores of healthcare professionals on assessments of mental and physical well-being. Complex healthcare settings present challenges for the scale-up and spread of successful interventions from one setting to another. Despite general agreement regarding the importance of the local setting in affecting intervention success across different settings, there is no consensus on what it is about a local setting that needs to be taken into account to design healthy workplace interventions appropriate for different local settings. Complexity theory principles were used to understand a workplace as a complex adaptive system and to create a framework of eight domains (system characteristics) that affect the emergence of system-level behaviour. This Workplace of Well-being (WoW) framework is responsive and adaptive to local settings and allows a shared understanding of the enablers and barriers to behaviour change by capturing local information for each of the eight domains. We use the results of applying the WoW framework to one workplace, a UK National Health Service ward, to describe the utility of this approach in informing design of setting-appropriate healthy workplace interventions that create workplaces conducive to healthy behaviour change.

  19. Tailoring Healthy Workplace Interventions to Local Healthcare Settings: A Complexity Theory-Informed Workplace of Well-Being Framework

    Directory of Open Access Journals (Sweden)

    Sarah L. Brand

    2015-01-01

    Full Text Available Many healthy workplace interventions have been developed for healthcare settings to address the consistently low scores of healthcare professionals on assessments of mental and physical well-being. Complex healthcare settings present challenges for the scale-up and spread of successful interventions from one setting to another. Despite general agreement regarding the importance of the local setting in affecting intervention success across different settings, there is no consensus on what it is about a local setting that needs to be taken into account to design healthy workplace interventions appropriate for different local settings. Complexity theory principles were used to understand a workplace as a complex adaptive system and to create a framework of eight domains (system characteristics that affect the emergence of system-level behaviour. This Workplace of Well-being (WoW framework is responsive and adaptive to local settings and allows a shared understanding of the enablers and barriers to behaviour change by capturing local information for each of the eight domains. We use the results of applying the WoW framework to one workplace, a UK National Health Service ward, to describe the utility of this approach in informing design of setting-appropriate healthy workplace interventions that create workplaces conducive to healthy behaviour change.

  20. Tailoring Healthy Workplace Interventions to Local Healthcare Settings: A Complexity Theory-Informed Workplace of Well-Being Framework

    Science.gov (United States)

    Brand, Sarah L.; Fleming, Lora E.; Wyatt, Katrina M.

    2015-01-01

    Many healthy workplace interventions have been developed for healthcare settings to address the consistently low scores of healthcare professionals on assessments of mental and physical well-being. Complex healthcare settings present challenges for the scale-up and spread of successful interventions from one setting to another. Despite general agreement regarding the importance of the local setting in affecting intervention success across different settings, there is no consensus on what it is about a local setting that needs to be taken into account to design healthy workplace interventions appropriate for different local settings. Complexity theory principles were used to understand a workplace as a complex adaptive system and to create a framework of eight domains (system characteristics) that affect the emergence of system-level behaviour. This Workplace of Well-being (WoW) framework is responsive and adaptive to local settings and allows a shared understanding of the enablers and barriers to behaviour change by capturing local information for each of the eight domains. We use the results of applying the WoW framework to one workplace, a UK National Health Service ward, to describe the utility of this approach in informing design of setting-appropriate healthy workplace interventions that create workplaces conducive to healthy behaviour change. PMID:26380358

  1. Impact of an intervention programme on knowledge, attitude and practice of healthcare staff regarding pharmaceutical waste management, Gaza, Palestine.

    Science.gov (United States)

    Tabash, M I; Hussein, R A; Mahmoud, A H; El-Borgy, M D; Abu-Hamad, B A

    2016-09-01

    To assess knowledge, attitude and practice (KAP) of healthcare staff regarding pharmaceutical waste management; and to determine the impact of an educational programme on the KAP survey items. Pre-post-test intervention study. The pre-intervention phase was performed using a sample of 530 out of 1500 healthcare workers. A predesigned interview questionnaire was used to assess KAP. Next, an educational programme was designed and offered to a subsample of 69 healthcare workers. KAP were re-assessed for the programme attendees using the same interview questionnaire, both immediately (post-test) and six months after the end of the programme (follow-up test). The parametric paired sample t-test was used to assess the difference between pre-test and follow-up test results. Poor knowledge and poor practice levels (scores 50%) detected in the pre-intervention phase were found to improve to satisfactory levels (scores ≥75%) in the follow-up phase. Attitude was found to be positive (score ≥75%) in all phases of the study. The educational programme led to a significant improvement in KAP of healthcare staff regarding pharmaceutical waste management (P<0.001). Copyright © 2016. Published by Elsevier Ltd.

  2. A training intervention on child feeding among primary healthcare workers in Ibadan Municipality

    Directory of Open Access Journals (Sweden)

    Folake O. Samuel

    2016-09-01

    Full Text Available Introduction: Health workers at the primary level are well positioned to provide health information and counselling on child feeding to mothers on antenatal visits. The study was designed to evaluate the effect of training on the knowledge, attitudes and provision of infant and young child feeding (IYCF information and counselling among primary healthcare (PHC workers. Methods: A two-stage cluster sample was used to select health workers for training on IYCF in Ibadan, Nigeria. Baseline, immediate and 4-week post-training surveys were conducted to assess knowledge, attitudes and practices of health workers regarding IYCF. Paired t-tests were used to measure differences (p < 0.05 before and after the training. Results: A total of 124 health workers were trained on current global IYCF recommendations. Participants included community health extension workers (59.7%, nurses (27.4%, community health officers (11.3%, and pharmacy technicians (1.6%. Mean age was 41.8 ± 8.2 years and 95.2% were women. Knowledge of health workers regarding IYCF, particularly complementary feeding, was low at baseline but improved significantly following the training intervention. Attitudes and practices regarding provision of IYCF were suboptimal among health workers at the PHC facilities, but this improved with training. Conclusion: Health workers at the PHC level need regular retraining exercises to ensure effective counselling on IYCF.

  3. Mental healthcare staff well-being and burnout: A narrative review of trends, causes, implications, and recommendations for future interventions.

    Science.gov (United States)

    Johnson, Judith; Hall, Louise H; Berzins, Kathryn; Baker, John; Melling, Kathryn; Thompson, Carl

    2018-02-01

    Rising levels of burnout and poor well-being in healthcare staff are an international concern for health systems. The need to improve well-being and reduce burnout has long been acknowledged, but few interventions target mental healthcare staff, and minimal improvements have been seen in services. This review aimed to examine the problem of burnout and well-being in mental healthcare staff and to present recommendations for future research and interventions. A discursive review was undertaken examining trends, causes, implications, and interventions in burnout and well-being in healthcare staff working in mental health services. Data were drawn from national surveys, reports, and peer-reviewed journal articles. These show that staff in mental healthcare report poorer well-being than staff in other healthcare sectors. Poorer well-being and higher burnout are associated with poorer quality and safety of patient care, higher absenteeism, and higher turnover rates. Interventions are effective, but effect sizes are small. The review concludes that grounding interventions in the research literature, emphasizing the positive aspects of interventions to staff, building stronger links between healthcare organizations and universities, and designing interventions targeting burnout and improved patient care together may improve the effectiveness and uptake of interventions by staff. © 2017 Australian College of Mental Health Nurses Inc.

  4. A communication skills intervention for community healthcare workers reduces perceived patient aggression: a pretest-postest study.

    Science.gov (United States)

    Swain, Nicola; Gale, Christopher

    2014-09-01

    Previous studies have shown that healthcare workers experience high levels of aggression from patients. Prevention packages to address this have received little research support. Communication skills have been shown to influence individuals' experience of aggression and are also amenable to training. This study aims to deliver a communication skills training package that will reduce the experience of aggression in the workplace for healthcare workers. An interactive, multimedia communication skills package was developed that would be suitable for community healthcare workers. The training consisted of four workshops, including teaching, discussion and DVD illustrative examples. These were based on research and clinical experience. This intervention was delivered in two community care organisations over several months. Fifty-six community healthcare workers took part in the trial in small groups. There were 46 females and 10 males with a median age of 45-54 years. For each group a series of four communication skills workshops were given. Measurements of perceived aggression and wellbeing were taken before the workshops, at the end of the workshops, one month after and two months after. Results show statistically significant reductions in perceived aggression one and two months after baseline measures (pcommunication skills training programme is both enjoyable and shows decreases in perceived aggression, distress, and increases in general mental wellness. A full RCT of this intervention is warranted. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Evaluation of a Tai Chi Intervention to Promote Well-Being in Healthcare Staff: A Pilot Study

    Directory of Open Access Journals (Sweden)

    David Marshall

    2018-01-01

    Full Text Available Whilst healthcare professions are already considered one of the most stressful occupations, workplaces are becoming busier, and the potential for workplace absenteeism and burnout has intensified. There is growing evidence that the mind–body practice of Tai Chi, which originated in China as a martial art, has value in treating or preventing many health-related problems, such as stress and anxiety, and that regular practice helps to significantly improve wellbeing, attention, focus, and resilience. This intervention provided 12 sessions of Tai Chi for a group of 12 multidisciplinary healthcare workers and was general wellbeing was measured pre- and post-intervention. Using a mixed methods research design, it was discovered that there were statistically significant gains in well-being during this timeframe with results indicating a strong case for further roll out of the program to a larger pool and more extensive study.

  6. Serious electronic games as behavioural change interventions in healthcare-associated infections and infection prevention and control: a scoping review of the literature and future directions

    Directory of Open Access Journals (Sweden)

    Enrique Castro-Sánchez

    2016-10-01

    Full Text Available Abstract Background The uptake of improvement initiatives in infection prevention and control (IPC has often proven challenging. Innovative interventions such as ‘serious games’ have been proposed in other areas to educate and help clinicians adopt optimal behaviours. There is limited evidence about the application and evaluation of serious games in IPC. The purposes of the study were: a to synthesise research evidence on the use of serious games in IPC to support healthcare workers’ behaviour change and best practice learning; and b to identify gaps across the formulation and evaluation of serious games in IPC. Methods A scoping study was conducted using the methodological framework developed by Arksey and O’Malley. We interrogated electronic databases (Ovid MEDLINE, Embase Classic + Embase, PsycINFO, Scopus, Cochrane, Google Scholar in December 2015. Evidence from these studies was assessed against an analytic framework of intervention formulation and evaluation. Results Nine hundred sixty five unique papers were initially identified, 23 included for full-text review, and four finally selected. Studies focused on intervention inception and development rather than implementation. Expert involvement in game design was reported in 2/4 studies. Potential game users were not included in needs assessment and game development. Outcome variables such as fidelity or sustainability were scarcely reported. Conclusions The growing interest in serious games for health has not been coupled with adequate evaluation of processes, outcomes and contexts involved. Explanations about the mechanisms by which game components may facilitate behaviour change are lacking, further hindering adoption.

  7. Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

    Science.gov (United States)

    Mogre, Victor; Scherpbier, Albert J J A; Stevens, Fred; Aryee, Paul; Cherry, Mary Gemma; Dornan, Tim

    2016-01-01

    Objective To determine what, how, for whom, why, and in what circumstances educational interventions improve the delivery of nutrition care by doctors and other healthcare professionals work. Design Realist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched MEDLINE, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations. Results Over half of the 46 studies from which we extracted data originated from the USA. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included feeling competent, feeling confident and comfortable, having greater self-efficacy, being less inhibited by barriers in healthcare systems and feeling that nutrition care was accepted and recognised. Conclusions These findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve

  8. The impact of a multimedia informational intervention on healthcare service use among women and men newly diagnosed with cancer.

    Science.gov (United States)

    Loiselle, Carmen G; Dubois, Sylvie

    2009-01-01

    This quasi-experimental longitudinal study documented the impact of a comprehensive cancer informational intervention using information technology on healthcare service use among individuals newly diagnosed with cancer. Women with breast cancer (n = 205) and men with prostate cancer (n = 45) were recruited within 8 weeks of diagnosis at 4 university teaching hospitals in Montreal, Quebec, Canada. The intervention group (n = 148) received a 1-hour training on information technology use, a CD-ROM on cancer, and a list of reputable cancer-related Web sites. The intervention material was available for a period of 8 weeks. The control group (n = 102) received usual care. Self-reported questionnaires were completed at T1 (baseline), T2 (1 week after intervention), and T3 (3 months after intervention). Using multivariate statistics, the experimental group reported significantly more satisfaction with cancer information received compared to the control group. No significant differences were found between experimental and control groups in their reliance on healthcare services. However, women as opposed to men spent more time with nurses, were more satisfied with cancer information received, and relied more heavily on health services. Future research would explore whether the latter observations reflect genuine sex differences or are more contingent on the specific cancer diagnosis.

  9. Agency for Healthcare Research and Quality Evidence-based Practice Center methods for systematically reviewing complex multicomponent health care interventions.

    Science.gov (United States)

    Guise, Jeanne-Marie; Chang, Christine; Viswanathan, Meera; Glick, Susan; Treadwell, Jonathan; Umscheid, Craig A; Whitlock, Evelyn; Fu, Rongwei; Berliner, Elise; Paynter, Robin; Anderson, Johanna; Motu'apuaka, Pua; Trikalinos, Tom

    2014-11-01

    The purpose of this Agency for Healthcare Research and Quality Evidence-based Practice Center methods white paper was to outline approaches to conducting systematic reviews of complex multicomponent health care interventions. We performed a literature scan and conducted semistructured interviews with international experts who conduct research or systematic reviews of complex multicomponent interventions (CMCIs) or organizational leaders who implement CMCIs in health care. Challenges identified include lack of consistent terminology for such interventions (eg, complex, multicomponent, multidimensional, multifactorial); a wide range of approaches used to frame the review, from grouping interventions by common features to using more theoretical approaches; decisions regarding whether and how to quantitatively analyze the interventions, from holistic to individual component analytic approaches; and incomplete and inconsistent reporting of elements critical to understanding the success and impact of multicomponent interventions, such as methods used for implementation the context in which interventions are implemented. We provide a framework for the spectrum of conceptual and analytic approaches to synthesizing studies of multicomponent interventions and an initial list of critical reporting elements for such studies. This information is intended to help systematic reviewers understand the options and tradeoffs available for such reviews. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Intervention for Smokers through New Communication Technologies: What Perceptions Do Patients and Healthcare Professionals Have? A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Jose Manuel Trujillo Gómez

    Full Text Available The use of information and communication technologies (ICTs in the health service is increasing. In spite of limitations, such as lack of time and experience, the deployment of ICTs in the healthcare system has advantages which include patient satisfaction with secure messaging, and time saving benefits and utility for patients and health professionals. ICTs may be helpful as either interventions on their own or as complementary tools to help patients stop smoking.To gather opinions from both medical professionals and smokers about an email-based application that had been designed by our research group to help smoking cessation, and identify the advantages and disadvantages associated with interventions based on the utilization of ICTs for this purpose.A qualitative, descriptive-interpretative study with a phenomenological perspective was performed to identify and interpret the discourses of the participating smokers and primary healthcare professionals. Data were obtained through two techniques: semi-structured individual interviews and discussion groups, which were recorded and later systematically and literally transcribed together with the interviewer's notes. Data were analyzed with the ATLAS TI 6.0 programme.Seven individual interviews and four focal groups were conducted. The advantages of the application based on the email intervention designed by our research group were said to be the saving of time in consultations and ease of access for patients who found work timetables and following a programme for smoking cessation incompatible. The disadvantages were thought to be a lack of personal contact with the healthcare professional, and the possibility of cheating/ self-deception, and a greater probability of relapse on the part of the smokers.Both patients and healthcare professionals viewed the email-based application to help patients stop smoking as a complementary aid to face-to-face consultations. Nevertheless, ICTs could not

  11. Intervention for Smokers through New Communication Technologies: What Perceptions Do Patients and Healthcare Professionals Have? A Qualitative Study.

    Science.gov (United States)

    Trujillo Gómez, Jose Manuel; Díaz-Gete, Laura; Martín-Cantera, Carlos; Fábregas Escurriola, Mireia; Lozano Moreno, Maribel; Burón Leandro, Raquel; Gomez Quintero, Ana María; Ballve, Jose Luis; Clemente Jiménez, María Lourdes; Puigdomènech Puig, Elisa; Casas More, Ramón; Garcia Rueda, Beatriz; Casajuana, Marc; Méndez-Aguirre, Marga; Garcia Bonias, David; Fernández Maestre, Soraya; Sánchez Fondevila, Jessica

    2015-01-01

    The use of information and communication technologies (ICTs) in the health service is increasing. In spite of limitations, such as lack of time and experience, the deployment of ICTs in the healthcare system has advantages which include patient satisfaction with secure messaging, and time saving benefits and utility for patients and health professionals. ICTs may be helpful as either interventions on their own or as complementary tools to help patients stop smoking. To gather opinions from both medical professionals and smokers about an email-based application that had been designed by our research group to help smoking cessation, and identify the advantages and disadvantages associated with interventions based on the utilization of ICTs for this purpose. A qualitative, descriptive-interpretative study with a phenomenological perspective was performed to identify and interpret the discourses of the participating smokers and primary healthcare professionals. Data were obtained through two techniques: semi-structured individual interviews and discussion groups, which were recorded and later systematically and literally transcribed together with the interviewer's notes. Data were analyzed with the ATLAS TI 6.0 programme. Seven individual interviews and four focal groups were conducted. The advantages of the application based on the email intervention designed by our research group were said to be the saving of time in consultations and ease of access for patients who found work timetables and following a programme for smoking cessation incompatible. The disadvantages were thought to be a lack of personal contact with the healthcare professional, and the possibility of cheating/ self-deception, and a greater probability of relapse on the part of the smokers. Both patients and healthcare professionals viewed the email-based application to help patients stop smoking as a complementary aid to face-to-face consultations. Nevertheless, ICTs could not substitute personal

  12. Hand hygiene in reducing transient flora on the hands of healthcare workers: an educational intervention.

    Science.gov (United States)

    Kapil, R; Bhavsar, H K; Madan, M

    2015-01-01

    Hand hygiene has now been recognised as one of the most effective intervention to control the transmission of infections in a hospital and education is an important tool to ensure its implementation. In order to convince the users and as a part of education, it is important to generate evidence on the role of hand hygiene in reducing the bacterial flora on their hands. The present study was undertaken in a tertiary care hospital to demonstrate the presence of bacterial flora on the hands of healthcare workers (HCW) in different categories, to teach them proper hand hygiene technique using alcohol-based hand rub and determine the outcome for reduction of bacteria. A total sample size of 60 subjects including resident doctors, medical students, nurses and hospital attendants were included in the study after obtaining informed consent. Each person was educated on the technique of hand hygiene with alcohol-based hand rub and hand impressions were cultured before and after hand hygiene. All the subjects were also given a questionnaire to assess their perception on hand hygiene. The WHO posters on proper hand hygiene were displayed in the appropriate areas of the hospital in addition, as an educational tool. Majority (42 out of 60) of the HCWs had bacterial count up to 100 colonies or more on both hands before the application of hand rub while working in the hospital. After use of alcohol hand rub with a proper hand hygiene technique, it was found that the percentage reduction was 95-99% among doctors and nurses, 70% among hospital attendants and 50% among sanitary attendants. Staphylococcus aureus was present on the hands of eight persons of which three were methicillin-resistant Staphylococcus aureus. The study demonstrates that transient bacteria are present on the hands of HCWs but majority could be removed by proper hand hygiene, which needs continuous education to be effective. It also shows that active education by demonstrating the proper hand hygiene technique

  13. Enhancing prescribing of guideline-recommended medications for ischaemic heart diseases: a systematic review and meta-analysis of interventions targeted at healthcare professionals

    NARCIS (Netherlands)

    Nguyen, Thang; Nguyen, Hoa Q; Widyakusuma, Niken N; Nguyen, Thao H; Pham, Tam T; Taxis, Katja

    Objectives Ischaemic heart diseases (IHDs) are a leading cause of death worldwide. Although prescribing according to guidelines improves health outcomes, it remains suboptimal. We determined whether interventions targeted at healthcare professionals are effective to enhance prescribing and health

  14. Qualitative interviews with healthcare staff in four European countries to inform adaptation of an intervention to increase chlamydia testing.

    Science.gov (United States)

    McNulty, Cliodna; Ricketts, Ellie J; Fredlund, Hans; Uusküla, Anneli; Town, Katy; Rugman, Claire; Tisler-Sala, Anna; Mani, Alix; Dunais, Brigitte; Folkard, Kate; Allison, Rosalie; Touboul, Pia

    2017-09-25

    To determine the needs of primary healthcare general practice (GP) staff, stakeholders and trainers to inform the adaptation of a locally successful complex intervention (Chlamydia Intervention Randomised Trial (CIRT)) aimed at increasing chlamydia testing within primary healthcare within South West England to three EU countries (Estonia, France and Sweden) and throughout England. Qualitative interviews. European primary healthcare in England, France, Sweden and Estonia with a range of chlamydia screening provision in 2013. 45 GP staff, 13 trainers and 18 stakeholders. The iterative interview schedule explored participants' personal attitudes, subjective norms and perceived behavioural controls around provision of chlamydia testing, sexual health services and training in general practice. Researchers used a common thematic analysis. Findings were similar across all countries. Most participants agreed that chlamydia testing and sexual health services should be offered in general practice. There was no culture of GP staff routinely offering opportunistic chlamydia testing or sexual health advice, and due to other priorities, participants reported this would be challenging. All participants indicated that the CIRT workshop covering chlamydia testing and sexual health would be useful if practice based, included all practice staff and action planning, and was adequately resourced. Participants suggested minor adaptations to CIRT to suit their country's health services. A common complex intervention can be adapted for use across Europe, despite varied sexual health provision. The intervention (ChlamydiA Testing Training in Europe (CATTE)) should comprise: a staff workshop covering sexual health and chlamydia testing rates and procedures, action planning and patient materials and staff reminders via computer prompts, emails or newsletters, with testing feedback through practice champions. CATTE materials are available at: www.STItraining.eu. © Article author(s) (or their

  15. Integrating socially assistive robotics into mental healthcare interventions: applications and recommendations for expanded use.

    Science.gov (United States)

    Rabbitt, Sarah M; Kazdin, Alan E; Scassellati, Brian

    2015-02-01

    As a field, mental healthcare is faced with major challenges as it attempts to close the huge gap between those who need services and those who receive services. In recent decades, technological advances have provided exciting new resources in this battle. Socially assistive robotics (SAR) is a particularly promising area that has expanded into several exciting mental healthcare applications. Indeed, a growing literature highlights the variety of clinically relevant functions that these robots can serve, from companion to therapeutic play partner. This paper reviews the ways that SAR have already been used in mental health service and research and discusses ways that these applications can be expanded. We also outline the challenges and limitations associated with further integrating SAR into mental healthcare. SAR is not proposed as a replacement for specially trained and knowledgeable professionals nor is it seen as a panacea for all mental healthcare needs. Instead, robots can serve as clinical tools and assistants in a wide range of settings. Given the dramatic growth in this area, now is a critical moment for individuals in the mental healthcare community to become engaged in this research and steer it toward our field's most pressing clinical needs. Copyright © 2014. Published by Elsevier Ltd.

  16. Developing and evaluating the implementation of a complex intervention: using mixed methods to inform the design of a randomised controlled trial of an oral healthcare intervention after stroke

    Directory of Open Access Journals (Sweden)

    St George Bridget

    2011-07-01

    Full Text Available Abstract Background Many interventions delivered within the stroke rehabilitation setting could be considered complex, though some are more complex than others. The degree of complexity might be based on the number of and interactions between levels, components and actions targeted within the intervention. The number of (and variation within participant groups and the contexts in which it is delivered might also reflect the extent of complexity. Similarly, designing the evaluation of a complex intervention can be challenging. Considerations include the necessity for intervention standardisation, the multiplicity of outcome measures employed to capture the impact of a multifaceted intervention and the delivery of the intervention across different clinical settings operating within varying healthcare contexts. Our aim was to develop and evaluate the implementation of a complex, multidimensional oral health care (OHC intervention for people in stroke rehabilitation settings which would inform the development of a randomised controlled trial. Methods After reviewing the evidence for the provision of OHC following stroke, multi-disciplinary experts informed the development of our intervention. Using both quantitative and qualitative methods we evaluated the implementation of the complex OHC intervention across patients, staff and service levels of care. We also adopted a pragmatic approach to patient recruitment, the completion of assessment tools and delivery of OHC, alongside an attention to the context in which it was delivered. Results We demonstrated the feasibility of implementing a complex OHC intervention across three levels of care. The complementary nature of the mixed methods approach to data gathering provided a complete picture of the implementation of the intervention and a detailed understanding of the variations within and interactions between the components of the intervention. Information on the feasibility of the outcome measures

  17. Explanations - Styles of explanation in science

    Science.gov (United States)

    Cornwell, John

    2004-06-01

    Our lives, states of health, relationships, behavior, experiences of the natural world, and the technologies that shape our contemporary existence are subject to a superfluity of competing, multi-faceted and sometimes incompatible explanations. Widespread confusion about the nature of "explanation" and its scope and limits pervades popular exposition of the natural sciences, popular history and philosophy of science. This fascinating book explores the way explanations work, why they vary between disciplines, periods, and cultures, and whether they have any necessary boundaries. In other words, Explanations aims to achieve a better understanding of explanation, both within the sciences and the humanities. It features contributions from expert writers from a wide range of disciplines, including science, philosophy, mathematics, and social anthropology.

  18. Alternative indicators for monitoring the quality of a continuous intervention program on antibiotic prescribing during changing healthcare conditions.

    Science.gov (United States)

    Bantar, C; Franco, D; Heft, C; Vesco, E; Arango, C; Izaguirre, M; Alcázar, G; Boleas, M; Oliva, M E

    2005-06-01

    We recently published on the impact of a four-phase hospital-wide intervention program designed to optimize the quality of antibiotic use, where a multidisciplinary team (MDT) could modify prescription at the last phase. Because health care quality was changing during the last 5 years (late 1999 to early 2004), we developed certain indicators to monitor the quality of our intervention over time. Different periods were defined as baseline (pre-intervention), initial intervention-active control, pre-crisis control, crisis control, post-crisis control and end of crisis control. Major indicators were rates of prescription modification by the MDT; prescription for an uncertain infection and a novel index formula (RIcarb) to estimate the rationale for carbapenem use. We assessed 2115 antimicrobial prescriptions. Modification of prescription rate was 30% at the beginning and decreased thereafter up to stable levels. Rate of prescriptions ordered for cases of both uncertain infection and unknown source of infection decreased significantly after intervention (i.e. from baseline to active control). In contrast, a doubling of culture-directed prescriptions was observed between these periods. RIcarb values lower and higher than 60% (modal, cut-off) were assumed as carbapenem overuse and underuse, respectively. Overuse was observed at the pre-intervention, while pronounced underuse was shown during the crisis (RIcarb, 45% and 87%, respectively). The present study demonstrates that certain indicators, other than the widely adopted impact outcomes, are a suitable tool for monitoring the quality of a continuous, long-term, active intervention on antimicrobial prescribing practice, especially when applied in a changing healthcare setting.

  19. Mobile health treatment support intervention for HIV and tuberculosis in Mozambique: Perspectives of patients and healthcare workers.

    Directory of Open Access Journals (Sweden)

    José António Nhavoto

    Full Text Available Studies have been conducted in developing countries using SMS to communicate with patients to reduce the number of missed appointments and improve retention in treatment, however; very few have been scaled up. One possible reason for this could be that patients or staff are dissatisfied with the method in some way. This paper reports a study of patients' and healthcare workers' (HCW views on an mHealth intervention aiming to support retention in antiretroviral therapy (ART and tuberculosis (TB treatment in Mozambique.The study was conducted at five healthcare centres in Mozambique. Automated SMS health promotions and reminders were sent to patients in a RCT. A total of 141 patients and 40 HCWs were interviewed. Respondents rated usefulness, perceived benefits, ease of use, satisfaction, and risks of the SMS system using a Likert scale questionnaire. A semi-structured interview guide was followed. Interviews were transcribed and thematic analysis was conducted.Both patients and HCW found the SMS system useful and reliable. Most highly rated positive effects were reducing the number of failures to collect medication and avoiding missing appointments. Patients' confidence in the system was high. Most perceived the system to improve communication between health-care provider and patient and assist in education and motivation. The automatic recognition of questions from patients and the provision of appropriate answers (a unique feature of this system was especially appreciated. A majority would recommend the system to other patients or healthcare centres. Risks also were mentioned, mostly by HCW, of unintentional disclosure of health status in cases where patients use shared phones.The results suggest that SMS technology for HIV and TB should be used to transmit reminders for appointments, medications, motivational texts, and health education to increase retention in care. Measures must be taken to reduce risks of privacy intrusion, but these are

  20. Healthcare in the Pocket: Mapping the Space of Mobile-Phone Health Interventions

    Science.gov (United States)

    Klasnja, Predrag; Pratt, Wanda

    2011-01-01

    Mobile phones are becoming an increasingly important platform for the delivery of health interventions. In recent years, researchers have used mobile phones as tools for encouraging physical activity and healthy diets, for symptom monitoring in asthma and heart disease, for sending patients reminders about upcoming appointments, for supporting smoking cessation, and for a range of other health problems. This paper provides an overview of this rapidly growing body of work. We describe the features of mobile phones that make them a particularly promising platform for health interventions, and we identify five basic intervention strategies that have been used in mobile-phone health applications across different health conditions. Finally, we outline the directions for future research that could increase our understanding of functional and design requirements for the development of highly effective mobile-phone health interventions. PMID:21925288

  1. Reporting quality of music intervention research in healthcare: A systematic review.

    Science.gov (United States)

    Robb, Sheri L; Hanson-Abromeit, Deanna; May, Lindsey; Hernandez-Ruiz, Eugenia; Allison, Megan; Beloat, Alyssa; Daugherty, Sarah; Kurtz, Rebecca; Ott, Alyssa; Oyedele, Oladele Oladimeji; Polasik, Shelbi; Rager, Allison; Rifkin, Jamie; Wolf, Emily

    2018-06-01

    Concomitant with the growth of music intervention research, are concerns about inadequate intervention reporting and inconsistent terminology, which limits validity, replicability, and clinical application of findings. Examine reporting quality of music intervention research, in chronic and acute medical settings, using the Checklist for Reporting Music-based Interventions. In addition, describe patient populations and primary outcomes, intervention content and corresponding interventionist qualifications, and terminology. Searching MEDLINE, PubMed, CINAHL, HealthSTAR, and PsycINFO we identified articles meeting inclusion/exclusion criteria for a five-year period (2010-2015) and extracted relevant data. Coded material included reporting quality across seven areas (theory, content, delivery schedule, interventionist qualifications, treatment fidelity, setting, unit of delivery), author/journal information, patient population/outcomes, and terminology. Of 860 articles, 187 met review criteria (128 experimental; 59 quasi-experimental), with 121 publishing journals, and authors from 31 countries. Overall reporting quality was poor with <50% providing information for four of the seven checklist components (theory, interventionist qualifications, treatment fidelity, setting). Intervention content reporting was also poor with <50% providing information about the music used, decibel levels/volume controls, or materials. Credentialed music therapists and registered nurses delivered most interventions, with clear differences in content and delivery. Terminology was varied and inconsistent. Problems with reporting quality impedes meaningful interpretation and cross-study comparisons. Inconsistent and misapplied terminology also create barriers to interprofessional communication and translation of findings to patient care. Improved reporting quality and creation of shared language will advance scientific rigor and clinical relevance of music intervention research. Copyright

  2. Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal.

    Science.gov (United States)

    Kohrt, Brandon A; Jordans, Mark J D; Turner, Elizabeth L; Sikkema, Kathleen J; Luitel, Nagendra P; Rai, Sauharda; Singla, Daisy R; Lamichhane, Jagannath; Lund, Crick; Patel, Vikram

    2018-01-01

    Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap, RE ducing S tigma among H ealthc A re P roviders to Improv E mental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services into primary healthcare. This protocol describes a mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal. The qualitative component will include key informant interviews and focus group discussions. The quantitative component consists of a pilot cluster randomized controlled trial (c-RCT), which will establish parameters for a future effectiveness study of RESHAPE compared to training as usual (TAU). Primary healthcare facilities (the cluster unit, k  = 34) will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention are the primary healthcare workers in the facilities ( n  = 150); indirect beneficiaries are their patients ( n  = 100). The TAU condition is existing mental health training and supervision for primary healthcare workers delivered through the Programme for Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme (mhGAP). The primary objective is to evaluate acceptability and feasibility through qualitative interviews with primary healthcare workers, trainers, and mental health service users. The secondary objective is to collect quantitative information on health worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge (mh

  3. A dialogue-based web application enhances personalized access to healthcare professionals – an intervention study

    Directory of Open Access Journals (Sweden)

    Bjoernes Charlotte D

    2012-09-01

    Full Text Available Abstract Background In today’s short stay hospital settings the contact time for patients is reduced. However, it seems to be more important for the patients that the healthcare professionals are easy to get in contact with during the whole course of treatment, and to have the opportunity to exchange information, as a basis for obtaining individualized information and support. Therefore, the aim was to explore the ability of a dialogue-based application to contribute to accessibility of the healthcare professionals and exchangeability of information. Method An application for online written and asynchronous contacts was developed, implemented in clinical practice, and evaluated. The qualitative effect of the online contact was explored using a Web-based survey comprised of open-ended questions. Results Patients valued the online contacts and experienced feelings of partnership in dialogue, in a flexible and calm environment, which supported their ability to be active partners and feelings of freedom and security. Conclusion The online asynchronous written environment can contribute to accessibility and exchangeability, and add new possibilities for dialogues from which the patients can benefit. The individualized information obtained via online contact empowers the patients. The Internet-based contacts are a way to differentiate and expand the possibilities for contacts outside the few scheduled face-to-face hospital contacts.

  4. Using the collaborative intervention planning framework to adapt a health-care manager intervention to a new population and provider group to improve the health of people with serious mental illness.

    Science.gov (United States)

    Cabassa, Leopoldo J; Gomes, Arminda P; Meyreles, Quisqueya; Capitelli, Lucia; Younge, Richard; Dragatsi, Dianna; Alvarez, Juana; Manrique, Yamira; Lewis-Fernández, Roberto

    2014-11-30

    Health-care manager interventions improve the physical health of people with serious mental illness (SMI) and could be widely implemented in public mental health clinics. Local adaptations and customization may be needed to increase the reach of these interventions in the public mental health system and across different racial and ethnic communities. In this study, we describe how we used the collaborative intervention planning framework to customize an existing health-care manager intervention to a new patient population (Hispanics with SMI) and provider group (social workers) to increase its fit with our local community. The study was conducted in partnership with a public mental health clinic that serves predominantly Hispanic clients. A community advisory board (CAB) composed of researchers and potential implementers (e.g., social workers, primary care physicians) used the collaborative intervention planning framework, an approach that combines community-based participatory research principles and intervention mapping (IM) procedures, to inform intervention adaptations. The adaptation process included four steps: fostering collaborations between CAB members; understanding the needs of the local population through a mixed-methods needs assessment, literature reviews, and group discussions; reviewing intervention objectives to identify targets for adaptation; and developing the adapted intervention. The application of this approach enabled the CAB to identify a series of cultural and provider level-adaptations without compromising the core elements of the original health-care manager intervention. Reducing health disparities in people with SMI requires community engagement, particularly when preparing existing interventions to be used with new communities, provider groups, and practice settings. Our study illustrates one approach that can be used to involve community stakeholders in the intervention adaptation process from the very beginning to enhance the

  5. Problematisations of Complexity: On the Notion and Production of Diverse Complexities in Healthcare Interventions and Evaluations

    NARCIS (Netherlands)

    T. Broer (Tineke); R.A. Bal (Roland); Pickersgill, M. (Martyn)

    2017-01-01

    textabstractWithin the literature on the evaluation of health (policy) interventions, complexity is a much-debated issue. In particular, many claim that so-called ‘complex interventions’ pose different challenges to evaluation studies than apparently ‘simple interventions’ do. Distinct ways of doing

  6. The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections

    Directory of Open Access Journals (Sweden)

    Steyerberg Ewout W

    2011-09-01

    Full Text Available Abstract Background Public health authorities have recognized lack of hand hygiene in hospitals as one of the important causes of preventable mortality and morbidity at population level. The implementation strategy ACCOMPLISH (Actively Creating COMPLIance Saving Health targets both individual and environmental determinants of hand hygiene. This study aims to evaluate the cost-effectiveness of a multicomponent implementation strategy aimed at the reduction of healthcare associated infections in Dutch hospital care, by promotion of hand hygiene. Methods/design The ACCOMPLISH package will be evaluated in a two-arm cluster randomised trial in 16 hospitals in the Netherlands, in one intensive care unit and one surgical ward per hospital. Intervention A multicomponent package, including e-learning, team training, introduction of electronic alcohol based hand rub dispensers and performance feedback. Variables The primary outcome measure will be the observed hand hygiene compliance rate, measured at baseline and after 6, 12 and 18 months; as a secondary outcome measure the prevalence of healthcare associated infections will be measured at the same time points. Process indicators of the intervention will be collected pre and post intervention. An ex-post economic evaluation of the ACCOMPLISH package from a healthcare perspective will be performed. Statistical analysis Multilevel analysis, using mixed linear modelling techniques will be conducted to assess the effect of the intervention strategy on the overall compliance rate among healthcare workers and on prevalence of healthcare associated infections. Questionnaires on process indicators will be analysed with multivariable linear regression, and will include both behavioural determinants and determinants of innovation. Cost-effectiveness will be assessed by calculating the incremental cost-effectiveness ratio, defined here as the costs for the intervention divided by the difference in prevalence of

  7. Understanding reactions to an internet-delivered health-care intervention: accommodating user preferences for information provision.

    Science.gov (United States)

    Yardley, Lucy; Morrison, Leanne G; Andreou, Panayiota; Joseph, Judith; Little, Paul

    2010-09-17

    It is recognised as good practice to use qualitative methods to elicit users' views of internet-delivered health-care interventions during their development. This paper seeks to illustrate the advantages of combining usability testing with 'theoretical modelling', i.e. analyses that relate the findings of qualitative studies during intervention development to social science theory, in order to gain deeper insights into the reasons and context for how people respond to the intervention. This paper illustrates how usability testing may be enriched by theoretical modelling by means of two qualitative studies of users' views of the delivery of information in an internet-delivered intervention to help users decide whether they needed to seek medical care for their cold or flu symptoms. In Study 1, 21 participants recruited from a city in southern England were asked to 'think aloud' while viewing draft web-pages presented in paper format. In Study 2, views of our prototype website were elicited, again using think aloud methods, in a sample of 26 participants purposively sampled for diversity in education levels. Both data-sets were analysed by thematic analysis. Study 1 revealed that although the information provided by the draft web-pages had many of the intended empowering benefits, users often felt overwhelmed by the quantity of information. Relating these findings to theory and research on factors influencing preferences for information-seeking we hypothesised that to meet the needs of different users (especially those with lower literacy levels) our website should be designed to provide only essential personalised advice, but with options to access further information. Study 2 showed that our website design did prove accessible to users with different literacy levels. However, some users seemed to want still greater control over how information was accessed. Educational level need not be an insuperable barrier to appreciating web-based access to detailed health

  8. Identifying complications of interventional procedures from UK routine healthcare databases: a systematic search for methods using clinical codes.

    Science.gov (United States)

    Keltie, Kim; Cole, Helen; Arber, Mick; Patrick, Hannah; Powell, John; Campbell, Bruce; Sims, Andrew

    2014-11-28

    Several authors have developed and applied methods to routine data sets to identify the nature and rate of complications following interventional procedures. But, to date, there has been no systematic search for such methods. The objective of this article was to find, classify and appraise published methods, based on analysis of clinical codes, which used routine healthcare databases in a United Kingdom setting to identify complications resulting from interventional procedures. A literature search strategy was developed to identify published studies that referred, in the title or abstract, to the name or acronym of a known routine healthcare database and to complications from procedures or devices. The following data sources were searched in February and March 2013: Cochrane Methods Register, Conference Proceedings Citation Index - Science, Econlit, EMBASE, Health Management Information Consortium, Health Technology Assessment database, MathSciNet, MEDLINE, MEDLINE in-process, OAIster, OpenGrey, Science Citation Index Expanded and ScienceDirect. Of the eligible papers, those which reported methods using clinical coding were classified and summarised in tabular form using the following headings: routine healthcare database; medical speciality; method for identifying complications; length of follow-up; method of recording comorbidity. The benefits and limitations of each approach were assessed. From 3688 papers identified from the literature search, 44 reported the use of clinical codes to identify complications, from which four distinct methods were identified: 1) searching the index admission for specified clinical codes, 2) searching a sequence of admissions for specified clinical codes, 3) searching for specified clinical codes for complications from procedures and devices within the International Classification of Diseases 10th revision (ICD-10) coding scheme which is the methodology recommended by NHS Classification Service, and 4) conducting manual clinical

  9. Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers.

    Science.gov (United States)

    Sakihama, Tomoko; Honda, Hitoshi; Saint, Sanjay; Fowler, Karen E; Kamiya, Toru; Sato, Yumiko; Iuchi, Ritsuko; Tokuda, Yasuharu

    2016-03-01

    Though hand hygiene is an important method of preventing healthcare-associated infection, we found suboptimal hand hygiene adherence among healthcare workers in 4 diverse Japanese hospitals (adherence rates of 11%-25%). Our goal was to assess multimodal hand hygiene intervention coupled with a contest to improve hand hygiene adherence. A total of 3 to 4 inpatient wards in 3 Japanese hospitals. Pre-post intervention study. The intervention was a multimodal hand hygiene intervention recommended by the World Health Organization that was tailored to each facility. The hospital with the highest adherence after the intervention was given $5000 US dollars and a trophy, provided by an American coinvestigator unaffiliated with any of the Japanese hospitals. We tracked hand hygiene adherence rates before patient contact for each unit and hospital and compared these to pre-intervention adherence rates. We observed 2982 postintervention provider-patient encounters in 10 units across 3 hospitals. Hand hygiene adherence rates were improved overall after the intervention (18% pre- to 33% postintervention; P hand hygiene rates among Japanese healthcare workers. Given the overall low rates, however, further improvement is necessary. © 2015 Society of Hospital Medicine.

  10. Analogy, explanation, and proof

    Science.gov (United States)

    Hummel, John E.; Licato, John; Bringsjord, Selmer

    2014-01-01

    People are habitual explanation generators. At its most mundane, our propensity to explain allows us to infer that we should not drink milk that smells sour; at the other extreme, it allows us to establish facts (e.g., theorems in mathematical logic) whose truth was not even known prior to the existence of the explanation (proof). What do the cognitive operations underlying the inference that the milk is sour have in common with the proof that, say, the square root of two is irrational? Our ability to generate explanations bears striking similarities to our ability to make analogies. Both reflect a capacity to generate inferences and generalizations that go beyond the featural similarities between a novel problem and familiar problems in terms of which the novel problem may be understood. However, a notable difference between analogy-making and explanation-generation is that the former is a process in which a single source situation is used to reason about a single target, whereas the latter often requires the reasoner to integrate multiple sources of knowledge. This seemingly small difference poses a challenge to the task of marshaling our understanding of analogical reasoning to understanding explanation. We describe a model of explanation, derived from a model of analogy, adapted to permit systematic violations of this one-to-one mapping constraint. Simulation results demonstrate that the resulting model can generate explanations for novel explananda and that, like the explanations generated by human reasoners, these explanations vary in their coherence. PMID:25414655

  11. A scoping review of online repositories of quality improvement projects, interventions and initiatives in healthcare.

    Science.gov (United States)

    Bytautas, Jessica P; Gheihman, Galina; Dobrow, Mark J

    2017-04-01

    Quality improvement (QI) is becoming an important focal point for health systems. There is increasing interest among health system stakeholders to learn from and share experiences on the use of QI methods and approaches in their work. Yet there are few easily accessible, online repositories dedicated to documenting QI activity. We conducted a scoping review of publicly available, web-based QI repositories to (i) identify current approaches to sharing information on QI practices; (ii) categorise these approaches based on hosting, scope and size, content acquisition and eligibility, content format and search, and evaluation and engagement characteristics; and (iii) review evaluations of the design, usefulness and impact of their online QI practice repositories. The search strategy consisted of traditional database and grey literature searches, as well as expert consultation, with the ultimate aim of identifying and describing QI repositories of practices undertaken in a healthcare context. We identified 13 QI repositories and found substantial variation across the five categories. The QI repositories used different terminology (eg, practices vs case studies) and approaches to content acquisition, and varied in terms of primary areas of focus. All provided some means for organising content according to categories or themes and most provided at least rudimentary keyword search functionality. Notably, none of the QI repositories included evaluations of their impact. With growing interest in sharing and spreading best practices and increasing reliance on QI as a key contributor to health system performance, the role of QI repositories is likely to expand. Designing future QI repositories based on knowledge of the range and type of features available is an important starting point for improving their usefulness and impact. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. A Randomized Trial to Determine the Impact of an Educational Patient Hand-Hygiene Intervention on Contamination of Hospitalized Patient's Hands with Healthcare-Associated Pathogens.

    Science.gov (United States)

    Sunkesula, Venkata C K; Kundrapu, Sirisha; Knighton, Shanina; Cadnum, Jennifer L; Donskey, Curtis J

    2017-05-01

    We conducted a non-blinded randomized trial to determine the impact of a patient hand-hygiene intervention on contamination of hospitalized patients' hands with healthcare-associated pathogens. Among patients with negative hand cultures on admission, recovery of pathogens from hands was significantly reduced in those receiving the intervention versus those receiving standard care. Infect Control Hosp Epidemiol 2017;38:595-597.

  13. Evaluating workforce developments to support children of mentally ill parents: implementing new interventions in the adult mental healthcare in Northern Norway

    OpenAIRE

    Reedtz, Charlotte; Lauritzen, Camilla; van Doesum, Karin T M

    2012-01-01

    Background According to new Norwegian laws, mental healthcare for adults are obligated to assess all patients who are parents and to act on their children's needs. This article describes the study protocol of implementing the interventions Family Assessment and Child Talks for children of patients in the adult psychiatry of the University Hospital of Northern Norway. The project is designed to evaluate the process of changes in clinical practice due to the implementation of two interventions....

  14. Methodology in conducting a systematic review of systematic reviews of healthcare interventions.

    LENUS (Irish Health Repository)

    Smith, Valerie

    2011-02-01

    Hundreds of studies of maternity care interventions have been published, too many for most people involved in providing maternity care to identify and consider when making decisions. It became apparent that systematic reviews of individual studies were required to appraise, summarise and bring together existing studies in a single place. However, decision makers are increasingly faced by a plethora of such reviews and these are likely to be of variable quality and scope, with more than one review of important topics. Systematic reviews (or overviews) of reviews are a logical and appropriate next step, allowing the findings of separate reviews to be compared and contrasted, providing clinical decision makers with the evidence they need.

  15. Great Explanations: Opinionated Explanations for Recommendation

    OpenAIRE

    Muhammad, Khalil; Lawlor, Aonghus; Rafter, Rachael; Smyth, Barry

    2015-01-01

    Explaining recommendations helps users to make better, more satisfying decisions. We describe a novel approach to explanation for recommender systems, one that drives the recommendation process, while at the same time providing the user with useful insights into the reason why items have been chosen and the trade-os they may need to consider when making their choice. We describe this approach in the context ofa case-based recommender system that harnesses opinions mined from user-generated re...

  16. An overview of educational interventions to improve healthcare providers´ handover skills in transition of patients between health care settings

    DEFF Research Database (Denmark)

    Bøje, Rikke Buus; Ludvigsen, Mette Spliid

    2017-01-01

    OBJECTIVES: The objective of this scoping review is to identify, organize and present existing literature on training interventions on handovers for healthcare professionals to highlight the existing gaps in evidence to inform future research in this field. More specifically the objectives are to....

  17. Evaluating workforce developments to support children of mentally ill parents: implementing new interventions in the adult mental healthcare in Northern Norway

    NARCIS (Netherlands)

    Reedtz, C.; Lauritzen, C.; Doesum, K.T.M. van

    2012-01-01

    Background According to new Norwegian laws, mental healthcare for adults are obligated to assess all patients who are parents and to act on their children's needs. This article describes the study protocol of implementing the interventions Family Assessment and Child Talks for children of patients

  18. Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings.

    LENUS (Irish Health Repository)

    Murphy, Mark E

    2017-08-04

    Poorly controlled type 2 diabetes mellitus (T2DM) is a major international health problem. Our aim was to assess the effectiveness of healthcare interventions, specifically targeting patients with poorly controlled T2DM, which seek to improve glycaemic control and cardiovascular risk in primary care settings.

  19. Strategies to Overcome Barriers to Implementation of Alcohol Screening and Brief Intervention in General Practice: a Delphi Study Among Healthcare Professionals and Addiction Prevention Experts

    NARCIS (Netherlands)

    L. Abidi; A. Oenema (Anke); P. Nilsen; P.D. Anderson (Peter); H. van de Mheen (Dike)

    2016-01-01

    textabstractDespite the evidence base, alcohol screening and brief intervention (ASBI) have rarely been integrated into routine clinical practice. The aim of this study is to identify strategies that could tackle barriers to ASBI implementation in general practice by involving primary healthcare

  20. Assessing refugee healthcare needs in Europe and implementing educational interventions in primary care: a focus on methods.

    Science.gov (United States)

    Lionis, Christos; Petelos, Elena; Mechili, Enkeleint-Aggelos; Sifaki-Pistolla, Dimitra; Chatzea, Vasiliki-Eirini; Angelaki, Agapi; Rurik, Imre; Pavlic, Danica Rotar; Dowrick, Christopher; Dückers, Michel; Ajdukovic, Dean; Bakic, Helena; Jirovsky, Elena; Mayrhuber, Elisabeth Sophie; van den Muijsenbergh, Maria; Hoffmann, Kathryn

    2018-02-08

    The current political crisis, conflicts and riots in many Middle Eastern and African countries have led to massive migration waves towards Europe. European countries, receiving these migratory waves as first port of entry (POE) over the past few years, were confronted with several challenges as a result of the sheer volume of newly arriving refugees. This humanitarian refugee crisis represents the biggest displacement crisis of a generation. Although the refugee crisis created significant challenges for all national healthcare systems across Europe, limited attention has been given to the role of primary health care (PHC) to facilitate an integrated delivery of care by enhancing care provision to refugees upon arrival, on transit or even for longer periods. Evidence-based interventions, encompassing elements of patient-centredness, shared decision-making and compassionate care, could contribute to the assessment of refugee healthcare needs and to the development and the implementation of training programmes for rapid capacity-building for the needs of these vulnerable groups and in the context of integrated PHC care. This article reports on methods used for enhancing PHC for refugees through rapid capacity-building actions in the context of a structured European project under the auspices of the European Commission and funded under the 3rd Health Programme by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). The methods include the assessment of the health needs of all the people reaching Europe during the study period, and the identification, development, and testing of educational tools. The developed tools were evaluated following implementation in selected European primary care settings.

  1. Analogy, Explanation, and Proof

    Directory of Open Access Journals (Sweden)

    John eHummel

    2014-11-01

    Full Text Available People are habitual explanation generators. At its most mundane, our propensity to explain allows us to infer that we should not drink milk that smells sour; at the other extreme, it allows us to establish facts (e.g., theorems in mathematical logic whose truth was not even known prior to the existence of the explanation (proof. What do the cognitive operations underlying the (inductive inference that the milk is sour have in common with the (deductive proof that, say, the square root of two is irrational? Our ability to generate explanations bears striking similarities to our ability to make analogies. Both reflect a capacity to generate inferences and generalizations that go beyond the featural similarities between a novel problem and familiar problems in terms of which the novel problem may be understood. However, a notable difference between analogy-making and explanation-generation is that the former is a process in which a single source situation is used to reason about a single target, whereas the latter often requires the reasoner to integrate multiple sources of knowledge. This small-seeming difference poses a challenge to the task of marshaling our understanding of analogical reasoning in the service of understanding explanation. We describe a model of explanation, derived from a model of analogy, adapted to permit systematic violations of this one-to-one mapping constraint. Simulation results demonstrate that the resulting model can generate explanations for novel explananda and that, like the explanations generated by human reasoners, these explanations vary in their coherence.

  2. Tailoring and evaluating an intervention to improve shared decision-making among seniors with dementia, their caregivers, and healthcare providers: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Giguere, Anik M C; Lawani, Moulikatou Adouni; Fortier-Brochu, Émilie; Carmichael, Pierre-Hugues; Légaré, France; Kröger, Edeltraut; Witteman, Holly O; Voyer, Philippe; Caron, Danielle; Rodríguez, Charo

    2018-06-25

    The increasing prevalence of Alzheimer's disease and other forms of dementia raises new challenges to ensure that healthcare decisions are informed by research evidence and reflect what is important for seniors and their caregivers. Therefore, we aim to evaluate a tailored intervention to help healthcare providers empower seniors and their caregivers in making health-related decisions. In two phases, we will: (1) design and tailor the intervention; and (2) implement and evaluate it. We will use theory and user-centered design to tailor an intervention comprising a distance professional training program on shared decision-making and five shared decision-making tools dealing with difficult decisions often faced by seniors with dementia and their caregivers. Each tool will be designed in two versions, one for clinicians and one for patients. We will recruit 49 clinicians and 27 senior/caregiver to participate in three cycles of design-evaluation-feedback of each intervention components. Besides think-aloud and interview approaches, users will also complete questionnaires based on the Theory of Planned Behavior to identify the factors most likely to influence their adoption of shared decision-making after exposure to the intervention. We will then modify the intervention by adding/enhancing behavior-change techniques targeting these factors. We will evaluate the effectiveness of this tailored intervention before/after implementation, in a two-armed, clustered randomized trial. We will enroll a convenience sample of six primary care clinics (unit of randomization) in the province of Quebec and recruit the clinicians who practice there (mostly family physicians, nurses, and social workers). These clinics will then be randomized to immediate exposure to the intervention or delayed exposure. Overall, we will recruit 180 seniors with dementia, their caregivers, and their healthcare providers. We will evaluate the impact of the intervention on patient involvement in the

  3. The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems.

    LENUS (Irish Health Repository)

    Corrrigan, Mairead

    2006-01-01

    BACKGROUND: Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems. METHODS: In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23) and four with staff (N = 29) informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients) and 10 interviews (staff). The data were analysed using thematic analysis. RESULTS: Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising administration

  4. The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems

    Directory of Open Access Journals (Sweden)

    Leathem Claire S

    2006-07-01

    Full Text Available Abstract Background Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD. It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems. Methods In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23 and four with staff (N = 29 informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients and 10 interviews (staff. The data were analysed using thematic analysis. Results Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising

  5. The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems.

    Science.gov (United States)

    Corrrigan, Mairead; Cupples, Margaret E; Smith, Susan M; Byrne, Molly; Leathem, Claire S; Clerkin, Pauline; Murphy, Andrew W

    2006-07-18

    Developing complex interventions for testing in randomised controlled trials is of increasing importance in healthcare planning. There is a need for careful design of interventions for secondary prevention of coronary heart disease (CHD). It has been suggested that integrating qualitative research in the development of a complex intervention may contribute to optimising its design but there is limited evidence of this in practice. This study aims to examine the contribution of qualitative research in developing a complex intervention to improve the provision and uptake of secondary prevention of CHD within primary care in two different healthcare systems. In four general practices, one rural and one urban, in Northern Ireland and the Republic of Ireland, patients with CHD were purposively selected. Four focus groups with patients (N = 23) and four with staff (N = 29) informed the development of the intervention by exploring how it could be tailored and integrated with current secondary prevention activities for CHD in the two healthcare settings. Following an exploratory trial the acceptability and feasibility of the intervention were discussed in four focus groups (17 patients) and 10 interviews (staff). The data were analysed using thematic analysis. Integrating qualitative research into the development of the intervention provided depth of information about the varying impact, between the two healthcare systems, of different funding and administrative arrangements, on their provision of secondary prevention and identified similar barriers of time constraints, training needs and poor patient motivation. The findings also highlighted the importance to patients of stress management, the need for which had been underestimated by the researchers. The qualitative evaluation provided depth of detail not found in evaluation questionnaires. It highlighted how the intervention needed to be more practical by minimising administration, integrating role plays into behaviour

  6. Methodology in conducting a systematic review of systematic reviews of healthcare interventions

    LENUS (Irish Health Repository)

    Smith, Valerie

    2011-02-03

    Abstract Background Hundreds of studies of maternity care interventions have been published, too many for most people involved in providing maternity care to identify and consider when making decisions. It became apparent that systematic reviews of individual studies were required to appraise, summarise and bring together existing studies in a single place. However, decision makers are increasingly faced by a plethora of such reviews and these are likely to be of variable quality and scope, with more than one review of important topics. Systematic reviews (or overviews) of reviews are a logical and appropriate next step, allowing the findings of separate reviews to be compared and contrasted, providing clinical decision makers with the evidence they need. Methods The methods used to identify and appraise published and unpublished reviews systematically, drawing on our experiences and good practice in the conduct and reporting of systematic reviews are described. The process of identifying and appraising all published reviews allows researchers to describe the quality of this evidence base, summarise and compare the review\\'s conclusions and discuss the strength of these conclusions. Results Methodological challenges and possible solutions are described within the context of (i) sources, (ii) study selection, (iii) quality assessment (i.e. the extent of searching undertaken for the reviews, description of study selection and inclusion criteria, comparability of included studies, assessment of publication bias and assessment of heterogeneity), (iv) presentation of results, and (v) implications for practice and research. Conclusion Conducting a systematic review of reviews highlights the usefulness of bringing together a summary of reviews in one place, where there is more than one review on an important topic. The methods described here should help clinicians to review and appraise published reviews systematically, and aid evidence-based clinical decision-making.

  7. Collaborative planning approach to inform the implementation of a healthcare manager intervention for Hispanics with serious mental illness: a study protocol.

    Science.gov (United States)

    Cabassa, Leopoldo J; Druss, Benjamin; Wang, Yuanjia; Lewis-Fernández, Roberto

    2011-07-26

    This study describes a collaborative planning approach that blends principles of community-based participatory research (CBPR) and intervention mapping to modify a healthcare manager intervention to a new patient population and provider group and to assess the feasibility and acceptability of this modified intervention to improve the physical health of Hispanics with serious mental illness (SMI) and at risk for cardiovascular disease (CVD). The proposed study uses a multiphase approach that applies CBPR principles and intervention-mapping steps--an intervention-planning approach--to move from intervention planning to pilot testing. In phase I, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. Phase II uses a combination of qualitative methods--patient focus groups and stakeholder interviews--to ensure that the modifications are acceptable to all stakeholders. Phase III uses results from phase II to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase IV consists of a 12-month open pilot study (N = 30) to assess the feasibility and acceptability of the modified intervention and explore its initial effects. Lastly, phase V consists of analysis of pilot study data and preparation for future funding to develop a more rigorous evaluation of the modified intervention. The proposed study is one of the few projects to date to focus on improving the physical health of Hispanics with SMI and at risk for CVD by using a collaborative planning approach to enhance the transportability and use of a promising healthcare manager intervention. This study illustrates how blending health-disparities research and implementation science can help reduce the disproportionate burden of medical illness in a vulnerable population.

  8. Collaborative planning approach to inform the implementation of a healthcare manager intervention for hispanics with serious mental illness: a study protocol

    Directory of Open Access Journals (Sweden)

    Cabassa Leopoldo J

    2011-07-01

    Full Text Available Abstract Background This study describes a collaborative planning approach that blends principles of community-based participatory research (CBPR and intervention mapping to modify a healthcare manager intervention to a new patient population and provider group and to assess the feasibility and acceptability of this modified intervention to improve the physical health of Hispanics with serious mental illness (SMI and at risk for cardiovascular disease (CVD. Methods The proposed study uses a multiphase approach that applies CBPR principles and intervention-mapping steps--an intervention-planning approach--to move from intervention planning to pilot testing. In phase I, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. Phase II uses a combination of qualitative methods--patient focus groups and stakeholder interviews--to ensure that the modifications are acceptable to all stakeholders. Phase III uses results from phase II to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase IV consists of a 12-month open pilot study (N = 30 to assess the feasibility and acceptability of the modified intervention and explore its initial effects. Lastly, phase V consists of analysis of pilot study data and preparation for future funding to develop a more rigorous evaluation of the modified intervention. Discussion The proposed study is one of the few projects to date to focus on improving the physical health of Hispanics with SMI and at risk for CVD by using a collaborative planning approach to enhance the transportability and use of a promising healthcare manager intervention. This study illustrates how blending health-disparities research and implementation science can help reduce the disproportionate burden of medical illness in a vulnerable population.

  9. Understanding reactions to an internet-delivered health-care intervention: accommodating user preferences for information provision

    Directory of Open Access Journals (Sweden)

    Yardley Lucy

    2010-09-01

    Full Text Available Abstract Background It is recognised as good practice to use qualitative methods to elicit users' views of internet-delivered health-care interventions during their development. This paper seeks to illustrate the advantages of combining usability testing with 'theoretical modelling', i.e. analyses that relate the findings of qualitative studies during intervention development to social science theory, in order to gain deeper insights into the reasons and context for how people respond to the intervention. This paper illustrates how usability testing may be enriched by theoretical modelling by means of two qualitative studies of users' views of the delivery of information in an internet-delivered intervention to help users decide whether they needed to seek medical care for their cold or flu symptoms. Methods In Study 1, 21 participants recruited from a city in southern England were asked to 'think aloud' while viewing draft web-pages presented in paper format. In Study 2, views of our prototype website were elicited, again using think aloud methods, in a sample of 26 participants purposively sampled for diversity in education levels. Both data-sets were analysed by thematic analysis. Results Study 1 revealed that although the information provided by the draft web-pages had many of the intended empowering benefits, users often felt overwhelmed by the quantity of information. Relating these findings to theory and research on factors influencing preferences for information-seeking we hypothesised that to meet the needs of different users (especially those with lower literacy levels our website should be designed to provide only essential personalised advice, but with options to access further information. Study 2 showed that our website design did prove accessible to users with different literacy levels. However, some users seemed to want still greater control over how information was accessed. Conclusions Educational level need not be an

  10. Beyond Effectiveness: A Pragmatic Evaluation Framework for Learning and Continuous Quality Improvement of e-Learning Interventions in Healthcare.

    Science.gov (United States)

    Dafalla, Tarig Dafalla Mohamed; Kushniruk, Andre W; Borycki, Elizabeth M

    2015-01-01

    A pragmatic evaluation framework for evaluating the usability and usefulness of an e-learning intervention for a patient clinical information scheduling system is presented in this paper. The framework was conceptualized based on two different but related concepts (usability and usefulness) and selection of appropriate and valid methods of data collection and analysis that included: (1) Low-Cost Rapid Usability Engineering (LCRUE), (2) Cognitive Task Analysis (CTA), (3) Heuristic Evaluation (HE) criteria for web-based learning, and (4) Software Usability Measurement Inventory (SUMI). The results of the analysis showed some areas where usability that were related to General Interface Usability (GIU), instructional design and content was problematic; some of which might account for the poorly rated aspects of usability when subjectively measured. This paper shows that using a pragmatic framework can be a useful way, not only for measuring the usability and usefulness, but also for providing a practical objective evidences for learning and continuous quality improvement of e-learning systems. The findings should be of interest to educators, developers, designers, researchers, and usability practitioners involved in the development of e-learning systems in healthcare. This framework could be an appropriate method for assessing the usability, usefulness and safety of health information systems both in the laboratory and in the clinical context.

  11. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration

    DEFF Research Database (Denmark)

    Liberati, Alessandro; Altman, Douglas G; Tetzlaff, Jennifer

    2009-01-01

    Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value...... to clinicians, policy makers, and other users. Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews...... and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic...

  12. Interventions to increase the use of electronic health information by healthcare practitioners to improve clinical practice and patient outcomes.

    Science.gov (United States)

    Fiander, Michelle; McGowan, Jessie; Grad, Roland; Pluye, Pierre; Hannes, Karin; Labrecque, Michel; Roberts, Nia W; Salzwedel, Douglas M; Welch, Vivian; Tugwell, Peter

    2015-03-14

    There is a large volume of health information available, and, if applied in clinical practice, may contribute to effective patient care. Despite an abundance of information, sub-optimal care is common. Many factors influence practitioners' use of health information, and format (electronic or other) may be one such factor. To assess the effects of interventions aimed at improving or increasing healthcare practitioners' use of electronic health information (EHI) on professional practice and patient outcomes. We searched The Cochrane Library (Wiley), MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO), and LISA (EBSCO) up to November 2013. We contacted researchers in the field and scanned reference lists of relevant articles. We included studies that evaluated the effects of interventions to improve or increase the use of EHI by healthcare practitioners on professional practice and patient outcomes. We defined EHI as information accessed on a computer. We defined 'use' as logging into EHI. We considered any healthcare practitioner involved in patient care. We included randomized, non-randomized, and cluster randomized controlled trials (RCTs, NRCTs, CRCTs), controlled clinical trials (CCTs), interrupted time series (ITS), and controlled before-and-after studies (CBAs).The comparisons were: electronic versus printed health information; EHI on different electronic devices (e.g. desktop, laptop or tablet computers, etc.; cell / mobile phones); EHI via different user interfaces; EHI provided with or without an educational or training component; and EHI compared to no other type or source of information. Two review authors independently extracted data and assessed the risk of bias for each study. We used GRADE to assess the quality of the included studies. We reassessed previously excluded studies following our decision to define logins to EHI as a measure of professional behavior. We reported results in natural units. When possible, we calculated and reported median effect size

  13. The Motivating Function of Healthcare Professional in eHealth and mHealth Interventions for Type 2 Diabetes Patients and the Mediating Role of Patient Engagement

    Directory of Open Access Journals (Sweden)

    Guendalina Graffigna

    2016-01-01

    Full Text Available eHealth and mHealth interventions for type 2 diabetes are emerging as useful strategies to accomplish the goal of a high functioning integrated care system. However, mHealth and eHealth interventions in order to be successful need the clear endorsement from the healthcare professionals. This cross-sectional study included a sample of 93 Italian-speaking type 2 diabetes patients and demonstrated the role of the perceived ability of healthcare professionals to motivate patients’ initiative in improving the level of their engagement and activation in type 2 diabetes self-management. The level of type 2 diabetes patients’ activation resulted also in being a direct precursor of their attitude to the use of mHealth and eHealth. Furthermore, patient engagement has been demonstrated to be a mediator of the relationship between the perceived ability of healthcare professionals in motivating type 2 diabetes patients and patients’ activation. Finally, type 2 diabetes patients adherence did not result in being a direct consequence of the frequency of mHealth and eHealth use. Patient adherence appeared to be directly influenced by the level of perceived healthcare professionals ability of motivating patients’ autonomy. These results offer important insights into the psychosocial and organizational elements that impact on type 2 diabetes patients’ activation in self-management and on their willingness to use mHealth and eHealth devices.

  14. The Motivating Function of Healthcare Professional in eHealth and mHealth Interventions for Type 2 Diabetes Patients and the Mediating Role of Patient Engagement.

    Science.gov (United States)

    Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea; Menichetti, Julia

    2016-01-01

    eHealth and mHealth interventions for type 2 diabetes are emerging as useful strategies to accomplish the goal of a high functioning integrated care system. However, mHealth and eHealth interventions in order to be successful need the clear endorsement from the healthcare professionals. This cross-sectional study included a sample of 93 Italian-speaking type 2 diabetes patients and demonstrated the role of the perceived ability of healthcare professionals to motivate patients' initiative in improving the level of their engagement and activation in type 2 diabetes self-management. The level of type 2 diabetes patients' activation resulted also in being a direct precursor of their attitude to the use of mHealth and eHealth. Furthermore, patient engagement has been demonstrated to be a mediator of the relationship between the perceived ability of healthcare professionals in motivating type 2 diabetes patients and patients' activation. Finally, type 2 diabetes patients adherence did not result in being a direct consequence of the frequency of mHealth and eHealth use. Patient adherence appeared to be directly influenced by the level of perceived healthcare professionals ability of motivating patients' autonomy. These results offer important insights into the psychosocial and organizational elements that impact on type 2 diabetes patients' activation in self-management and on their willingness to use mHealth and eHealth devices.

  15. Algorithms and Their Explanations

    NARCIS (Netherlands)

    Benini, M.; Gobbo, F.; Beckmann, A.; Csuhaj-Varjú, E.; Meer, K.

    2014-01-01

    By analysing the explanation of the classical heapsort algorithm via the method of levels of abstraction mainly due to Floridi, we give a concrete and precise example of how to deal with algorithmic knowledge. To do so, we introduce a concept already implicit in the method, the ‘gradient of

  16. Promoting Early, Safe Return to Work in Injured Employees: A Randomized Trial of a Supervisor Training Intervention in a Healthcare Setting.

    Science.gov (United States)

    Spector, June T; Reul, Nicholas K

    2017-03-01

    Purpose Supervisors in the healthcare sector have the potential to contribute to disability prevention in injured employees. Published data on the evaluation of return to work (RTW) interventions aimed at direct supervisors are scarce. We sought to determine the effect of a brief audiovisual supervisor training module on supervisor RTW attitudes and knowledge. Methods A parallel-group study, using equal randomization, comparing the training module intervention to usual practice in healthcare supervisors at a quaternary care hospital was conducted. Differences between groups in changes in RTW attitude and knowledge survey question scores between baseline and 3 months were assessed using the Mann-Whitney U test. The Benjamini-Hochberg-Yekutieli procedure was used to control for false discovery rate and generate adjusted p values. Results Forty supervisors were allocated to the intervention group and 41 to the usual practice group. Attitude and knowledge scores for most questions improved between baseline and immediately after intervention administration. Comparing intervention (n = 33) and usual practice groups (n = 37), there was a trend toward greater increase between baseline and 3 months follow-up in agreement that the supervisor can manage the RTW process (U = 515, adjusted p value = 0.074) and in confidence that the supervisor can answer employees' questions (U = 514, adjusted p value = 0.074) in the intervention group, although these findings were not statistically significant. Conclusions The training intervention may have provided the initial tools for supervisors to navigate the RTW process in collaboration with others in the RTW community of practice. A larger study with longer follow-up is needed to confirm results.

  17. Human resource for health reform in peri-urban areas: a cross-sectional study of the impact of policy interventions on healthcare workers in Epworth, Zimbabwe.

    Science.gov (United States)

    Taderera, Bernard Hope; Hendricks, Stephen James Heinrich; Pillay, Yogan

    2017-12-16

    The need to understand how healthcare worker reform policy interventions impact health personnel in peri-urban areas is important as it also contributes towards setting of priorities in pursuing the universal health coverage goal of health sector reform. This study explored the impact of post 2008 human resource for health reform policy interventions on healthcare workers in Epworth, a peri-urban community in Harare, Zimbabwe, and the implications towards health sector reform policy in peri-urban areas. The study design was exploratory and cross-sectional and involved the use of qualitative and quantitative methods in data collection, presentation, and analysis. A qualitative study in which data were collected through a documentary search, five key informant interviews, seven in-depth interviews, and five focus group discussions was carried out first. This was followed by a quantitative study in which data were collected through a documentary search and 87 semi-structured sample interviews with healthcare workers. Qualitative data were analyzed thematically whilst descriptive statistics were used to examine quantitative data. All data were integrated during analysis to ensure comprehensive, reliable, and valid analysis of the dataset. Three main factors were identified to help interpret findings. The first main factor consisted policy result areas that impacted most successfully on healthcare workers. These included the deployment of community health workers with the highest correlation of 0.83. Policy result areas in the second main factor included financial incentives with a correlation of 0.79, training and development (0.77), deployment (0.77), and non-financial incentives (0.75). The third factor consisted policy result areas that had the lowest satisfaction amongst healthcare workers in Epworth. These included safety (0.72), equipment and tools of trade (0.72), health welfare (0.65), and salaries (0.55). The deployment of community health volunteers impacted

  18. DianaHealth.com, an On-Line Database Containing Appraisals of the Clinical Value and Appropriateness of Healthcare Interventions: Database Development and Retrospective Analysis.

    Science.gov (United States)

    Bonfill, Xavier; Osorio, Dimelza; Solà, Ivan; Pijoan, Jose Ignacio; Balasso, Valentina; Quintana, Maria Jesús; Puig, Teresa; Bolibar, Ignasi; Urrútia, Gerard; Zamora, Javier; Emparanza, José Ignacio; Gómez de la Cámara, Agustín; Ferreira-González, Ignacio

    2016-01-01

    To describe the development of a novel on-line database aimed to serve as a source of information concerning healthcare interventions appraised for their clinical value and appropriateness by several initiatives worldwide, and to present a retrospective analysis of the appraisals already included in the database. Database development and a retrospective analysis. The database DianaHealth.com is already on-line and it is regularly updated, independent, open access and available in English and Spanish. Initiatives are identified in medical news, in article references, and by contacting experts in the field. We include appraisals in the form of clinical recommendations, expert analyses, conclusions from systematic reviews, and original research that label any health care intervention as low-value or inappropriate. We obtain the information necessary to classify the appraisals according to type of intervention, specialties involved, publication year, authoring initiative, and key words. The database is accessible through a search engine which retrieves a list of appraisals and a link to the website where they were published. DianaHealth.com also provides a brief description of the initiatives and a section where users can report new appraisals or suggest new initiatives. From January 2014 to July 2015, the on-line database included 2940 appraisals from 22 initiatives: eleven campaigns gathering clinical recommendations from scientific societies, five sets of conclusions from literature review, three sets of recommendations from guidelines, two collections of articles on low clinical value in medical journals, and an initiative of our own. We have developed an open access on-line database of appraisals about healthcare interventions considered of low clinical value or inappropriate. DianaHealth.com could help physicians and other stakeholders make better decisions concerning patient care and healthcare systems sustainability. Future efforts should be focused on

  19. DianaHealth.com, an On-Line Database Containing Appraisals of the Clinical Value and Appropriateness of Healthcare Interventions: Database Development and Retrospective Analysis.

    Directory of Open Access Journals (Sweden)

    Xavier Bonfill

    Full Text Available To describe the development of a novel on-line database aimed to serve as a source of information concerning healthcare interventions appraised for their clinical value and appropriateness by several initiatives worldwide, and to present a retrospective analysis of the appraisals already included in the database.Database development and a retrospective analysis. The database DianaHealth.com is already on-line and it is regularly updated, independent, open access and available in English and Spanish. Initiatives are identified in medical news, in article references, and by contacting experts in the field. We include appraisals in the form of clinical recommendations, expert analyses, conclusions from systematic reviews, and original research that label any health care intervention as low-value or inappropriate. We obtain the information necessary to classify the appraisals according to type of intervention, specialties involved, publication year, authoring initiative, and key words. The database is accessible through a search engine which retrieves a list of appraisals and a link to the website where they were published. DianaHealth.com also provides a brief description of the initiatives and a section where users can report new appraisals or suggest new initiatives. From January 2014 to July 2015, the on-line database included 2940 appraisals from 22 initiatives: eleven campaigns gathering clinical recommendations from scientific societies, five sets of conclusions from literature review, three sets of recommendations from guidelines, two collections of articles on low clinical value in medical journals, and an initiative of our own.We have developed an open access on-line database of appraisals about healthcare interventions considered of low clinical value or inappropriate. DianaHealth.com could help physicians and other stakeholders make better decisions concerning patient care and healthcare systems sustainability. Future efforts should be

  20. Explanations and expectations

    DEFF Research Database (Denmark)

    Järvinen, Margaretha; Ravn, Signe

    2015-01-01

    drug use ‘aetiologies’ drawn upon by the interviewees. These cover childhood experiences, self-medication, the influence of friends and cannabis use as a specific lifestyle. A central argument of the article is that these explanations not only concern the past but also point towards the future......This article analyses how young people enrolled in drug addiction treatment in Copenhagen, Denmark, explain their cannabis careers and how they view their possibilities for quitting drug use again. Inspired by Mead and narrative studies of health and illness, the article identifies four different...

  1. The web of silence: a qualitative case study of early intervention and support for healthcare workers with mental ill-health.

    Science.gov (United States)

    Moll, Sandra E

    2014-02-08

    There is a high rate of stress and mental illness among healthcare workers, yet many continue to work despite symptoms that affect their performance. Workers with mental health issues are typically ostracized and do not get the support that they need. If issues are not addressed, however, they could become worse and compromise the health and safety, not only of the worker, but his/her colleagues and patients. Early identification and support can improve work outcomes and facilitate recovery, but more information is needed about how to facilitate this process in the context of healthcare work. The purpose of this study was to explore the key individual and organizational forces that shape early intervention and support for healthcare workers who are struggling with mental health issues, and to identify barriers and opportunities for change. A qualitative, case study in a large, urban healthcare organization was conducted in order to explore the perceptions and experiences of employees across the organization. In-depth interviews were conducted with eight healthcare workers who had experienced mental health issues at work as well as eight workplace stakeholders who interacted with workers who were struggling (managers, coworkers, union leaders). An online survey was completed by an additional 67 employees. Analysis of the interviews and surveys was guided by a process of interpretive description to identify key barriers to early intervention and support. There were many reports of silence and inaction in response to employee mental health issues. Uncertainty in identifying mental health problems, stigma regarding mental ill health, a discourse of professional competence, social tensions, workload pressures, confidentiality expectations and lack of timely access to mental health supports were key forces in preventing employees from getting the help that they needed. Although there were a few exceptions, the overall study findings point to many barriers to supporting

  2. The web of silence: a qualitative case study of early intervention and support for healthcare workers with mental ill-health

    Science.gov (United States)

    2014-01-01

    Background There is a high rate of stress and mental illness among healthcare workers, yet many continue to work despite symptoms that affect their performance. Workers with mental health issues are typically ostracized and do not get the support that they need. If issues are not addressed, however, they could become worse and compromise the health and safety, not only of the worker, but his/her colleagues and patients. Early identification and support can improve work outcomes and facilitate recovery, but more information is needed about how to facilitate this process in the context of healthcare work. The purpose of this study was to explore the key individual and organizational forces that shape early intervention and support for healthcare workers who are struggling with mental health issues, and to identify barriers and opportunities for change. Methods A qualitative, case study in a large, urban healthcare organization was conducted in order to explore the perceptions and experiences of employees across the organization. In-depth interviews were conducted with eight healthcare workers who had experienced mental health issues at work as well as eight workplace stakeholders who interacted with workers who were struggling (managers, coworkers, union leaders). An online survey was completed by an additional 67 employees. Analysis of the interviews and surveys was guided by a process of interpretive description to identify key barriers to early intervention and support. Results There were many reports of silence and inaction in response to employee mental health issues. Uncertainty in identifying mental health problems, stigma regarding mental ill health, a discourse of professional competence, social tensions, workload pressures, confidentiality expectations and lack of timely access to mental health supports were key forces in preventing employees from getting the help that they needed. Although there were a few exceptions, the overall study findings point to

  3. Constructing Scientific Explanations: a System of Analysis for Students' Explanations

    Science.gov (United States)

    de Andrade, Vanessa; Freire, Sofia; Baptista, Mónica

    2017-08-01

    This article describes a system of analysis aimed at characterizing students' scientific explanations. Science education literature and reform documents have been highlighting the importance of scientific explanations for students' conceptual understanding and for their understanding of the nature of scientific knowledge. Nevertheless, and despite general agreement regarding the potential of having students construct their own explanations, a consensual notion of scientific explanation has still not been reached. As a result, within science education literature, there are several frameworks defining scientific explanations, with different foci as well as different notions of what accounts as a good explanation. Considering this, and based on a more ample project, we developed a system of analysis to characterize students' explanations. It was conceptualized and developed based on theories and models of scientific explanations, science education literature, and from examples of students' explanations collected by an open-ended questionnaire. With this paper, it is our goal to present the system of analysis, illustrating it with specific examples of students' collected explanations. In addition, we expect to point out its adequacy and utility for analyzing and characterizing students' scientific explanations as well as for tracing their progression.

  4. Addressing the intersection between alcohol consumption and antiretroviral treatment: needs assessment and design of interventions for primary healthcare workers, the Western Cape, South Africa.

    Science.gov (United States)

    Schneider, M; Chersich, M; Temmerman, M; Parry, C D

    2016-10-26

    interviews: one face-to-face with healthcare workers at the same primary healthcare clinics from which the clinic attendees were sampled, and the other with administrators from the local government health service via email. The qualitative analysis from the primary healthcare worker interviews has been analysed using thematic content analysis. The key capacity gaps for nurses include the definition of different patterns and volumes of alcohol consumption, resultant health outcomes and how to answer patient questions on alcohol consumption while on antiretroviral treatment. Not only did the counsellors lack knowledge regarding alcohol abuse and its treatment, but they were also they were unclear on their role and rights in relation to their patients. Doctors highlighted the need for additional training for clinicians in diagnosing alcohol use disorders and information on the pharmacological interventions to treat alcoholism. Pertinent knowledge regarding patient alcohol consumption while taking ARVs needs to be disseminated to primary healthcare workers.

  5. Evaluating workforce developments to support children of mentally ill parents: implementing new interventions in the adult mental healthcare in Northern Norway.

    Science.gov (United States)

    Reedtz, Charlotte; Lauritzen, Camilla; van Doesum, Karin T M

    2012-01-01

    According to new Norwegian laws, mental healthcare for adults are obligated to assess all patients who are parents and to act on their children's needs. This article describes the study protocol of implementing the interventions Family Assessment and Child Talks for children of patients in the adult psychiatry of the University Hospital of Northern Norway. The project is designed to evaluate the process of changes in clinical practice due to the implementation of two interventions. The interventions to be implemented are a standardised Family Assessment Form and the intervention called Child Talks. The family assessment form is an intervention to identify children of mentally ill parents and their needs. The intervention Child Talks is a health-promoting and preventive intervention where the mental health workers talk with the family about the situation of the children and their needs. There are two groups of participants in this study: (1) mental health workers in the clinic (N=220) and (2) patients who are parents (N=200) receiving treatment in the clinic. (1) In the evaluation of clinical practice, the authors use a pre-test, post-test and 1-year follow-up design. At pre-test, the authors evaluate status quo among mental health workers in the clinic regarding knowledge, attitudes, collaborative routines and clinical practice related to families with parental mental illness. After the pre-test is finished, the project move on to implement the interventions Family Assessment Form and Child Talks in the clinic. At post-test and 1-year follow-up, the authors evaluate the impact of implementing the Family Assessment Form in terms of how many children were identified and offered Child Talks in the clinic or referred to other services for additional support. (2) In the evaluation of parents/patients experience with the interventions, the authors use a pre-test post-test design. To identify children of mentally ill patients, the authors collect data on demographical

  6. Hospital cultural competency as a systematic organizational intervention: Key findings from the national center for healthcare leadership diversity demonstration project.

    Science.gov (United States)

    Weech-Maldonado, Robert; Dreachslin, Janice L; Epané, Josué Patien; Gail, Judith; Gupta, Shivani; Wainio, Joyce Anne

    Cultural competency or the ongoing capacity of health care systems to provide for high-quality care to diverse patient populations (National Quality Forum, 2008) has been proposed as an organizational strategy to address disparities in quality of care, patient experience, and workforce representation. But far too many health care organizations still do not treat cultural competency as a business imperative and driver of strategy. The aim of the study was to examine the impact of a systematic, multifaceted, and organizational level cultural competency initiative on hospital performance metrics at the organizational and individual levels. This demonstration project employs a pre-post control group design. Two hospital systems participated in the study. Within each system, two hospitals were selected to serve as the intervention and control hospitals. Executive leadership (C-suite) and all staff at one general medical/surgical nursing unit at the intervention hospitals experienced a systematic, planned cultural competency intervention. Assessments and interventions focused on three organizational level competencies of cultural competency (diversity leadership, strategic human resource management, and patient cultural competency) and three individual level competencies (diversity attitudes, implicit bias, and racial/ethnic identity status). In addition, we evaluated the impact of the intervention on diversity climate and workforce diversity. Overall performance improvement was greater in each of the two intervention hospitals than in the control hospital within the same health care system. Both intervention hospitals experienced improvements in the organizational level competencies of diversity leadership and strategic human resource management. Similarly, improvements were observed in the individual level competencies for diversity attitudes and implicit bias for Blacks among the intervention hospitals. Furthermore, intervention hospitals outperformed their respective

  7. Eliciting explanations: Constraints on when self-explanation aids learning.

    Science.gov (United States)

    Rittle-Johnson, Bethany; Loehr, Abbey M

    2017-10-01

    Generating explanations for oneself in an attempt to make sense of new information (i.e., self-explanation) is often a powerful learning technique. Despite its general effectiveness, in a growing number of studies, prompting for self-explanation improved some aspects of learning, but reduced learning of other aspects. Drawing on this recent research, as well as on research comparing self-explanation under different conditions, we propose four constraints on the effectiveness of self-explanation. First, self-explanation promotes attention to particular types of information, so it is better suited to promote particular learning outcomes in particular types of domains, such as transfer in domains guided by general principles or heuristics. Second, self-explaining a variety of types of information can improve learning, but explaining one's own solution methods or choices may reduce learning under certain conditions. Third, explanation prompts focus effort on particular aspects of the to-be-learned material, potentially drawing effort away from other important information. Explanation prompts must be carefully designed to align with target learning outcomes. Fourth, prompted self-explanation often promotes learning better than unguided studying, but alternative instructional techniques may be more effective under some conditions. Attention to these constraints should optimize the effectiveness of self-explanation as an instructional technique in future research and practice.

  8. Developing and evaluating the implementation of a complex intervention: using mixed methods to inform the design of a randomised controlled trial of an oral healthcare intervention after stroke

    OpenAIRE

    Brady, Marian C; Stott, David J; Norrie, John; Chalmers, Campbell; St George, Bridget; Sweeney, Petrina M; Langhorne, Peter

    2011-01-01

    Abstract Background Many interventions delivered within the stroke rehabilitation setting could be considered complex, though some are more complex than others. The degree of complexity might be based on the number of and interactions between levels, components and actions targeted within the intervention. The number of (and variation within) participant groups and the contexts in which it is delivered might also reflect the extent of complexity. Similarly, designing the evaluation of a compl...

  9. Interventions to increase recommendation and delivery of screening for breast, cervical, and colorectal cancers by healthcare providers systematic reviews of provider assessment and feedback and provider incentives.

    Science.gov (United States)

    Sabatino, Susan A; Habarta, Nancy; Baron, Roy C; Coates, Ralph J; Rimer, Barbara K; Kerner, Jon; Coughlin, Steven S; Kalra, Geetika P; Chattopadhyay, Sajal

    2008-07-01

    Most major medical organizations recommend routine screening for breast, cervical, and colorectal cancers. Screening can lead to early detection of these cancers, resulting in reduced mortality. Yet not all people who should be screened are screened, either regularly or, in some cases, ever. This report presents results of systematic reviews of effectiveness, applicability, economic efficiency, barriers to implementation, and other harms or benefits of two provider-directed intervention approaches to increase screening for breast, cervical, and colorectal cancers. These approaches, provider assessment and feedback, and provider incentives encourage providers to deliver screening services at appropriate intervals. Evidence in these reviews indicates that provider assessment and feedback interventions can effectively increase screening by mammography, Pap test, and fecal occult blood test. Health plans, healthcare systems, and cancer control coalitions should consider such evidence-based findings when implementing interventions to increase screening use. Evidence was insufficient to determine the effectiveness of provider incentives in increasing use of any of these tests. Specific areas for further research are suggested in this report, including the need for additional research to determine whether provider incentives are effective in increasing use of any of these screening tests, and whether assessment and feedback interventions are effective in increasing other tests for colorectal cancer (i.e., flexible sigmoidoscopy, colonoscopy, or double-contrast barium enema).

  10. Interventions for healthcare professionals, organizations and patients to enhance quality of life for people diagnosed with palliative esophagogastric cancer: a systematic review.

    Science.gov (United States)

    Cowley, Alison; Bath-Hextall, Fiona; Cooper, Joanne

    2017-03-01

    Esophagogastric (EG) cancer is the fifth most common malignancy, and its incidence is increasing. The disease is fast paced, and five-year survival rates are poor. Treatment with palliative intent is provided for the majority of patients but there remains a lack of empirical evidence into the most effective service models to support EG cancer patients. The overall objective of this quantitative systematic review was to establish best practice in relation to interventions targeted at healthcare professionals or the structures in which healthcare professionals deliver care (i.e. models of care and practice) and patients (diagnosed with palliative EG cancer) to enhance the quality of life for people diagnosed with palliative EG cancer. The current review considered studies that included patients diagnosed with palliative EG cancer and any health professionals involved in the delivery of palliative care to this patient group in a hospital, home or community setting. The current review considered studies that evaluated any intervention or combination of intervention strategies aimed at healthcare professionals, organizations or patients to improve quality of life for people diagnosed with palliative EG cancer. The current review considered both experimental and epidemiological study designs. Studies were excluded that evaluated: screening programs, pharmacology alone, palliative oncology and palliative endoscopy. The primary outcome measure was objectively measured quality of life. A three-step search strategy was utilized. Sixteen databases were searched for papers from the year 2000 onward and followed by hand searching of reference lists. Methodological quality was not assessed as no articles were found that met the inclusion criteria. Data extraction was not possible as no articles were found that met the inclusion criteria. It was not possible to complete data synthesis as no articles were found that met the inclusion criteria. Comprehensive searching and study

  11. Constructions and experiences of motherhood in the context of an early intervention for Aboriginal mothers and their children: mother and healthcare worker perspectives.

    Science.gov (United States)

    Ussher, Jane M; Charter, Rosie; Parton, Chloe; Perz, Janette

    2016-07-22

    The colonisation of Australia has been associated with traumatic consequences for Aboriginal health and wellbeing, including the breakdown of the traditional family unit and negative consequences for the mother/child relationship. Early-intervention programs have been developed to assist families to overcome disadvantage and strengthen mother/child attachment. However, there is no research examining Aboriginal women's subjective experiences and constructions of motherhood in the context of such programs, and no research on the perceived impact of such programs, from the perspective of Aboriginal mothers and healthcare workers (HCWs), with previous research focusing on child outcomes. Researchers conducted participant observation of an early intervention program for Aboriginal mothers and young children over a 6 month period, one-to-one interviews and a focus group with 10 mothers, and interviews with nine HCWs, in order to examine their perspectives on motherhood and the intervention program. Thematic analysis identified 2 major themes under which subthemes were clustered. Constructions of motherhood: 'The resilient mother: Coping with life trauma and social stress' and 'The good mother: Transformation of self through motherhood'; Perspectives on the intervention: '"Mothers come to life": Transformation through therapy'; and '"I know I'm a good mum": The need for connections, skills and time for self'. The mothers constructed themselves as being resilient 'good mothers', whilst also acknowledging their own traumatic life experiences, predominantly valuing the peer support and time-out aspects of the program. HCWs positioned the mothers as 'traumatised', yet also strong, and expressed the view that in order to improve mother/child attachment a therapeutic transformation is required. These results suggest that early interventions for Aboriginal mothers should acknowledge and strengthen constructions of the good and resilient mother. The differing perspectives of

  12. Creating visual explanations improves learning.

    Science.gov (United States)

    Bobek, Eliza; Tversky, Barbara

    2016-01-01

    Many topics in science are notoriously difficult for students to learn. Mechanisms and processes outside student experience present particular challenges. While instruction typically involves visualizations, students usually explain in words. Because visual explanations can show parts and processes of complex systems directly, creating them should have benefits beyond creating verbal explanations. We compared learning from creating visual or verbal explanations for two STEM domains, a mechanical system (bicycle pump) and a chemical system (bonding). Both kinds of explanations were analyzed for content and learning assess by a post-test. For the mechanical system, creating a visual explanation increased understanding particularly for participants of low spatial ability. For the chemical system, creating both visual and verbal explanations improved learning without new teaching. Creating a visual explanation was superior and benefitted participants of both high and low spatial ability. Visual explanations often included crucial yet invisible features. The greater effectiveness of visual explanations appears attributable to the checks they provide for completeness and coherence as well as to their roles as platforms for inference. The benefits should generalize to other domains like the social sciences, history, and archeology where important information can be visualized. Together, the findings provide support for the use of learner-generated visual explanations as a powerful learning tool.

  13. Strengthening the decentralised healthcare system in rural South Africa through improved service delivery: testing mobility, information and communication technology intervention options

    CSIR Research Space (South Africa)

    Chakwizira, J

    2010-09-01

    Full Text Available their own human resources in providing healthcare services that ultimately counteract these inequalities. Presently, what could be considered the last level of decentralised healthcare is mostly represented by home and community-based healthcare...

  14. Effectiveness of a motivational intervention on overweight/obese patients in the primary healthcare: a cluster randomized trial.

    Science.gov (United States)

    Rodriguez-Cristobal, Juan Jose; Alonso-Villaverde, Carlos; Panisello, Jose Ma; Travé-Mercade, Pere; Rodriguez-Cortés, Francisca; Marsal, Josep Ramon; Peña, Esther

    2017-06-20

    Overweight and obesity are common health problems which increase the risk of developing several serious health conditions. The main difficulty in the management of weight-loss lies in its maintenance, once it is achieved. The aim of this study was to investigate whether a motivational intervention, together with current clinical practice, was more efficient than a traditional intervention, in the treatment of overweight and obesity and whether this intervention reduces cardiovascular risk factors associated with overweight and obesity. Multi-centre cluster randomized trial with a 24-month follow-up included 864 overweight/obese patients randomly assigned. Motivational intervention group (400 patients), delivered by a nurse trained by an expert psychologist, in 32 sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard programmed diet and exercise. The control group (446 patients), received the usual follow-up. Weight reduction was statistically significant in the second year with a mean reduction of 1.0 Kg in the control group and 2.5 Kg in the intervention group (p = 0. 02). While 18.1% of patients in the control group reduced their weight by more than 5%, this percentage rose to 26.9% in the intervention group, which is statistically significant (p = 0.04). Patients in the motivational intervention group had significantly greater improvements in triglycerides and APOB/APOA1ratio. The results highlight the importance of the group motivational interview in the treatment of overweight /obese patients in primary care, and in the improvement of their associated cardiovascular risks factors. ClinicalTrials.gov Identifier: NCT01006213 October 30, 2009.

  15. Explanation components as interactive tools

    Energy Technology Data Exchange (ETDEWEB)

    Wahlster, W.

    1983-01-01

    The ability to explain itself is probably the most important criterion of the user-friendliness of interactive systems. Explanation aids in the form of simple help functions do not meet this criterion. The reasons for this are outlined. More promising is an explanation component which can give the user intelligible and context-oriented explanations. The essential requirement for this is the development of knowledge-based interactive systems using artificial intelligence methods and techniques. The authors report on experiences with the development of explanation components, in particular a number of examples from the HAM-ANS project. 12 references.

  16. Recent trends in working with the private sector to improve basic healthcare: a review of evidence and interventions.

    Science.gov (United States)

    Montagu, Dominic; Goodman, Catherine; Berman, Peter; Penn, Amy; Visconti, Adam

    2016-10-01

    The private sector provides the majority of health care in Africa and Asia. A number of interventions have, for many years, applied different models of subsidy, support and engagement to address social and efficiency failures in private health care markets. We have conducted a review of these models, and the evidence in support of them, to better understand what interventions are currently common, and to what extent practice is based on evidence. Using established typologies, we examined five models of intervention with private markets for care: commodity social marketing, social franchising, contracting, accreditation and vouchers. We conducted a systematic review of both published and grey literature, identifying programmes large enough to be cited in publications, and studies of the listed intervention types. 343 studies were included in the review, including both published and grey literature. Three hundred and eighty programmes were identified, the earliest having begun operation in 1955. Commodity social marketing programmes were the most common intervention type, with 110 documented programmes operating for condoms alone at the highest period. Existing evidence shows that these models can improve access and utilization, and possibly quality, but for all programme types, the overall evidence base remains weak, with practice in private sector engagement consistently moving in advance of evidence. Future research should address key questions concerning the impact of interventions on the market as a whole, the distribution of benefits by socio-economic status, the potential for scale up and sustainability, cost-effectiveness compared to relevant alternatives and the risk of unintended consequences. Alongside better data, a stronger conceptual basis linking programme design and outcomes to context is also required. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Effect of a group intervention in the primary healthcare setting on continuing adherence to physical exercise routines in obese women.

    Science.gov (United States)

    del Rey-Moya, Luz Maria; Castilla-Álvarez, Carmen; Pichiule-Castañeda, Myrian; Rico-Blázquez, Milagros; Escortell-Mayor, Esperanza; Gómez-Quevedo, Rosa

    2013-08-01

    To determine the effect of a seven-week-long, group-delivered, nurse-monitored, exercise training programme on the adherence of obese women to physical exercise routines at 12 months. The worldwide obesity epidemic is posing huge public health challenges. The main cause of obesity in Europe is very possibly a sedentary lifestyle. Uncertainty exists regarding whether people will continue to exercise once a structured intervention programme of physical activity ends. No-control-group (before-after) intervention study. One Hundred Seventy-Four women from the Madrid region (Spain) aged ≥ 45 years with a body mass index of ≥30 undertook a maximum of 21 × 1 hour exercise training programme sessions (three per week) over seven weeks starting in February 2009. The number of women making use of exercise training programme before the intervention, and at 6 and 12 months postintervention, was recorded using the Nursing Outcome Classification. Information was collected by interviewing the study subjects. Bivariate (McNemar and Student's t-tests) and multivariate (binary logistic regression) analyses were then performed. The Nursing Outcome Classification Indicator 'Does the subject follow an exercise training programme?' showed that at the end of one year, the percentage of women who remained adhered to exercise training programme increased in those who completed the study (from 11-41%). As the number of programmed exercise training programme sessions completed increased beyond 14, so too did the likelihood of adhering to an exercise training programme regime at one year. The results show that an exercise training programme intervention can encourage obese women to continue exercising after exercise interventions end. This type of intervention could provide a valuable means of helping women lose weight and improve their health. It may also have important economic benefits for health systems. Clinical trials with longer follow-up times and in other populations are needed

  18. Group motivational intervention in overweight/obese patients in primary prevention of cardiovascular disease in the primary healthcare area.

    Science.gov (United States)

    Rodríguez Cristóbal, Juan José; Panisello Royo, Josefa Ma; Alonso-Villaverde Grote, Carlos; Pérez Santos, José Ma; Muñoz Lloret, Anna; Rodríguez Cortés, Francisca; Travé Mercadé, Pere; Benavides Márquez, Francisca; Martí de la Morena, Pilar; González Burgillos, Ma José; Delclós Baulies, Marta; Bleda Fernández, Domingo; Quillama Torres, Elida

    2010-03-18

    The global mortality caused by cardiovascular disease increases with weight. The Framingham study showed that obesity is a cardiovascular risk factor independent of other risks such as type 2 diabetes mellitus, dyslipidemia and smoking. Moreover, the main problem in the management of weight-loss is its maintenance, if it is achieved. We have designed a study to determine whether a group motivational intervention, together with current clinical practice, is more efficient than the latter alone in the treatment of overweight and obesity, for initial weight loss and essentially to achieve maintenance of the weight achieved; and, secondly, to know if this intervention is more effective for reducing cardiovascular risk factors associated with overweight and obesity. This 26-month follow up multi-centre trial, will include 1200 overweight/obese patients. Random assignment of the intervention by Basic Health Areas (BHA): two geographically separate groups have been created, one of which receives group motivational intervention (group intervention), delivered by a nurse trained by an expert phsychologist, in 32 group sessions, 1 to 12 fortnightly, and 13 to 32, monthly, on top of their standard program of diet, exercise, and the other (control group), receiving the usual follow up, with regular visits every 3 months. By addressing currently unanswered questions regarding the maintenance in weight loss in obesity/overweight, upon the expected completion of participant follow-up in 2012, the IMOAP trial should document, for the first time, the benefits of a motivational intervention as a treatment tool of weight loss in a primary care setting. ClinicalTrials.gov Identifier: NCT01006213.

  19. Explanation and inference: Mechanistic and functional explanations guide property generalization

    Directory of Open Access Journals (Sweden)

    Tania eLombrozo

    2014-09-01

    Full Text Available The ability to generalize from the known to the unknown is central to learning and inference. Two experiments explore the relationship between how a property is explained and how that property is generalized to novel species and artifacts. The experiments contrast the consequences of explaining a property mechanistically, by appeal to parts and processes, with the consequences of explaining the property functionally, by appeal to functions and goals. The findings suggest that properties that are explained functionally are more likely to be generalized on the basis of shared functions, with a weaker relationship between mechanistic explanations and generalization on the basis of shared parts and processes. The influence of explanation type on generalization holds even though all participants are provided with the same mechanistic and functional information, and whether an explanation type is freely generated (Experiment 1, experimentally provided (Experiment 2, or experimentally induced (Experiment 2. The experiments also demonstrate that explanations and generalizations of a particular type (mechanistic or functional can be experimentally induced by providing sample explanations of that type, with a comparable effect when the sample explanations come from the same domain or from a different domains. These results suggest that explanations serve as a guide to generalization, and contribute to a growing body of work supporting the value of distinguishing mechanistic and functional explanations.

  20. Explanation and inference: mechanistic and functional explanations guide property generalization.

    Science.gov (United States)

    Lombrozo, Tania; Gwynne, Nicholas Z

    2014-01-01

    The ability to generalize from the known to the unknown is central to learning and inference. Two experiments explore the relationship between how a property is explained and how that property is generalized to novel species and artifacts. The experiments contrast the consequences of explaining a property mechanistically, by appeal to parts and processes, with the consequences of explaining the property functionally, by appeal to functions and goals. The findings suggest that properties that are explained functionally are more likely to be generalized on the basis of shared functions, with a weaker relationship between mechanistic explanations and generalization on the basis of shared parts and processes. The influence of explanation type on generalization holds even though all participants are provided with the same mechanistic and functional information, and whether an explanation type is freely generated (Experiment 1), experimentally provided (Experiment 2), or experimentally induced (Experiment 2). The experiments also demonstrate that explanations and generalizations of a particular type (mechanistic or functional) can be experimentally induced by providing sample explanations of that type, with a comparable effect when the sample explanations come from the same domain or from a different domains. These results suggest that explanations serve as a guide to generalization, and contribute to a growing body of work supporting the value of distinguishing mechanistic and functional explanations.

  1. The value of intermittent point-prevalence surveys of healthcare-associated infections for evaluating infection control interventions at Angkor Hospital for Children, Siem Reap, Cambodia.

    Science.gov (United States)

    Stoesser, N; Emary, K; Soklin, S; Peng An, K; Sophal, S; Chhomrath, S; Day, N P J; Limmathurotsakul, D; Nget, P; Pangnarith, Y; Sona, S; Kumar, V; Moore, C E; Chanpheaktra, N; Parry, C M

    2013-04-01

    There are limited data on the epidemiology of paediatric healthcare-associated infection (HCAI) and infection control in low-income countries. We describe the value of intermittent point-prevalence surveys for monitoring HCAI and evaluating infection control interventions in a Cambodian paediatric hospital. Hospital-wide, point-prevalence surveys were performed monthly in 2011. Infection control interventions introduced during this period included a hand hygiene programme and a ventilator-associated pneumonia (VAP) care bundle. Overall HCAI prevalence was 13.8/100 patients at-risk, with a significant decline over time. The highest HCAI rates (50%) were observed in critical care; the majority of HCAIs were respiratory (61%). Klebsiella pneumoniae was most commonly isolated and antimicrobial resistance was widespread. Hand hygiene compliance doubled to 51.6%, and total VAP cases/1000 patient-ventilator days fell from 30 to 10. Rates of HCAI were substantial in our institution, and antimicrobial resistance a major concern. Point-prevalence surveys are effective for HCAI surveillance, and in monitoring trends in response to infection control interventions.

  2. Effect and maintenance of the SLIMMER diabetes prevention lifestyle intervention in Dutch primary healthcare: a randomised controlled trial

    NARCIS (Netherlands)

    Duijzer, G.; Haveman-Nies, A.; Jansen, S.C.; Beek, van J.; Bruggen, van Rykel; Willink, M.; Hiddink, G.J.; Feskens, E.J.M.

    2017-01-01

    Background/Objectives: To assess the effectiveness of the SLIMMER combined dietary and physical activity lifestyle intervention on clinical and metabolic risk factors, dietary intake, physical activity, and quality of life after 12 months, and to investigate whether effects sustained six months

  3. Evaluation of a theory-driven e-learning intervention for future oral healthcare providers on secondary prevention of disordered eating behaviors.

    Science.gov (United States)

    DeBate, Rita D; Severson, Herbert H; Cragun, Deborah L; Gau, Jeff M; Merrell, Laura K; Bleck, Jennifer R; Christiansen, Steve; Koerber, Anne; Tomar, Scott L; McCormack Brown, Kelli R; Tedesco, Lisa A; Hendricson, William

    2013-06-01

    Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning can supplement and reinforce traditional learning and has the potential to develop skills. The study purpose was to determine the efficacy of a theory-driven Web-based training program to increase the capacity of oral health students to perform behaviors related to the secondary prevention of disordered eating behaviors. Using the Reach, Effectiveness, Adoption, Implementation and Maintenance evaluation framework, a longitudinal group-randomized controlled trial involving 27 oral health classes from 12 oral health education programs in the United States was implemented to assess the efficacy of the Web-based training on attitudes, knowledge, self-efficacy and skills related to the secondary prevention of disordered eating behaviors. Mixed-model analysis of covariance indicated substantial improvements among students in the intervention group (effect sizes: 0.51-0.83) on all six outcomes of interest. Results suggest that the Web-based training program may increase the capacity of oral healthcare providers to deliver secondary prevention of disordered eating behaviors. Implications and value of using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework are discussed.

  4. Automated Explanation for Educational Applications.

    Science.gov (United States)

    Suthers, Daniel D.

    1991-01-01

    Artificial intelligence techniques available for generating explanations for teaching purposes are surveyed, and the way in which they are combined in a computer program that provides explanations is described. The program responds to questions in the physical sciences. Potential contributions of this technology to computer-based education are…

  5. Healthcare system intervention for prevention of birth injuries – process evaluation of self-assessment, peer review, feedback and agreement for change

    Science.gov (United States)

    2012-01-01

    Background Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors’ mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased. Methods Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change. Results The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions). The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change. Conclusions Our findings are in line with several studies stressing the importance of self-evaluation by encouraging a thorough review of

  6. Healthcare system intervention for prevention of birth injuries – process evaluation of self-assessment, peer review, feedback and agreement for change

    Directory of Open Access Journals (Sweden)

    Nyström Monica E

    2012-08-01

    Full Text Available Abstract Background Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors’ mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased. Methods Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change. Results The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions. The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change. Conclusions Our findings are in line with several studies stressing the importance of self-evaluation by

  7. Health promotion interventions and policies addressing excessive alcohol use: a systematic review of national and global evidence as a guide to health-care reform in China.

    Science.gov (United States)

    Li, Qing; Babor, Thomas F; Zeigler, Donald; Xuan, Ziming; Morisky, Donald; Hovell, Melbourne F; Nelson, Toben F; Shen, Weixing; Li, Bing

    2015-01-01

    Steady increases in alcohol consumption and related problems are likely to accompany China's rapid epidemiological transition and profit-based marketing activities. We reviewed research on health promotion interventions and policies to address excessive drinking and to guide health-care reform. We searched Chinese- and English-language databases and included 21 studies in China published between 1980 and 2013 that covered each policy area from the World Health Organization (WHO) Global Strategy to Reduce the Harmful Use of Alcohol. We evaluated and compared preventive interventions to the global alcohol literature for cross-national applicability. In contrast with hundreds of studies in the global literature, 11 of 12 studies from mainland China were published in Chinese; six of 10 in English were on taxation from Taiwan or Hong Kong. Most studies demonstrated effectiveness in reducing excessive drinking, and some reported the reduction of health problems. Seven were randomized controlled trials. Studies targeted schools, drink-driving, work-places, the health sector and taxation. China is the world's largest alcohol market, yet there has been little growth in alcohol policy research related to health promotion interventions over the past decade. Guided by a public health approach, the WHO Global Strategy and health reform experience in Russia, Australia, Mexico and the United States, China could improve its public health response through better coordination and implementation of surveillance and evidence-based research, and through programmatic and legal responses such as public health law research, screening and early intervention within health systems and the implementation of effective alcohol control strategies. © 2014 Society for the Study of Addiction.

  8. Disaster healthcare system management and crisis intervention leadership in Thailand--lessons learned from the 2004 Tsunami disaster.

    Science.gov (United States)

    Peltz, Rami; Ashkenazi, Issac; Schwartz, Dagan; Shushan, Ofer; Nakash, Guy; Leiba, Adi; Levi, Yeheskel; Goldberg, Avishay; Bar-Dayan, Yaron

    2006-01-01

    Quarantelli established criteria for evaluating the effectiveness of disaster management. The objectives of this study were to analyze the response of the healthcare system to the Tsunami disaster according to the Quarantelli principles, and to validate these principles in a scenario of a disaster due to natural hazards. The Israeli Defense Forces (IDF) Home Front Command Medical Department sent a research team to study the response of the Thai medical system to the disaster. The analysis of the disaster management was based on Quarantelli's 10 criteria for evaluating the management of community disasters. Data were collected through personal and group interviews. The three most important elements for effective disaster management were: (1) the flow of information; (2) overall coordination; and (3) leadership. Although pre-event preparedness was for different and smaller scenarios, medical teams repeatedly reported a better performance in hospitals that recently conducted drills. In order to increase effectiveness, disaster management response should focus on: (1) the flow of information; (2) overall coordination; and (3) leadership.

  9. Constructions and experiences of motherhood in the context of an early intervention for Aboriginal mothers and their children: mother and healthcare worker perspectives

    Directory of Open Access Journals (Sweden)

    Jane M. Ussher

    2016-07-01

    Full Text Available Abstract Background The colonisation of Australia has been associated with traumatic consequences for Aboriginal health and wellbeing, including the breakdown of the traditional family unit and negative consequences for the mother/child relationship. Early-intervention programs have been developed to assist families to overcome disadvantage and strengthen mother/child attachment. However, there is no research examining Aboriginal women’s subjective experiences and constructions of motherhood in the context of such programs, and no research on the perceived impact of such programs, from the perspective of Aboriginal mothers and healthcare workers (HCWs, with previous research focusing on child outcomes. Method Researchers conducted participant observation of an early intervention program for Aboriginal mothers and young children over a 6 month period, one-to-one interviews and a focus group with 10 mothers, and interviews with nine HCWs, in order to examine their perspectives on motherhood and the intervention program. Results Thematic analysis identified 2 major themes under which subthemes were clustered. Constructions of motherhood: ‘The resilient mother: Coping with life trauma and social stress’ and ‘The good mother: Transformation of self through motherhood’; Perspectives on the intervention: ‘“Mothers come to life”: Transformation through therapy’; and ‘“I know I’m a good mum”: The need for connections, skills and time for self’. Conclusions The mothers constructed themselves as being resilient ‘good mothers’, whilst also acknowledging their own traumatic life experiences, predominantly valuing the peer support and time-out aspects of the program. HCWs positioned the mothers as ‘traumatised’, yet also strong, and expressed the view that in order to improve mother/child attachment a therapeutic transformation is required. These results suggest that early interventions for Aboriginal mothers should

  10. A successful strategy for increasing the influenza vaccination rate of healthcare workers without a mandatory policy outside of the United States: a multifaceted intervention in a Japanese tertiary care center.

    Science.gov (United States)

    Honda, Hitoshi; Sato, Yumiko; Yamazaki, Akinori; Padival, Simi; Kumagai, Akira; Babcock, Hilary

    2013-11-01

    Although mandatory vaccination programs have been effective in improving the vaccination rate among healthcare workers, implementing this type of program can be challenging because of varied reasons for vaccine refusal. The purpose of our study is to measure improvement in the influenza vaccination rate from a multifaceted intervention at a Japanese tertiary care center where implementing a mandatory vaccination program is difficult. Before-and-after trial. Healthcare workers at a 550-bed, tertiary care, academic medical center in Sapporo, Japan. We performed a multifaceted intervention including (1) use of a declination form, (2) free vaccination, (3) hospital-wide announcements during the vaccination period, (4) prospective audit and real-time telephone interview for healthcare workers who did not receive the vaccine, (5) medical interview with the hospital executive for noncompliant (no vaccine, no declination form) healthcare workers during the vaccination period, and (6) mandatory submission of a vaccination document if vaccinated outside of the study institution. With the new multifaceted intervention, the vaccination rate in the 2012-2013 season increased substantially, up to 97%. This rate is similar to that reported in studies with a mandatory vaccination program. Improved vaccination acceptance, particularly among physicians, likely contributed to the overall increase in the vaccination rate reported in the study. Implementation of comprehensive strategies with strong leadership can lead to substantial improvements in vaccine uptake among healthcare workers even without a mandatory vaccination policy. The concept is especially important for institutions where implementing mandatory vaccination programs is challenging.

  11. Impact of the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention on adherence to national obesity clinical practice guidelines in a primary care centre.

    Science.gov (United States)

    Barnes, Emily R; Theeke, Laurie A; Mallow, Jennifer

    2015-04-01

    Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits. © 2015 John Wiley & Sons, Ltd.

  12. Valuing inter-sectoral costs and benefits of interventions in the healthcare sector: methods for obtaining unit prices.

    Science.gov (United States)

    Drost, Ruben M W A; Paulus, Aggie T G; Ruwaard, Dirk; Evers, Silvia M A A

    2017-02-01

    There is a lack of knowledge about methods for valuing health intervention-related costs and monetary benefits in the education and criminal justice sectors, also known as 'inter-sectoral costs and benefits' (ICBs). The objective of this study was to develop methods for obtaining unit prices for the valuation of ICBs. By conducting an exploratory literature study and expert interviews, several generic methods were developed. The methods' feasibility was assessed through application in the Netherlands. Results were validated in an expert meeting, which was attended by policy makers, public health experts, health economists and HTA-experts, and discussed at several international conferences and symposia. The study resulted in four methods, including the opportunity cost method (A) and valuation using available unit prices (B), self-constructed unit prices (C) or hourly labor costs (D). The methods developed can be used internationally and are valuable for the broad international field of HTA.

  13. Improving opioid safety practices in primary care: protocol for the development and evaluation of a multifaceted, theory-informed pilot intervention for healthcare providers

    Science.gov (United States)

    Leece, Pamela; Buchman, Daniel Z; Hamilton, Michael; Timmings, Caitlyn; Shantharam, Yalnee; Moore, Julia; Furlan, Andrea D

    2017-01-01

    Introduction In North America, drug overdose deaths are reaching unprecedented levels, largely driven by increasing prescription opioid-related deaths. Despite the development of several opioid guidelines, prescribing behaviours still contribute to poor patient outcomes and societal harm. Factors at the provider and system level may hinder or facilitate the application of evidence-based guidelines; interventions designed to address such factors are needed. Methods and analysis Using implementation science and behaviour change theory, we have planned the development and evaluation of a comprehensive Opioid Self-Assessment Package, designed to increase adherence to the Canadian Opioid Guideline among family physicians. The intervention uses practical educational and self-assessment tools to provide prescribers with feedback on their current knowledge and practices, and resources to improve their practice. The evaluation approach uses a pretest and post-test design and includes both quantitative and qualitative methods at baseline and 6 months. We will recruit a purposive sample of approximately 10 family physicians in Ontario from diverse practice settings, who currently treat patients with long-term opioid therapy for chronic pain. Quantitative data will be analysed using basic descriptive statistics, and qualitative data will be analysed using the Framework Method. Ethics and dissemination The University Health Network Research Ethics Board approved this study. Dissemination plan includes publications, conference presentations and brief stakeholder reports. This evidence-informed, theory-driven intervention has implications for national application of opioid quality improvement tools in primary care settings. We are engaging experts and end users in advisory and stakeholder roles throughout our project to increase its national relevance, application and sustainability. The performance measures could be used as the basis for health system quality improvement

  14. Survival outcomes post percutaneous coronary intervention: Why the hype about stent type? Lessons from a healthcare system in India.

    Directory of Open Access Journals (Sweden)

    Bhanu Duggal

    Full Text Available A prospective, multicenter study was initiated by the Government of Maharashtra, India, to determine predictors of long-term outcomes of percutaneous coronary intervention (PCI for coronary artery disease, and to compare the effectiveness of drug-eluting stents (DESs and bare-metal stents (BMSs in patients undergoing PCI under government-funded insurance. The present analysis included 4595 patients managed between August 2012 and November 2016 at any of 110 participating centers. Using the classical multivariable regression and propensity-matching approach, we found age to be the most important predictor of 1-year mortality and target lesion revascularization at 1 year post-PCI. However, using machine learning methods to account for unmeasured confounders and bias in this large observational study, we determined total stent length and number of stents deployed as the most important predictors of 1-year survival, followed by age and employment status. The unadjusted death rates were 5.0% and 3.8% for the BMS and DES groups, respectively (p = 0.185, log-rank test. The rate of re-hospitalization (p<0.001 and recurrence of unstable angina (p = 0.08 was significantly lower for DESs than for BMSs. Increased use of DES after 2015 (following establishment of a price cap on DESs was associated with a sharp decrease in adjusted hazard ratios of DESs versus BMSs (from 0.94 in 2013 to 0.58 in 2016, suggesting that high price was limiting DES use in some high-risk patients. Since stented length and stent number were the most important predictors of survival outcomes, adopting an ischemia-guided revascularization strategy is expected to help improve outcomes and reduce procedural costs. In the elderly, PCI should be reserved for cases where the benefits outweigh the higher risk of the procedure. As unemployed patients had poorer long-term outcomes, we expect that implementation of a post-PCI cardiovascular rehabilitation program may improve long-term outcomes.

  15. The Hand Eczema Trial (HET): Design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema

    DEFF Research Database (Denmark)

    Ibler, Kristina Sophie; Agner, Tove; Hansen, Jane L.

    2010-01-01

    strategies are needed to reduce occupational hand eczema. METHODS/DESIGN: We describe the design of a randomised clinical trial to investigate the effects of classification of hand eczema plus individual counselling versus no intervention. The trial includes health-care workers with hand eczema identified...... from a self-administered questionnaire delivered to 3181 health-care workers in three Danish hospitals. The questionnaire identifies the prevalence of hand eczema, knowledge of skin-protection, and exposures that can lead to hand eczema. At entry, all participants are assessed regarding: disease...

  16. WPPSS debacle: explanations and lessons

    International Nuclear Information System (INIS)

    Meyer, M.B.

    1984-01-01

    Principal explanations for the WPPSS events to date can be more or less satisfactorily derived. Five explanations appear to dominate: (1) the long and previously successful history of public power in the Pacific Northwest; (2) overoptimism by architect/engineers and consulting engineers about construction costs and construction durations; (3) laxness by bond counsel in scrutinizing and disclosing potential legal impediments to the various transactions involved; (4) WPPSS easy access to capital markets, combined with naivete in those markets; and (5) the inability of WPPSS to manage and oversee the construction process. This paper explains the specific reasons for, and the importance of, each of these five explanations for the WPPSS debacle. It then develops lessons and conclusions for the future which can be derived from this debacle. 12 references

  17. Evolutionary Explanations of Eating Disorders

    Directory of Open Access Journals (Sweden)

    Igor Kardum

    2008-12-01

    Full Text Available This article reviews several most important evolutionary mechanisms that underlie eating disorders. The first part clarifies evolutionary foundations of mental disorders and various mechanisms leading to their development. In the second part selective pressures and evolved adaptations causing contemporary epidemic of obesity as well as differences in dietary regimes and life-style between modern humans and their ancestors are described. Concerning eating disorders, a number of current evolutionary explanations of anorexia nervosa are presented together with their main weaknesses. Evolutionary explanations of eating disorders based on the reproductive suppression hypothesis and its variants derived from kin selection theory and the model of parental manipulation were elaborated. The sexual competition hypothesis of eating disorder, adapted to flee famine hypothesis as well as explanation based on the concept of social attention holding power and the need to belonging were also explained. The importance of evolutionary theory in modern conceptualization and research of eating disorders is emphasized.

  18. Economic explanations for concurrent sourcing

    DEFF Research Database (Denmark)

    Mols, Niels Peter

    2010-01-01

    Concurrent sourcing is a phenomenon where firms simultaneously make and buy the same good, i.e. they simultaneously use the governance modes of market and hierarchy. Though concurrent sourcing seems to be widespread, few studies of sourcing have focused on this phenomenon. This paper reviews...... different economic explanations for why firms use concurrent sourcing. The distinctive features of the explanations are compared, and it is discussed how they may serve as a springboard for research on concurrent sourcing. Managerial implications are also offered....

  19. Turing patterns and biological explanation

    DEFF Research Database (Denmark)

    Serban, Maria

    2017-01-01

    , promoting theory exploration, and acting as constitutive parts of empirically adequate explanations of naturally occurring phenomena, such as biological pattern formation. Focusing on the roles that minimal model explanations play in science motivates the adoption of a broader diachronic view of scientific......Turing patterns are a class of minimal mathematical models that have been used to discover and conceptualize certain abstract features of early biological development. This paper examines a range of these minimal models in order to articulate and elaborate a philosophical analysis...

  20. Improving opioid safety practices in primary care: protocol for the development and evaluation of a multifaceted, theory-informed pilot intervention for healthcare providers.

    Science.gov (United States)

    Leece, Pamela; Buchman, Daniel Z; Hamilton, Michael; Timmings, Caitlyn; Shantharam, Yalnee; Moore, Julia; Furlan, Andrea D

    2017-04-26

    In North America, drug overdose deaths are reaching unprecedented levels, largely driven by increasing prescription opioid-related deaths. Despite the development of several opioid guidelines, prescribing behaviours still contribute to poor patient outcomes and societal harm. Factors at the provider and system level may hinder or facilitate the application of evidence-based guidelines; interventions designed to address such factors are needed. Using implementation science and behaviour change theory, we have planned the development and evaluation of a comprehensive Opioid Self-Assessment Package, designed to increase adherence to the Canadian Opioid Guideline among family physicians. The intervention uses practical educational and self-assessment tools to provide prescribers with feedback on their current knowledge and practices, and resources to improve their practice. The evaluation approach uses a pretest and post-test design and includes both quantitative and qualitative methods at baseline and 6 months. We will recruit a purposive sample of approximately 10 family physicians in Ontario from diverse practice settings, who currently treat patients with long-term opioid therapy for chronic pain. Quantitative data will be analysed using basic descriptive statistics, and qualitative data will be analysed using the Framework Method. The University Health Network Research Ethics Board approved this study. Dissemination plan includes publications, conference presentations and brief stakeholder reports. This evidence-informed, theory-driven intervention has implications for national application of opioid quality improvement tools in primary care settings. We are engaging experts and end users in advisory and stakeholder roles throughout our project to increase its national relevance, application and sustainability. The performance measures could be used as the basis for health system quality improvement indicators to monitor opioid prescribing. Additionally, the

  1. Supernatural Explanations: Science or Not?

    Science.gov (United States)

    Eastwell, Peter

    2011-01-01

    Contrary to the advice of supposedly authoritative sources, the a priori exclusion of supernatural explanations or claims from scientific scrutiny is not appropriate. This paper shows how supernatural hypotheses or claims should be treated by science and, in the process, differentiates scientific and non-scientific hypotheses or claims.…

  2. Sublime Views and Beautiful Explanations

    DEFF Research Database (Denmark)

    Barry, Daved; Meisiek, Stefan; Hatch, Mary Jo

    To create a generative theory that provides beautiful explanations and sublime views requires both a crafts and an art approach to scientific theorizing. The search for generativity leads scholars to perform various theorizing moves between the confines of simple, yet eloquent beauty...

  3. Lean healthcare.

    Science.gov (United States)

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  4. A systematic review of interventions by healthcare professionals to improve management of non-communicable diseases and communicable diseases requiring long-term care in adults who are homeless.

    Science.gov (United States)

    Hanlon, Peter; Yeoman, Lynsey; Gibson, Lauren; Esiovwa, Regina; Williamson, Andrea E; Mair, Frances S; Lowrie, Richard

    2018-04-07

    Identify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults. Systematic review of randomised controlled trials (RCTs), non-RCTs and controlled before-after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria. Database searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors. Community. Adults (≥18 years) fulfilling European Typology of Homelessness criteria. Delivered by healthcare professionals managing NCD and LT-CDs. Primary outcome: unscheduled healthcare utilisation. mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness. 11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9-520 participants (67%-94% male, median age 37-49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease

  5. The Hand Eczema Trial (HET): Design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema

    DEFF Research Database (Denmark)

    Ibler, Kristina Sophie; Agner, Tove; Hansen, Jane L.

    2010-01-01

    . The experimental group undergoes patch and prick testing; classification of the hand eczema; demonstration of hand washing and appliance of emollients; individual counselling, and a skin-care programme. The control group receives no intervention. All participants are reassessed after six months. The primary...... strategies are needed to reduce occupational hand eczema. METHODS/DESIGN: We describe the design of a randomised clinical trial to investigate the effects of classification of hand eczema plus individual counselling versus no intervention. The trial includes health-care workers with hand eczema identified...

  6. Generating explanations via analogical comparison.

    Science.gov (United States)

    Hoyos, Christian; Gentner, Dedre

    2017-10-01

    Generating explanations can be highly effective in promoting learning in both adults and children. Our interest is in the mechanisms that underlie this effect and in whether and how they operate in early learning. In adult reasoning, explanation may call on many subprocesses-including comparison, counterfactual reasoning, and reasoning by exclusion; but it is unlikely that all these processes are available to young children. We propose that one process that may serve both children and adults is comparison. In this study, we asked whether children would use the results of a comparison experience when asked to explain why a model skyscraper was stable. We focused on a challenging principle-that diagonal cross-bracing lends stability to physical structures (Gentner et al., Cognitive Science, 40, 224-240, 2016). Six-year-olds either received no training or interacted with model skyscrapers in one of three different conditions, designed to vary in their potential to invite and support comparison. In the Single Model condition, children interacted with a single braced model. In the comparison conditions (Low Alignability and High Alignability), children compared braced and unbraced models. Following experience with the models, children were asked to explain why the braced model was stable. They then received two transfer tasks. We found that children who received highly alignable pairs were most likely to (a) produce brace-based explanations and (b) transfer the brace principle to a dissimilar context. This provides evidence that children can benefit from analogical comparison in generating explanations and also suggests limitations on this ability.

  7. Healthcare Robotics

    OpenAIRE

    Riek, Laurel D.

    2017-01-01

    Robots have the potential to be a game changer in healthcare: improving health and well-being, filling care gaps, supporting care givers, and aiding health care workers. However, before robots are able to be widely deployed, it is crucial that both the research and industrial communities work together to establish a strong evidence-base for healthcare robotics, and surmount likely adoption barriers. This article presents a broad contextualization of robots in healthcare by identifying key sta...

  8. Exploring attitudes of healthcare professionals towards ICT-based interventions for nursing home residents with dementia: a mixed-methods approach.

    Science.gov (United States)

    O'Sullivan, Julie Lorraine; Gellert, Paul; Hesse, Britta; Jordan, Laura-Maria; Möller, Sebastian; Voigt-Antons, Jan-Niklas; Nordheim, Johanna

    2018-02-01

    Information and Communication Technologies (ICTs) could be useful for delivering non-pharmacological therapies (NPTs) for dementia in nursing home settings. To identify technology-related expectations and inhibitions of healthcare professionals associated with the intention to use ICT-based NPTs. Cross-sectional multi-method survey. N = 205 healthcare professionals completed a quantitative survey on usage and attitudes towards ICTs. Additionally, N = 11 semi-structured interviews were conducted. Participants were classified as intenders to use ICTs (53%), non-intenders (14%) or ambivalent (32%). A MANCOVA revealed higher perceived usefulness for intenders compared to non-intenders and ambivalent healthcare professionals (V =.28, F(12, 292)= 3.94, p ICTs in the workplace. Furthermore, benefits for residents emerged as a key requirement. Staff trainings should stress specific benefits for residents and healthcare professionals to facilitate successful implementation and acceptance of ICTs in nursing home settings.

  9. Inside case-based explanation

    CERN Document Server

    Schank, Roger C; Riesbeck, Christopher K

    2014-01-01

    This book is the third volume in a series that provides a hands-on perspective on the evolving theories associated with Roger Schank and his students. The primary focus of this volume is on constructing explanations. All of the chapters relate to the problem of building computer programs that can develop hypotheses about what might have caused an observed event. Because most researchers in natural language processing don't really want to work on inference, memory, and learning issues, most of their sample text fragments are chosen carefully to de-emphasize the need for non text-related reasoni

  10. Healthcare avoidance: a critical review.

    Science.gov (United States)

    Byrne, Sharon K

    2008-01-01

    The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.

  11. An Analysis of the Massachusetts Healthcare Law.

    Science.gov (United States)

    Stephens, James H; Ledlow, Gerald R; Sach, Michael V; Reagan, Julie K

    2017-01-01

    Healthcare in the United States has been one topic of the debates and discussion in the country for many years. The challenge for affordable, accessible, and quality healthcare for most Americans has been on the agenda of federal and state legislatures. There is probably no other state that has drawn as much individual attention regarding this challenge as the state of Massachusetts. While researching the topic for this article, it was discovered that financial and political perspectives on the success or failure of the healthcare model in Massachusetts vary depending on the aspect of the system being discussed. In this article the authors give a brief history and description of the Massachusetts Healthcare Law, explanation of how the law is financed, identification of the targeted populations in Massachusetts for which the law provides coverage, demonstration of the actual benefit coverage provided by the law, and review of the impact of the law on healthcare providers such as physicians and hospitals. In addition, there are explanations about the impact of the law on health insurance companies, discussion of changes in healthcare premiums, explanation of costs to the state for the new program, reviews of the impact on the health of the insured, and finally, projections on the changes that healthcare facilities will need to make to maintain fiscal viability as a result of this program.

  12. Effectiveness of a virtual intervention for primary healthcare professionals aimed at improving attitudes towards the empowerment of patients with chronic diseases: study protocol for a cluster randomized controlled trial (e-MPODERA project).

    Science.gov (United States)

    González-González, Ana Isabel; Orrego, Carola; Perestelo-Perez, Lilisbeth; Bermejo-Caja, Carlos Jesús; Mora, Nuria; Koatz, Débora; Ballester, Marta; Del Pino, Tasmania; Pérez-Ramos, Jeannet; Toledo-Chavarri, Ana; Robles, Noemí; Pérez-Rivas, Francisco Javier; Ramírez-Puerta, Ana Belén; Canellas-Criado, Yolanda; Del Rey-Granado, Yolanda; Muñoz-Balsa, Marcos José; Becerril-Rojas, Beatriz; Rodríguez-Morales, David; Sánchez-Perruca, Luis; Vázquez, José Ramón; Aguirre, Armando

    2017-10-30

    Communities of practice are based on the idea that learning involves a group of people exchanging experiences and knowledge. The e-MPODERA project aims to assess the effectiveness of a virtual community of practice aimed at improving primary healthcare professional attitudes to the empowerment of patients with chronic diseases. This paper describes the protocol for a cluster randomized controlled trial. We will randomly assign 18 primary-care practices per participating region of Spain (Catalonia, Madrid and Canary Islands) to a virtual community of practice or to usual training. The primary-care practice will be the randomization unit and the primary healthcare professional will be the unit of analysis. We will need a sample of 270 primary healthcare professionals (general practitioners and nurses) and 1382 patients. We will perform randomization after professionals and patients are selected. We will ask the intervention group to participate for 12 months in a virtual community of practice based on a web 2.0 platform. We will measure the primary outcome using the Patient-Provider Orientation Scale questionnaire administered at baseline and after 12 months. Secondary outcomes will be the sociodemographic characteristics of health professionals, sociodemographic and clinical characteristics of patients, the Patient Activation Measure questionnaire for patient activation and outcomes regarding use of the virtual community of practice. We will calculate a linear mixed-effects regression to estimate the effect of participating in the virtual community of practice. This cluster randomized controlled trial will show whether a virtual intervention for primary healthcare professionals improves attitudes to the empowerment of patients with chronic diseases. ClicalTrials.gov, NCT02757781 . Registered on 25 April 2016. Protocol Version. PI15.01 22 January 2016.

  13. Experiences and Explanations of ADHD

    DEFF Research Database (Denmark)

    Nielsen, Mikka

    Research on Attention Deficit Hyperactivity Disorder (ADHD) usually presents the disorder from either a neurobiological perspective, describing the disorder as an impairment in executive functions, or from a critical, sociological perspective, whereby ADHD is explained as a consequence...... of the medicalization of deviant behaviour. Neither of these perspectives tells us about the experience of living with ADHD, or explains how ADHD unfolds within specific contexts and relations. Experiences and Explanations of ADHD addresses this lacuna by exploring bodily experiences of ADHD and people’s experiences...... of obtaining a diagnosis. Drawing on in-depth interviews with adults diagnosed with ADHD, the book provides an examination of how the diagnosis is understood, used and acted upon by the people receiving the diagnosis. This book delves into the phenomenology of ADHD and uncovers the experiences of a highly...

  14. Pluralism, Pragmatism and Functional Explanations

    Directory of Open Access Journals (Sweden)

    Shaw Jamie

    2016-04-01

    Full Text Available While many philosophers speak of ‘pluralism’ within philosophy of biology, there has been little said about what such pluralism amounts to or what its underlying assumptions are. This has provoked so me anxiety about whether pluralism is compatible with their commitment to naturalism (Cussins 1992. This paper surveys three prominent pluralist positions (Sandra Mitchell and Michael Dietrich’s (2006 ‘integrative pluralism’, and both Peter Godfrey-Smith’s (1993 and Beth Preston’s (1998 pluralist analyses of functional explanations in evolutionary biology and demonstrates how all three are committed to a form of pragmatism. This analysis both clarifies the justification and grounding of pluralism and allows these pluralisms to avoid the criticisms of Cussins. I close by making some more general points about pluralism and its relationship to history and integration.

  15. Why did an effective Dutch complex psycho-social intervention for people with dementia not work in the German healthcare context? Lessons learnt from a process evaluation alongside a multicentre RCT.

    Science.gov (United States)

    Voigt-Radloff, Sebastian; Graff, Maud; Leonhart, Rainer; Hüll, Michael; Rikkert, Marcel Olde; Vernooij-Dassen, Myrra

    2011-08-09

    Background The positive effects of the Dutch Community Occupational Therapy in Dementia programme on patients' daily functioning were not found in a multicentre randomised controlled trial (RCT) in Germany. Objectives To evaluate possible effect modification on the primary outcome within the German RCT with regard to (1) participant characteristics, (2) treatment performance and (3) healthcare service utilisation; and (4) to compare the design and primary outcome between the German and the original Dutch study. Methods (1) The impact of participant baseline data on the primary outcome was analysed in exploratory ANCOVA and regression analyses. (2) Therapists completed questionnaires on context and performance problems. The main problems were identified by a qualitative content analysis and focus-group discussion. Associations of the primary outcome with scores of participant adherence and treatment performance were evaluated by regression analysis. (3) Utilisation rates of healthcare services were controlled for significant group differences. (4) Differences in the Dutch and German study design were identified, and the primary outcome was contrasted at the item level. Results (1) Participant characteristics could not explain more than 5% of outcome variance. (2) The treatment performance of some active intervention components was poor but not significantly associated with the primary outcome. (3) There were no significant group differences in the utilisation of healthcare resources. (4) In contrast to the Dutch waiting-control group, the active intervention in the German control group may have reduced group differences in the current RCT. The German patients demonstrated a higher independence at baseline and less improvement in instrumental activities of daily living. Conclusion The differences in outcome may be explained by a more active control treatment, partially poor experimental treatment and less room for improvement in the German sample. Future cross

  16. Why the Difference Between Explanation and Argument Matters to Science Education

    Science.gov (United States)

    Brigandt, Ingo

    2016-05-01

    Contributing to the recent debate on whether or not explanations ought to be differentiated from arguments, this article argues that the distinction matters to science education. I articulate the distinction in terms of explanations and arguments having to meet different standards of adequacy. Standards of explanatory adequacy are important because they correspond to what counts as a good explanation in a science classroom, whereas a focus on evidence-based argumentation can obscure such standards of what makes an explanation explanatory. I provide further reasons for the relevance of not conflating explanations with arguments (and having standards of explanatory adequacy in view). First, what guides the adoption of the particular standards of explanatory adequacy that are relevant in a scientific case is the explanatory aim pursued in this context. Apart from explanatory aims being an important aspect of the nature of science, including explanatory aims in classroom instruction also promotes students seeing explanations as more than facts, and engages them in developing explanations as responses to interesting explanatory problems. Second, it is of relevance to science curricula that science aims at intervening in natural processes, not only for technological applications, but also as part of experimental discovery. Not any argument enables intervention in nature, as successful intervention specifically presupposes causal explanations. Students can fruitfully explore in the classroom how an explanatory account suggests different options for intervention.

  17. Scientific explanation in school: An enactive view

    Science.gov (United States)

    Ibrahim-Didi, Khadeeja

    This study explores explanation-in-action, a corollary to an enactive orientation to cognition. Explanation, understood this way is identified as a semiotic, perceptually driven activity, where the interactions that arise between students that enable the engagement to continue indicate a certain tentative coherence of meaning that is brought forth in interaction in a constraining environment. Challenging summary state views of explanation as statement, this study explores the evolution of scientific explanation in two Grade Eight Maldivian classrooms. Enactivism, understood across different embodied cognitive systems, reconfigures the discourse on explanation by re-orienting the form in which explanation is understood. The notion of explanation-in-action as a topological function implicates the boundary of the cognitive system in the action. Further, it also recognizes that embedding boundaries and the dynamics that create the boundaries can constrain the explanation that occurs in different domains. In effect, the study calls for reconfiguring validation as in-action---as the constraining dynamic feature that emerges in the ongoing explanation-in-action. In the study I pay attention to the different boundaries of some systemic configurations in the classroom. I consider how the boundary conditions create the possibility for signification, and therefore, explanation. This research suggests that in explaining-in-action students are able to draw on the enabling possibilities of personal boundaries and the constraining social boundaries to further structure their explaining in ways that are local to the task at hand.

  18. Model-based explanation of plant knowledge

    Energy Technology Data Exchange (ETDEWEB)

    Huuskonen, P.J. [VTT Electronics, Oulu (Finland). Embedded Software

    1997-12-31

    This thesis deals with computer explanation of knowledge related to design and operation of industrial plants. The needs for explanation are motivated through case studies and literature reviews. A general framework for analysing plant explanations is presented. Prototypes demonstrate key mechanisms for implementing parts of the framework. Power plants, steel mills, paper factories, and high energy physics control systems are studied to set requirements for explanation. The main problems are seen to be either lack or abundance of information. Design knowledge in particular is found missing at plants. Support systems and automation should be enhanced with ways to explain plant knowledge to the plant staff. A framework is formulated for analysing explanations of plant knowledge. It consists of three parts: 1. a typology of explanation, organised by the class of knowledge (factual, functional, or strategic) and by the target of explanation (processes, automation, or support systems), 2. an identification of explanation tasks generic for the plant domain, and 3. an identification of essential model types for explanation (structural, behavioural, functional, and teleological). The tasks use the models to create the explanations of the given classes. Key mechanisms are discussed to implement the generic explanation tasks. Knowledge representations based on objects and their relations form a vocabulary to model and present plant knowledge. A particular class of models, means-end models, are used to explain plant knowledge. Explanations are generated through searches in the models. Hypertext is adopted to communicate explanations over dialogue based on context. The results are demonstrated in prototypes. The VICE prototype explains the reasoning of an expert system for diagnosis of rotating machines at power plants. The Justifier prototype explains design knowledge obtained from an object-oriented plant design tool. Enhanced access mechanisms into on-line documentation are

  19. Model-based explanation of plant knowledge

    Energy Technology Data Exchange (ETDEWEB)

    Huuskonen, P J [VTT Electronics, Oulu (Finland). Embedded Software

    1998-12-31

    This thesis deals with computer explanation of knowledge related to design and operation of industrial plants. The needs for explanation are motivated through case studies and literature reviews. A general framework for analysing plant explanations is presented. Prototypes demonstrate key mechanisms for implementing parts of the framework. Power plants, steel mills, paper factories, and high energy physics control systems are studied to set requirements for explanation. The main problems are seen to be either lack or abundance of information. Design knowledge in particular is found missing at plants. Support systems and automation should be enhanced with ways to explain plant knowledge to the plant staff. A framework is formulated for analysing explanations of plant knowledge. It consists of three parts: 1. a typology of explanation, organised by the class of knowledge (factual, functional, or strategic) and by the target of explanation (processes, automation, or support systems), 2. an identification of explanation tasks generic for the plant domain, and 3. an identification of essential model types for explanation (structural, behavioural, functional, and teleological). The tasks use the models to create the explanations of the given classes. Key mechanisms are discussed to implement the generic explanation tasks. Knowledge representations based on objects and their relations form a vocabulary to model and present plant knowledge. A particular class of models, means-end models, are used to explain plant knowledge. Explanations are generated through searches in the models. Hypertext is adopted to communicate explanations over dialogue based on context. The results are demonstrated in prototypes. The VICE prototype explains the reasoning of an expert system for diagnosis of rotating machines at power plants. The Justifier prototype explains design knowledge obtained from an object-oriented plant design tool. Enhanced access mechanisms into on-line documentation are

  20. The Hand Eczema Trial (HET): Design of a randomised clinical trial of the effect of classification and individual counselling versus no intervention among health-care workers with hand eczema.

    Science.gov (United States)

    Ibler, Kristina Sophie; Agner, Tove; Hansen, Jane Lindschou; Gluud, Christian

    2010-08-31

    Hand eczema is the most frequently recognized occupational disease in Denmark with an incidence of approximately 0.32 per 1000 person-years. Consequences of hand eczema include chronic severe eczema, prolonged sick leave, unemployment, and impaired quality of life. New preventive strategies are needed to reduce occupational hand eczema. We describe the design of a randomised clinical trial to investigate the effects of classification of hand eczema plus individual counselling versus no intervention. The trial includes health-care workers with hand eczema identified from a self-administered questionnaire delivered to 3181 health-care workers in three Danish hospitals. The questionnaire identifies the prevalence of hand eczema, knowledge of skin-protection, and exposures that can lead to hand eczema. At entry, all participants are assessed regarding: disease severity (Hand Eczema Severity Index); self-evaluated disease severity; number of eruptions; quality of life; skin protective behaviour, and knowledge of skin protection. The patients are centrally randomised to intervention versus no intervention 1:1 stratified for hospital, profession, and severity score. The experimental group undergoes patch and prick testing; classification of the hand eczema; demonstration of hand washing and appliance of emollients; individual counselling, and a skin-care programme. The control group receives no intervention. All participants are reassessed after six months. The primary outcome is observer-blinded assessment of disease severity and the secondary outcomes are unblinded assessments of disease severity; number of eruptions; knowledge of skin protection; skin-protective behaviour, and quality of life. The trial is registered in ClinicalTrials.Gov, NCT01012453.

  1. The impact of national-level interventions to improve hygiene on the incidence of irritant contact dermatitis in healthcare workers: changes in incidence from 1996 to 2012 and interrupted times series analysis.

    Science.gov (United States)

    Stocks, S J; McNamee, R; Turner, S; Carder, M; Agius, R M

    2015-07-01

    Reducing healthcare-associated infections (HCAI) has been a priority in the U.K. over recent decades and this has been reflected in interventions focusing on improving hygiene procedures. To evaluate whether these interventions coincided with an increased incidence of work-related irritant contact dermatitis (ICD) attributed to hand hygiene or/and other hygiene measures in healthcare workers (HCWs). A quasi-experimental (interrupted time series) design was used to compare trends in incidence of ICD in HCWs attributed to hygiene before and after interventions to reduce HCAI with trends in the same periods in control groups (ICD in other workers). Cases of ICD reported to a U.K. surveillance scheme from 1996 to 2012 were analysed. The time periods compared were defined objectively based on the dates of the publication of national evidence-based guidelines, the U.K. Health Act 2006 and the Cleanyourhands campaign. The reported incidence of ICD in HCWs attributed to hygiene has increased steadily from 1996 to 2012 [annual incidence rate ratio (95% confidence interval): hand hygiene only 1.10 (1.07-1.12); all hygiene 1.05 (1.03-1.07)], whereas the incidence in other workers is declining. An increase in incidence of ICD in HCWs attributed to hand hygiene was observed at the beginning of the Cleanyourhands campaign. The increasing incidence of ICD in HCWs combined with the popularity of interventions to reduce HCAI warrants increased efforts towards identifying products and implementing practices posing the least risk of ICD. © 2015 British Association of Dermatologists.

  2. The web of silence: a qualitative case study of early intervention and support for healthcare workers with mental ill-health

    OpenAIRE

    Moll, Sandra E

    2014-01-01

    Background There is a high rate of stress and mental illness among healthcare workers, yet many continue to work despite symptoms that affect their performance. Workers with mental health issues are typically ostracized and do not get the support that they need. If issues are not addressed, however, they could become worse and compromise the health and safety, not only of the worker, but his/her colleagues and patients. Early identification and support can improve work outcomes and facilitate...

  3. Control of corruption in healthcare.

    Science.gov (United States)

    Ahmed, Armin; Azim, Afzal

    2015-01-01

    A recently published article on corruption in Indian healthcare in the BMJ has triggered a hot debate and numerous responses (1, 2, 3, 4). We do agree that corruption in Indian healthcare is a colossal issue and needs to be tackled urgently (5). However, we want to highlight that corruption in healthcare is not a local phenomenon confined to the Indian subcontinent, though India does serve as a good case study and intervention area due to the magnitude of the problem and the country's large population (6). Good governance, strict rules, transparency and zero tolerance are some of the strategies prescribed everywhere to tackle corruption. However, those entrusted with implementing good governance and strict rules in India need to go through a process of introspection to carry out their duties in a responsible fashion. At present, it looks like a no-win situation. In this article, we recommend education in medical ethics as the major intervention for dealing with corruption in healthcare.

  4. Mesopause Jumps: Observations and Explanation

    Science.gov (United States)

    Luebken, F. J.; Becker, E.; Höffner, J.; Viehl, T. P.; Latteck, R.

    2017-12-01

    Recent high resolution temperature measurements by resonance lidar at Davis (69°S) occasionally showed a sudden mesopause altitude increase by 5km and an associated mesopause temperature decrease by 10K. We present further observations which are closely related to this `mesopause jump', namely the increase of mean height of polar mesospheric summer echoes (PMSE) observed by a VHF radar, very strong westward winds in the upper mesosphere measured by an MF radar, and relatively large eastward winds in the stratosphere taken from reanalysis. We compare to similar observations in the Northern Hemisphere, namely at ALOMAR (69°N) where such mesopause jumps have never been observed. We present a detailed explanation of mesopause jumps. They occur only when stratospheric winds are moderately eastward and mesospheric winds are very large (westward). Under these conditions, gravity waves with comparatively large eastward phase speeds can pass the stratosphere and propagate to the lower thermosphere because their vertical wavelengths in the mesosphere are rather large which implies reduced dynamical stability. When finally breaking in the lower thermosphere, these waves drive an enhanced residual circulation that causes a cold and high-altitude mesopause. The conditions for a mesopause jump occur only in the Southern Hemisphere (SH) and are associated with the late breakdown of the polar vortex.Mesopause jumps are primarily, but not only, observed prior and close to solstice. We also show that during the onset of PMSE in the SH, stratospheric zonal winds are still eastward (up to 30m/s), and that the onset is not closely related to the transition of the stratospheric circulation.

  5. A “Pathology Explanation Clinic (PEC” for Patient-Centered Laboratory Medicine Test Results

    Directory of Open Access Journals (Sweden)

    Blake Gibson MD

    2018-03-01

    Full Text Available This concept paper addresses communication issues arising between physicians and their patients. To facilitate the communication of essential diagnostic pathology information to patients, and address their questions and concerns, we propose that “Pathology Explanation Clinics” be created. The Pathology Explanation Clinics would provide a channel for direct communications between pathologists and patients. Pathologists would receive special training as “Certified Pathologist Navigators” in preparation for this role. The goal of Pathology Explanation Clinics would be to help fill gaps in communication of information contained in laboratory reports to patients, further explain its relevance, and improve patient understanding of the meaning of such information and its impact on their health and health-care choices. Effort would be made to ensure that Certified Pathologist Navigators work within the overall coordination of care by the health-care team.

  6. A primary health-care intervention on pre- and postnatal risk factor behavior to prevent childhood allergy. The Prevention of Allergy among Children in Trondheim (PACT) study.

    Science.gov (United States)

    Storrø, Ola; Oien, Torbjørn; Dotterud, Christian K; Jenssen, Jon A; Johnsen, Roar

    2010-07-28

    This study aimed to evaluate the impact of a primary prevention intervention program on risk behavior for allergic diseases among children up to 2 years of age. The setting was in ordinary pre- and postnatal primary health care in Trondheim, Norway. The Prevention of Allergy among Children in Trondheim, Norway (PACT) study invited all pregnant women and parents to children up to 2 years of age in the community to participate in a non-randomized, controlled, multiple life-style intervention study. Interventional topics was increased dietary intake of cod liver oil and oily fish for women during pregnancy and for infants during the first 2 years of life, reduced parental smoking and reduced indoor dampness. A control cohort was established prior to the intervention cohort with "follow up as usual". Questionnaires were completed in pregnancy, 6 weeks after birth and at 1 and 2 years of age. Trends in exposure and behavior are described. Intake of oily fish and cod liver oil increased statistically significantly among women and infants in the intervention cohort compared to the control cohort. There was a low postnatal smoking prevalence in both cohorts, with a trend towards a decreasing smoking prevalence in the control cohort. There was no change in indoor dampness or in behavior related to non- intervened life-style factors. The dietary intervention seemed to be successful. The observed reduced smoking behavior could not be attributed to the intervention program, and the latter had no effect on indoor dampness. (Current Controlled Trials registration number: ISRCTN28090297).

  7. The Feedback Intervention Trial (FIT) — Improving Hand-Hygiene Compliance in UK Healthcare Workers: A Stepped Wedge Cluster Randomised Controlled Trial

    Science.gov (United States)

    Fuller, Christopher; Michie, Susan; Savage, Joanne; McAteer, John; Besser, Sarah; Charlett, Andre; Hayward, Andrew; Cookson, Barry D.; Cooper, Ben S.; Duckworth, Georgia; Jeanes, Annette; Roberts, Jenny; Teare, Louise; Stone, Sheldon

    2012-01-01

    Introduction Achieving a sustained improvement in hand-hygiene compliance is the WHO’s first global patient safety challenge. There is no RCT evidence showing how to do this. Systematic reviews suggest feedback is most effective and call for long term well designed RCTs, applying behavioural theory to intervention design to optimise effectiveness. Methods Three year stepped wedge cluster RCT of a feedback intervention testing hypothesis that the intervention was more effective than routine practice in 16 English/Welsh Hospitals (16 Intensive Therapy Units [ITU]; 44 Acute Care of the Elderly [ACE] wards) routinely implementing a national cleanyourhands campaign). Intervention-based on Goal & Control theories. Repeating 4 week cycle (20 mins/week) of observation, feedback and personalised action planning, recorded on forms. Computer-generated stepwise entry of all hospitals to intervention. Hospitals aware only of own allocation. Primary outcome: direct blinded hand hygiene compliance (%). Results All 16 trusts (60 wards) randomised, 33 wards implemented intervention (11 ITU, 22 ACE). Mixed effects regression analysis (all wards) accounting for confounders, temporal trends, ward type and fidelity to intervention (forms/month used). Intention to Treat Analysis Estimated odds ratio (OR) for hand hygiene compliance rose post randomisation (1.44; 95% CI 1.18, 1.76;phand-hygiene compliance, in wards implementing a national hand-hygiene campaign. Further implementation studies are needed to maximise the intervention’s effect in different settings. Trial Registration Controlled-Trials.com ISRCTN65246961 PMID:23110040

  8. EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings.

    Science.gov (United States)

    Browne, Annette J; Varcoe, Colleen; Ford-Gilboe, Marilyn; Wathen, C Nadine

    2015-12-14

    The primary health care (PHC) sector is increasingly relevant as a site for population health interventions, particularly in relation to marginalized groups, where the greatest gains in health status can be achieved. The purpose of this paper is to provide an overview of an innovative multi-component, organizational-level intervention designed to enhance the capacity of PHC clinics to provide equity-oriented care, particularly for marginalized populations. The intervention, known as EQUIP, is being implemented in Canada in four diverse PHC clinics serving populations who are impacted by structural inequities. These PHC clinics serve as case studies for the implementation and evaluation of the EQUIP intervention. We discuss the evidence and theory that provide the basis for the intervention, describe the intervention components, and discuss the methods used to evaluate the implementation and impact of the intervention in diverse contexts. Research and theory related to equity-oriented care, and complexity theory, are central to the design of the EQUIP intervention. The intervention aims to enhance capacity for equity-oriented care at the staff level, and at the organizational level (i.e., policy and operations) and is novel in its dual focus on: (a) Staff education: using standardized educational models and integration strategies to enhance staff knowledge, attitudes and practices related to equity-oriented care in general, and cultural safety, and trauma- and violence-informed care in particular, and; (b) Organizational integration and tailoring: using a participatory approach, practice facilitation, and catalyst grants to foster shifts in organizational structures, practices and policies to enhance the capacity to deliver equity-oriented care, improve processes of care, and shift key client outcomes. Using a mixed methods, multiple case-study design, we are examining the impact of the intervention in enhancing staff knowledge, attitudes and practices; improving

  9. Experimental Philosophy of Explanation Rising: The Case for a Plurality of Concepts of Explanation.

    Science.gov (United States)

    Colombo, Matteo

    2017-03-01

    This paper brings together results from the philosophy and the psychology of explanation to argue that there are multiple concepts of explanation in human psychology. Specifically, it is shown that pluralism about explanation coheres with the multiplicity of models of explanation available in the philosophy of science, and it is supported by evidence from the psychology of explanatory judgment. Focusing on the case of a norm of explanatory power, the paper concludes by responding to the worry that if there is a plurality of concepts of explanation, one will not be able to normatively evaluate what counts as good explanation. Copyright © 2016 Cognitive Science Society, Inc.

  10. Kinds and problems of geomorphological explanation

    Science.gov (United States)

    Cox, Nicholas J.

    2007-07-01

    What characterises satisfactory explanations in geomorphology is a key methodological question deserving continued analysis. In turn it raises the issue of the role played by methodology within the science. At its best, methodology can provide helpful distinctions, identify key issues and yield guidance for researchers. The substantive context for debates on explanation is the apparent complexity and difficulty of geomorphology as a science, which is arguably no greater than that of other Earth or environmental sciences. The logical view of explanation dominant in the 1950s and 1960s still has value, but a broader view is needed of explanations, related to the questions geomorphologists (and others) ask and to the answers that they find interesting. Answers may be sought in terms of purpose, history, mechanisms and statistics. Arguments over what is supposed to be reductionism can be clarified by underlining that both micro- and macro-explanations may be helpful. Although many geomorphologists aspire to mechanistic explanations, they often stop short at statistical explanations, making use of convenient functional forms such as power laws. Explanations have both social and psychological dimensions, the former much stressed in history of science and recent science studies, the latter deserving greater emphasis at present. Complicated models raise the question of how far it can be said that geomorphologists understand them in totality. A bestiary of poor explanations is needed, so that geomorphologists are not seduced by weak arguments and because they often serve as steps towards better explanations. Circular arguments, ad hoc explanations, and mistaking the name of the problem for the solution are cases in point.

  11. When the healthcare does not follow the evidence: The case of the lack of early intervention programs for psychosis in Spain.

    Science.gov (United States)

    Arango, Celso; Bernardo, Miguel; Bonet, Pere; Cabrera, Ana; Crespo-Facorro, Benedicto; Cuesta, Manuel J; González, Nel; Parrabera, Sílvia; Sanjuan, Julio; Serrano, Alfonso; Vieta, Eduard; Lennox, Belinda R; Melau, Marianne

    There is now sufficient evidence to support the importance of interventions in the early stages of psychosis. The delay in the detection and treatment of the first-episode psychosis is related to a lower and slower recovery, as well as a higher risk of relapse. Despite this fact, early intervention units or teams are still not regularly implemented in mental health service settings in Spain. In this opinion article, a review is presented of the main arguments for defending the need to implement these programs and strategies in order to achieve this aim. There are a number of programs for early intervention for psychosis currently working in other countries, with a therapeutic program that includes pharmacological and psychosocial interventions, together with public awareness, information dissemination, and family-professional collaboration activities. Published literature on the experience of these programs indicates that early intervention is not only effective in terms of the improvement of health status, but is also economically efficient. The main steps and recommendations needed to implement such early intervention programs in our country are described. Copyright © 2017 SEP y SEPB. All rights reserved.

  12. Healthcare Lean.

    Science.gov (United States)

    Long, John C

    2003-01-01

    Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

  13. Explanation and Categorization: How "Why?" Informs "What?"

    Science.gov (United States)

    Lombrozo, Tania

    2009-01-01

    Recent theoretical and empirical work suggests that explanation and categorization are intimately related. This paper explores the hypothesis that explanations can help structure conceptual representations, and thereby influence the relative importance of features in categorization decisions. In particular, features may be differentially important…

  14. Scientific Explanations and Piagetian Operational Levels.

    Science.gov (United States)

    Bass, Joel E.; Maddux, Cleborne D.

    1982-01-01

    Examined effects of operational levels of ninth-grade (N=16) and college (N=40) students on causal explanations they recalled after instruction. Results indicate concrete/formal students recalled explanations requiring chaining of two implication statements while formal subjects outperformed concrete subjects in reconstruction of complex…

  15. A primary health-care intervention on pre- and postnatal risk factor behavior to prevent childhood allergy. The Prevention of Allergy among Children in Trondheim (PACT study

    Directory of Open Access Journals (Sweden)

    Jenssen Jon A

    2010-07-01

    Full Text Available Abstract Background This study aimed to evaluate the impact of a primary prevention intervention program on risk behavior for allergic diseases among children up to 2 years of age. The setting was in ordinary pre- and postnatal primary health care in Trondheim, Norway. Methods The Prevention of Allergy among Children in Trondheim, Norway (PACT study invited all pregnant women and parents to children up to 2 years of age in the community to participate in a non-randomized, controlled, multiple life-style intervention study. Interventional topics was increased dietary intake of cod liver oil and oily fish for women during pregnancy and for infants during the first 2 years of life, reduced parental smoking and reduced indoor dampness. A control cohort was established prior to the intervention cohort with "follow up as usual". Questionnaires were completed in pregnancy, 6 weeks after birth and at 1 and 2 years of age. Trends in exposure and behavior are described. Results Intake of oily fish and cod liver oil increased statistically significantly among women and infants in the intervention cohort compared to the control cohort. There was a low postnatal smoking prevalence in both cohorts, with a trend towards a decreasing smoking prevalence in the control cohort. There was no change in indoor dampness or in behavior related to non- intervened life-style factors. Conclusions The dietary intervention seemed to be successful. The observed reduced smoking behavior could not be attributed to the intervention program, and the latter had no effect on indoor dampness. Trial registrations (Current Controlled Trials registration number: ISRCTN28090297

  16. Modelos explicativos e de intervenção na promoção da saúde do trabalhador Modelos explicativos de intervención en la promoción de la salud del trabajador Explanative and intervention models in workers' health promotion

    Directory of Open Access Journals (Sweden)

    Maria Helena Palucci Marziale

    2008-01-01

    Full Text Available OBJETIVO: Buscar evidências científicas, na literatura, de modelos explicativos e de intervenção para promoção da saúde do trabalhador e prevenção de acidentes de trabalho com material biológico. MÉTODOS: Revisão integrativa da literatura. RESULTADOS: Onze artigos atenderam aos critérios estabelecidos, 36,4% usaram modelos explicativos centrados no comportamento individual ou possibilitaram a interação entre os indivíduos e prestadores de serviço, 63,6% usaram modelos de intervenção para a promoção da saúde de trabalhadores expostos a riscos biológicos. CONCLUSÃO: Os modelos de intervenção são os mais relevantes na área de saúde do trabalhador, pois direcionam para um modo de dispor os meios técnicos e científicos para intervir sobre riscos e danos à saúde, incorporando uma lógica que orienta as intervenções técnicas sobre os problemas e necessidades dos trabalhadores.OBJETIVO: Buscar evidencias científicas, en la literatura, de modelos explicativos y de intervención para la promoción de la salud del trabajador y prevención de accidentes de trabajo con material biológico. MÉTODOS: Revisión integrada de la literatura. RESULTADOS: Once artículos atendieron a los criterios establecidos, 36,4% usaron modelos explicativos centrados en el comportamiento individual o posibilitaron la interacción entre los individuos y prestadores de servicio, 63,6% usaron modelos de intervención para la promoción de la salud de trabajadores expuestos a riesgos biológicos. CONCLUSIÓN: Los modelos de intervención son los más relevantes en el área de salud del trabajador, pues orientan hacia un modo de disponer los medios técnicos y científicos para intervenir sobre los riesgos y daños a la salud, incorporando una lógica que orienta las intervenciones técnicas sobre los problemas y necesidades de los trabajadores.OBJECTIVE: To search for scientific evidence in literature of explanative and intervention models to

  17. Explaining the accreditation process from the institutional isomorphism perspective: a case study of Jordanian primary healthcare centers.

    Science.gov (United States)

    Alyahya, Mohammad; Hijazi, Heba; Harvey, Heather

    2018-01-01

    While the main focus of accreditation initiatives has been on hospitals, the implementation of these programs is a relatively new notion among other types of healthcare facilities. Correspondingly, this study aims to understand how accreditation is perceived among primary public healthcare centers using an isomorphic institutional theory. Semi-structured, in-depth interviews were conducted with 56 healthcare professionals and administrative staff from seven non-profit healthcare centers in Jordan using an explanatory case-study approach. The informants' narratives revealed that all three components of institutional theory: coercive, mimetic, and normative pressure, were drivers for institutional change in seeking accreditation. There was an overlapping and blending between the three various types of pressure. While participants perceived that healthcare centers faced formal and informal pressures to achieve accreditation, health centers were reluctant about the time, amount of effort, and their ability to achieve the accreditation. Ambiguity and fear of failure forced them to model successful ones. Moreover, the findings revealed that normative values of health professionals enhanced institutional isomorphism and influenced the accreditation process. Identifying these isomorphic changes may help key stakeholders to develop plans, policies, and procedures that could improve the quality of healthcare and enhance accreditation as an organizational strategic plan. Moreover, the study provided explanations of why and how organizations move to adopt new interventions and grow over time. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  18. Effectiveness of a physical activity program on cardiovascular disease risk in adult primary health-care users: the “Pas-a-Pas” community intervention trial

    Directory of Open Access Journals (Sweden)

    Victoria Arija

    2017-06-01

    Full Text Available Abstract Background Physical activity is a major, modifiable, risk factor for cardiovascular disease (CVD that contributes to the prevention and management of CVD. The aim of this study was to assess the short- and medium-term effectiveness of 9 months of a supervised physical activity program, including sociocultural activities, on CVD risk in adults. Methods Multicentered, randomized, controlled community intervention involving 364 patients in four primary care centers. The participants were randomly assigned to a Control Group (CG = 104 or Intervention Group (IG = 260; mean age 65.19 years; 76.8% women. The intervention consisted of 120 min/week walking (396 METs/min/week and sociocultural gathering once a month. Clinical history, physical activity, dietary intake, CVD risk factors (smoking, systolic and diastolic blood pressure, weight, waist circumference, BMI, total cholesterol, LDL- and HDL-cholesterol, triglycerides, glycosylated hemoglobin and glucose and global CVD risk were assessed at baseline and at the end of the intervention and multivariate models were applied to the data. Incidence of adverse cardiovascular events and continued adherence to the physical activity were assessed 2 years after intervention. Results At the end of the intervention period, in the IG relative to the CG group, there was a significant increase in physical activity (774.81 METs/min/week, a significant change during the intervention period in systolic blood pressure (−6.63 mmHg, total cholesterol (−10.12 mg/dL and LDL-cholesterol (−9.05 mg/dL even after adjustment for potential confounders. At 2 years after the intervention, in the IG, compared with the CG, tthe incidence of adverse cardiovascular events was significantly lower (2.5% vs. 10.5% and the adherence to regular physical activity was higher (72.8% vs 27.2% in IG compared to CG. Conclusions This community-based physical activity program improved cardiovascular health in the short

  19. From the risk analysis to the development of interventions and training for the prevention and control of healthcare associated infections. The experience of G. Pini Orthopedic Institute.

    Science.gov (United States)

    Navone, P; Conti, C; Domeniconi, G; Nobile, M

    2015-01-01

    Health-care associated infections (HAIs) represents a phenomenon of central importance all over Europe. Every year 4,5 millions cases are detected in European Union, with 37.000 related deaths. Surgical-site infections (SSIs) are one of the most common HAIs, that are associated with an increased length of stay, re-operation rate, intensive care admissions rate, and higher mortality rate. G. Pini Orthopedics Institute implemented in the last two years a multimodal strategy for controlling and preventing HAIs, in particular for SSIs. This paper describes the prevention's strategies adopted for prevention of HAIs, at G. Pini Orthopedic Institute. Our findings show that application of a multi modal promotion strategy was associated with an improvement in HAI prevention.

  20. Raising awareness on cyber safety: adolescents' experience of a primary healthcare professional-led, school-based, multi-center intervention.

    Science.gov (United States)

    Tsimtsiou, Zoi; Drosos, Evangelos; Drontsos, Anastasios; Haidich, Anna-Bettina; Dantsi, Fotini; Sekeri, Zafiria; Dardavesis, Theodoros; Nanos, Panagiotis; Arvanitidou, Malamatenia

    2017-09-15

    Purpose Although safe Internet use is an emerging public health issue, there is a scarcity of published work describing relevant school-based interventions. The objective of this study was to explore the impact of a health professional-led, school-based intervention in raising awareness on cyber-safety in adolescents, Therefore, the aim of this study was to investigate adolescents' evaluation of this school-based intervention, 6 months after its implementation, as well as the impact of adolescents' school class and gender on their evaluation. Methods A student sample was selected using a multistage stratified random sampling technique, according to the location and school grade level (middle, high school). The students - aged from 12 to 18 years old experienced an interactive presentation in their classrooms on the amount of time spent online, the use of social networks and the available support services. An evaluation tool was completed anonymously and voluntarily 6 months after the intervention. Results Four hundred and sixty-two students (response rate 90.7%, 246 middle, 216 high school) completed the evaluation tool. Younger students, especially the ones in the first year of middle school, scored significantly higher in all six parameters used in the evaluation of this intervention compared with all the older participants: (a) they had kept the presented information on Safeline and Saferinternet websites and the helpline Ypostirizo (70.2% vs. 33.7%, p < 0.001) (b) they had already used it (32.5% vs. 12.3%, p < 0.001), (c) they had learned new information on cyber safety (66.4% vs. 34%, p < 0.001), (d) they rated the intervention as more interesting (median 8 vs. 7, p < 0.05), (e) they had reconsidered the way they use Internet (median 7 vs. 6, p < 0.05) and (f) they had changed their cyber behavior (median 7 vs. 5, p < 0.05). Conclusion The active involvement of students in a discussion on cyber-safety based on their experiences was highly evaluated. The impact

  1. Expert consensus (SBC/SBHCI) on the use of drug-eluting stents: recommendations of the Brazilian society of interventional cardiology/ Brazilian society of cardiology for the Brazilian public single healthcare system.

    Science.gov (United States)

    Lima, Valter C; Mattos, Luiz Alberto P; Caramori, Paulo R A; Perin, Marco A; Mangione, José A; Machado, Bruno M; Coelho, Wilson M C; Bueno, Ronaldo R L

    2006-10-01

    The authors review percutaneous coronary intervention (PCI) evolution and its growing application in myocardial revascularization for patients with coronary heart disease in Brazil and worldwide. PCI was introduced in 1977 using only the catheter balloon. Limitations of this method (acute occlusion and coronary restenosis) led to the adoption of coronary stents and more recently the advent of drug-eluting stents2, which were developed to drastically reduce restenosis rates. These developments allowed the exponential growth of percutaneous coronary intervention (PCI) procedures in Brazil which have replaced many bypass surgery procedures and have become the gold standard for the majority of symptomatic patients suffering from coronary artery disease. The preference for this procedure gained new dimensions in 2000 when the Brazilian Public Healthcare System (SUS) began reimbursing for stent procedures. This measure exemplified the importance of the Public Healthcare System's participation in incorporating medical advances and offering a high standard of cardiovascular treatment to a large portion of the Brazilian population. It is emphasized that prevention of in-stent restenosis is complex due to its unpredictable and ubiquitous occurrence. Control of this condition improves quality of life and reduces the recurrence of angina pectoris, the need to perform new revascularization procedures and hospital readmissions. The overall success of the drug-eluting stents has proven to be reliable and consistent in overcoming restenosis and has some beneficial impact for all clinical and angiographic conditions. This paper discusses the adoption and criteria for the use of drug-eluting stents in other countries as well as the recommendations established by the Brazilian Society of Interventional Cardiology for their reimbursement by SUS. The incorporation of new healthcare technology involves two distinct stages. During the first stage, the product is registered with the

  2. Increase in physical activity and cardiometabolic risk profile change during lifestyle intervention in primary healthcare: 1-year follow-up study among individuals at high risk for type 2 diabetes.

    Science.gov (United States)

    Kujala, Urho M; Jokelainen, Jari; Oksa, Heikki; Saaristo, Timo; Rautio, Nina; Moilanen, Leena; Korpi-Hyövälti, Eeva; Saltevo, Juha; Vanhala, Mauno; Niskanen, Leo; Peltonen, Markku; Tuomilehto, Jaakko; Uusitupa, Matti; Keinänen-Kiukaannemi, Sirkka

    2011-01-01

    Objectives To investigate the association between increase in physical activity and changes in cardiometabolic risk factors during a lifestyle intervention programme in routine clinical settings. Design Prospective follow-up. Setting 400 primary healthcare centres and occupational healthcare outpatient clinics in Finland. Participants Individuals at high risk for type 2 diabetes identified in the implementation project of the national diabetes prevention programme (FIN-D2D) and participating in baseline and 1-year follow-up visits. Final study group comprised the 1871 non-diabetic participants who responded at follow-up visit to a question on stability versus increase of physical activity. Interventions Lifestyle intervention. Primary outcome measures Cardiometabolic risk factors (body composition, blood pressure and those measured from fasting venous blood samples) measured at baseline and follow-up visits. Results Of the participants, 310 (16.6% of all responders) reported at follow-up having clearly increased their physical activity during the past year, while 1380 (73.8%) had been unable to increase their physical activity. Those who increased their activity decreased their weight by 3.6 kg (95% CI 2.9 to 4.3, age and sex adjusted, p<0.001) and waist circumference by 3.6 cm (95% CI 2.9 to 4.3, p<0.001) more than those who did not increase their activity. Similarly, those who increased their physical activity had greater reductions in total cholesterol (group difference in reduction 0.17 mmol/l, 95% CI 0.06 to 0.28, p=0.002), low-density lipoprotein cholesterol (0.16 mmol/l, 95% CI 0.06 to 0.26, p=0.001), low-density lipoprotein/high-density lipoprotein ratio (0.17, 95% CI 0.08 to 0.25, p<0.001) as well as fasting glucose (0.09 mmol/l, 95% CI 0.03 to 0.15, p=0.004) and 2 h glucose levels (0.36 mmol/l, 95% CI 0.17 to 0.55, p=0.023) than those who did not increase their physical activity. Conclusion Increasing physical activity seems to be an important feature of

  3. Qualitative explanations for red giant formation

    International Nuclear Information System (INIS)

    Bhaskar, R.; Nigam, A.

    1991-01-01

    Recent research on giant formation has focused on the need for qualitative explanations. The explanations have the following general, qualitative form: the polytrope n assumes a certain value, that makes (d ln r)/(d ln z) take on a very large value; large increases in r can then be explained in terms of small changes in the variable z. This form is applicable to all the explanations current in the literature: they all have (1) either implicitly or explicitly, both a hydrostatic component and a luminosity-opacity component, and (2) a reliance on singular solutions. Dimensional analysis reveals that power laws that assume the polytrope n to 5 are identical in both the hydrostatic and luminosity-based explanations. 12 refs

  4. Research traditions and evolutionary explanations in medicine.

    Science.gov (United States)

    Méthot, Pierre-Olivier

    2011-02-01

    In this article, I argue that distinguishing 'evolutionary' from 'Darwinian' medicine will help us assess the variety of roles that evolutionary explanations can play in a number of medical contexts. Because the boundaries of evolutionary and Darwinian medicine overlap to some extent, however, they are best described as distinct 'research traditions' rather than as competing paradigms. But while evolutionary medicine does not stand out as a new scientific field of its own, Darwinian medicine is united by a number of distinctive theoretical and methodological claims. For example, evolutionary medicine and Darwinian medicine can be distinguished with respect to the styles of evolutionary explanations they employ. While the former primarily involves 'forward looking' explanations, the latter depends mostly on 'backward looking' explanations. A forward looking explanation tries to predict the effects of ongoing evolutionary processes on human health and disease in contemporary environments (e.g., hospitals). In contrast, a backward looking explanation typically applies evolutionary principles from the vantage point of humans' distant biological past in order to assess present states of health and disease. Both approaches, however, are concerned with the prevention and control of human diseases. In conclusion, I raise some concerns about the claim that 'nothing in medicine makes sense except in the light of evolution'.

  5. Impact of Self-Explanation and Analogical Comparison Support on Learning Processes, Motivation, Metacognition, and Transfer

    Science.gov (United States)

    Richey, J. Elizabeth

    Research examining analogical comparison and self-explanation has produced a robust set of findings about learning and transfer supported by each instructional technique. However, it is unclear how the types of knowledge generated through each technique differ, which has important implications for cognitive theory as well as instructional practice. I conducted a pair of experiments to directly compare the effects of instructional prompts supporting self-explanation, analogical comparison, and the study of instructional explanations across a number of fine-grained learning process, motivation, metacognition, and transfer measures. Experiment 1 explored these questions using sequence extrapolation problems, and results showed no differences between self-explanation and analogical comparison support conditions on any measure. Experiment 2 explored the same questions in a science domain. I evaluated condition effects on transfer outcomes; self-reported self-explanation, analogical comparison, and metacognitive processes; and achievement goals. I also examined relations between transfer and self-reported processes and goals. Receiving materials with analogical comparison support and reporting greater levels of analogical comparison were both associated with worse transfer performance, while reporting greater levels of self-explanation was associated with better performance. Learners' self-reports of self-explanation and analogical comparison were not related to condition assignment, suggesting that the questionnaires did not measure the same processes promoted by the intervention, or that individual differences in processing are robust even when learners are instructed to engage in self-explanation or analogical comparison.

  6. Competing explanations for adopting energy innovations for new office buildings

    International Nuclear Information System (INIS)

    Vermeulen, Walter J.V.; Hovens, Jeroen

    2006-01-01

    An integrative model to explain potential adopters' decisions to adopt energy innovations was adapted and applied in the field of new office building construction. We tested the relative effects of competing theoretical explanations (derived from economics, innovation science and policy science) on the decision to adopt. The research covered 35 projects representing 9% of the total volume of new office construction in the Netherlands between 2000 and mid-2002. Two levels of explanations for adopting innovations were derived: (a) the potential adopter's weighed assessments of the innovations and his or her nature of decision making and (b) explanation of those first-level variables. Using multiple regression techniques, we determined the relative influence on innovation-adoption of variables covering economy and technology, government intervention, company characteristics, and influences from market and society. The decision to adopt 'mature' innovations, in contrast to 'young' innovations, is based more on routine procedures than project-specific considerations. Policies need to take this difference into consideration. We also show evidence that in promoting adoption of E-innovations for new office buildings the Dutch system of applying Energy Performance Standards and subsidies proofs to be effective

  7. Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association.

    Science.gov (United States)

    Barnason, Susan; White-Williams, Connie; Rossi, Laura P; Centeno, Mae; Crabbe, Deborah L; Lee, Kyoung Suk; McCabe, Nancy; Nauser, Julie; Schulz, Paula; Stamp, Kelly; Wood, Kathryn

    2017-06-01

    The burden of cardiovascular disease as a chronic illness increasingly requires patients to assume more responsibility for their self-management. Patient education is believed to be an essential component of cardiovascular care; however, there is limited evidence about specific therapeutic patient education approaches used and the impact on patient self-management outcomes. An integrative review of the literature was conducted to critically analyze published research studies of therapeutic patient education for self-management in selected cardiovascular conditions. There was variability in methodological approaches across settings and disease conditions. The most effective interventions were tailored to individual patient needs, used multiple components to improve self-management outcomes, and often used multidisciplinary approaches. This synthesis of evidence expands the base of knowledge related to the development of patient self-management skills and provides direction for more rigorous research. Recommendations are provided to guide the implementation of therapeutic patient education in clinical practice and the design of comprehensive self-management interventions to improve outcomes for cardiovascular patients. © 2017 American Heart Association, Inc.

  8. Axis: Generating Explanations at Scale with Learnersourcing and Machine Learning

    Science.gov (United States)

    Williams, Joseph Jay; Kim, Juho; Rafferty, Anna; Heffernan, Neil; Maldonado, Samuel; Gajos, Krzysztof Z.; Lasecki, Walter S.; Heffernan, Neil

    2016-01-01

    While explanations may help people learn by providing information about why an answer is correct, many problems on online platforms lack high-quality explanations. This paper presents AXIS (Adaptive eXplanation Improvement System), a system for obtaining explanations. AXIS asks learners to generate, revise, and evaluate explanations as they solve…

  9. The Treatment of cardiovascular Risk in Primary care using Electronic Decision supOrt (TORPEDO) study-intervention development and protocol for a cluster randomised, controlled trial of an electronic decision support and quality improvement intervention in Australian primary healthcare.

    Science.gov (United States)

    Peiris, David; Usherwood, Tim; Panaretto, Katie; Harris, Mark; Hunt, Jenny; Patel, Bindu; Zwar, Nicholas; Redfern, Julie; Macmahon, Stephen; Colagiuri, Stephen; Hayman, Noel; Patel, Anushka

    2012-01-01

    Large gaps exist in the implementation of guideline recommendations for cardiovascular disease (CVD) risk management. Electronic decision support (EDS) systems are promising interventions to close these gaps but few have undergone clinical trial evaluation in Australia. We have developed HealthTracker, a multifaceted EDS and quality improvement intervention to improve the management of CVD risk. It is hypothesised that the use of HealthTracker over a 12-month period will result in: (1) an increased proportion of patients receiving guideline-indicated measurements of CVD risk factors and (2) an increased proportion of patients at high risk will receive guideline-indicated prescriptions for lowering their CVD risk. Sixty health services (40 general practices and 20 Aboriginal Community Controlled Health Services (ACCHSs) will be randomised in a 1:1 allocation to receive either the intervention package or continue with usual care, stratified by service type, size and participation in existing quality improvement initiatives. The intervention consists of point-of-care decision support; a risk communication interface; a clinical audit tool to assess performance on CVD-related indicators; a quality improvement component comprising peer-ranked data feedback and support to develop strategies to improve performance. The control arm will continue with usual care without access to these intervention components. Quantitative data will be derived from cross-sectional samples at baseline and end of study via automated data extraction. Detailed process and economic evaluations will also be conducted. The general practice component of the study is approved by the University of Sydney Human Research Ethics Committee (HREC) and the ACCHS component is approved by the Aboriginal Health and Medical Research Council HREC. Formal agreements with each of the participating sites have been signed. In addition to the usual scientific forums, results will be disseminated via newsletters

  10. Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention.

    Science.gov (United States)

    Sohal, Alex Hardip; Pathak, Neha; Blake, Sarah; Apea, Vanessa; Berry, Judith; Bailey, Jayne; Griffiths, Chris; Feder, Gene

    2018-03-01

    Sexual health and gynaecological problems are the most consistent and largest physical health differences between abused and non-abused female populations. Sexual health services are well placed to identify and support patients experiencing domestic violence and abuse (DVA). Most sexual health professionals have had minimal DVA training despite English National Institute for Health and Care Excellence recommendations. We sought to determine the feasibility of an evidence-based complex DVA training intervention in female sexual health walk-in services (IRIS ADViSE: Identification and Referral to Improve Safety whilst Assessing Domestic Violence in Sexual Health Environments). An adaptive mixed method pilot study in the female walk-in service of two sexual health clinics. Following implementation and evaluation at site 1, the intervention was refined before implementation at site 2. The intervention comprised electronic prompts, multidisciplinary training sessions, clinic materials and simple referral pathways to IRIS ADViSE advocate-educators (AEs). The pilot lasted 7 weeks at site 1 and 12 weeks at site 2. Feasibility outcomes were to assign a supportive DVA clinical lead, an IRIS ADViSE AE employed by a local DVA service provider, adapt electronic records, develop local referral pathways, assess whether enquiry, identification and referral rates were measurable. Both sites achieved all feasibility outcomes: appointing a supportive DVA clinical lead and IRIS ADViSE AE, establishing links with a local DVA provider, adapting electronic records, developing local referral pathways and rates of enquiry, identification and referral were found to be measurable. Site 1: 10% enquiry rate (n=267), 4% identification rate (n=16) and eight AE referrals. Site 2: 61% enquiry rate (n=1090), a 7% identification rate (n=79) and eight AE referrals. IRIS ADViSE can be successfully developed and implemented in sexual health clinics. It fulfils the unmet need for DVA training. Longer

  11. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Lewin, Simon; Lavis, John N; Oxman, Andrew D; Bastías, Gabriel; Chopra, Mickey; Ciapponi, Agustín; Flottorp, Signe; Martí, Sebastian García; Pantoja, Tomas; Rada, Gabriel; Souza, Nathan; Treweek, Shaun; Wiysonge, Charles S; Haines, Andy

    2008-09-13

    Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades.

  12. A new explanation of the extinction paradox

    International Nuclear Information System (INIS)

    Berg, M.J.; Sorensen, C.M.; Chakrabarti, A.

    2011-01-01

    This work presents a new explanation for the extinction paradox and shows that the canonical explanations are incorrect. This paradox refers to the large size limit of a particle's extinction cross section. It is called a paradox because the geometrical optics approximation, which should be valid in this limit, predicts a cross section that is half of the true value. The new explanation is achieved by formulating the scattered wave in terms of an integral over the particle's surface where the seemingly unrelated Ewald-Oseen theorem appears in the formulation. By expressing the cross section in terms of this surface integral, the Ewald-Oseen theorem is analytically connected to the cross section. Several illustrations are used to reveal the significance of this connection: The paradox is seen to be a consequence of the requirement that the incident wave be canceled within the particle by secondary radiation from its own internal field. Following this, the canonical explanations are examined to reveal serious problems. In the process, the same asymptotic extinction behavior is shown to occur for small highly refractive dielectric particles, and thus is not just a large particle size or small wavelength effect as is often stated. The traditional explanations cannot account for this behavior while the new one actually predicts it. All in all, this work constitutes a fundamental reworking of 60 years of accepted understanding for the cause of the asymptotic behavior of the extinction cross section.

  13. Healthcare professional behaviour change using technological supports: A realist literature review

    OpenAIRE

    Chris Keyworth; Jo Hart; Chris A. Armitage

    2015-01-01

    Background Changing healthcare professional behaviour is fundamental to effective patient management. Recent systematic reviews examining healthcare professional behaviour change interventions (such as audit and feedback) suggest that technological support is likely to be crucial in helping healthcare professionals to improve patient outcomes. However we know little about the effectiveness of technological support interventions, and whether the design of technological support interventions...

  14. Register-based studies of healthcare costs

    DEFF Research Database (Denmark)

    Kruse, Marie; Christiansen, Terkel

    2011-01-01

    Introduction: The aim of this paper is to provide an overview and a few examples of how national registers are used in analyses of healthcare costs in Denmark. Research topics: The paper focuses on health economic analyses based on register data. For the sake of simplicity, the studies are divided...... into three main categories: economic evaluations of healthcare interventions, cost-of-illness analyses, and other analyses such as assessments of healthcare productivity. Conclusion: We examined a number of studies using register-based data on healthcare costs. Use of register-based data renders...

  15. Facility-Level Variation in Hospitalization, Mortality, and Costs in the 30 Days After Percutaneous Coronary Intervention: Insights on Short-Term Healthcare Value From the Veterans Affairs Clinical Assessment, Reporting, and Tracking System (VA CART) Program.

    Science.gov (United States)

    Bradley, Steven M; O'Donnell, Colin I; Grunwald, Gary K; Liu, Chuan-Fen; Hebert, Paul L; Maddox, Thomas M; Jesse, Robert L; Fihn, Stephan D; Rumsfeld, John S; Ho, P Michael

    2015-07-14

    Policies to reduce unnecessary hospitalizations after percutaneous coronary intervention (PCI) are intended to improve healthcare value by reducing costs while maintaining patient outcomes. Whether facility-level hospitalization rates after PCI are associated with cost of care is unknown. We studied 32,080 patients who received PCI at any 1 of 62 Veterans Affairs hospitals from 2008 to 2011. We identified facility outliers for 30-day risk-standardized hospitalization, mortality, and cost. Compared with the risk-standardized average, 2 hospitals (3.2%) had a lower-than-expected hospitalization rate, and 2 hospitals (3.2%) had a higher-than-expected hospitalization rate. We observed no statistically significant variation in facility-level risk-standardized mortality. The facility-level unadjusted median per patient 30-day total cost was $23,820 (interquartile range, $19,604-$29,958). Compared with the risk-standardized average, 17 hospitals (27.4%) had lower-than-expected costs, and 14 hospitals (22.6%) had higher-than-expected costs. At the facility level, the index PCI accounted for 83.1% of the total cost (range, 60.3%-92.2%), whereas hospitalization after PCI accounted for only 5.8% (range, 2.0%-12.7%) of the 30-day total cost. Facilities with higher hospitalization rates were not more expensive (Spearman ρ=0.16; 95% confidence interval, -0.09 to 0.39; P=0.21). In this national study, hospitalizations in the 30 day after PCI accounted for only 5.8% of 30-day cost, and facility-level cost was not correlated with hospitalization rates. This challenges the focus on reducing hospitalizations after PCI as an effective means of improving healthcare value. Opportunities remain to improve PCI value by reducing the variation in total cost of PCI without compromising patient outcomes. © 2015 American Heart Association, Inc.

  16. Examining elementary teachers' knowledge and instruction of scientific explanations for fostering children's explanations in science

    Science.gov (United States)

    Wiebke, Heidi Lynn

    This study employed an embedded mixed methods multi-case study design (Creswell, 2014) with six early childhood (grades K-2) teachers to examine a) what changes occurred to their subject matter knowledge (SMK) and pedagogical content knowledge (PCK) for teaching scientific explanations while participating in a professional development program, b) how they planned for and implemented scientific explanation instruction within a teacher developed unit on properties of matter, and c) what affordances their instruction of scientific explanations had on fostering their students' abilities to generate explanations in science. Several quantitative and qualitative measures were collected and analyzed in accordance to this studies conceptual framework, which consisted of ten instructional practices teachers should consider assimilating or accommodating into their knowledge base (i.e., SMK & PCK) for teaching scientific explanations. Results of this study indicate there was little to no positive change in the teachers' substantive and syntactic SMK. However, all six teachers did make significant changes to all five components of their PCK for teaching explanations in science. While planning for scientific explanation instruction, all six teachers' contributed some ideas for how to incorporate seven of the ten instructional practices for scientific explanations within the properties of matter unit they co-developed. When enacting the unit, the six teachers' employed seven to nine of the instructional practices to varying levels of effectiveness, as measured by researcher developed rubrics. Given the six teachers' scientific explanation instruction, many students did show improvement in their ability to formulate a scientific explanation, particularly their ability to provide multiple pieces of evidence. Implications for professional developers, teacher educators, researchers, policy makers, and elementary teachers regarding how to prepare teachers for and support students

  17. Reasoning in explanation-based decision making.

    Science.gov (United States)

    Pennington, N; Hastie, R

    1993-01-01

    A general theory of explanation-based decision making is outlined and the multiple roles of inference processes in the theory are indicated. A typology of formal and informal inference forms, originally proposed by Collins (1978a, 1978b), is introduced as an appropriate framework to represent inferences that occur in the overarching explanation-based process. Results from the analysis of verbal reports of decision processes are presented to demonstrate the centrality and systematic character of reasoning in a representative legal decision-making task.

  18. Foreword: Surface Tensions: Between Explanation and Understanding.

    Science.gov (United States)

    Blauvelt, Andrew

    1995-01-01

    Introduces this issue of the journal, which is devoted to new perspectives on critical histories of graphic design. Notes that the essays in this issue offer examples of the variety of interpretative approaches available that serve to question both the previously unchallenged acceptance of historical explanations and the transcendent understanding…

  19. Students' reasons for preferring teleological explanations

    Science.gov (United States)

    Trommler, Friederike; Gresch, Helge; Hammann, Marcus

    2018-01-01

    The teleological bias, a major learning obstacle, involves explaining biological phenomena in terms of purposes and goals. To probe the teleological bias, researchers have used acceptance judgement tasks and preference judgement tasks. In the present study, such tasks were used with German high school students (N = 353) for 10 phenomena from human biology, that were explained both teleologically and causally. A sub-sample (n = 26) was interviewed about the reasons for their preferences. The results showed that the students favoured teleological explanations over causal explanations. Although the students explained their preference judgements etiologically (i.e. teleologically and causally), they also referred to a wide range of non-etiological criteria (i.e. familiarity, complexity, relevance and five more criteria). When elaborating on their preference for causal explanations, the students often focused not on the causality of the phenomenon, but on mechanisms whose complexity they found attractive. When explaining their preference for teleological explanations, they often focused not teleologically on purposes and goals, but rather on functions, which they found familiar and relevant. Generally, students' preference judgements rarely allowed for making inferences about causal reasoning and teleological reasoning, an issue that is controversial in the literature. Given that students were largely unaware of causality and teleology, their attention must be directed towards distinguishing between etiological and non-etiological reasoning. Implications for educational practice as well as for future research are discussed.

  20. Social Groups, Explanation and Ontological Holism | Sheehy ...

    African Journals Online (AJOL)

    The paper begins from the claim that ontological holism is given prima facie plausibility by the apparently ineliminable role of groups in some descriptions and explanations of the social domain. If the individualist accepts the link between indispensabilty and realism, then individualism must show that groups cannot play the ...

  1. Ontological Order in Scientific Explanation | Park | Philosophical ...

    African Journals Online (AJOL)

    A conceptually sound explanation, I claim, respects the ontological order between properties. A dependent property is to be explained in terms of its underlying property, not the other way around. The applicability of this point goes well beyond the realm of the debate between scientific realists and antirealists.

  2. Age and the Explanation of Crime, Revisited

    Science.gov (United States)

    Sweeten, Gary; Piquero, Alex R.; Steinberg, Laurence

    2013-01-01

    Age is one of the most robust correlates of criminal behavior. Yet, explanations for this relationship are varied and conflicting. Developmental theories point to a multitude of sociological, psychological, and biological changes that occur during adolescence and adulthood. One prominent criminological perspective outlined by Gottfredson and…

  3. Enhancing human understanding through intelligent explanations

    NARCIS (Netherlands)

    Mioch, T.; Harbers, M.; Doesburg, W.A. van; Bosch, K. van den

    2007-01-01

    Ambient systems that explain their actions promote the user's understanding as they give the user more insight in the e®ects of their behavior on the environment. In order to provide individualized intelligent explanations, we need not only to evaluate a user's observable behavior, but we also need

  4. Competence Matching Tool - Explanations and Implementation

    NARCIS (Netherlands)

    Herder, Eelco; Kärger, Philipp

    2010-01-01

    Herder, E., Kärger, P. (2009) Competence Matching Tool - Explanations and Implementation. The document contains the technical specification of the competence matching tool. The tool can be found at http://tencompetence.cvs.sourceforge.net/viewvc/tencompetence/wp7/CompetenceMatcher/ and the location

  5. Separable explanations of neural network decisions

    DEFF Research Database (Denmark)

    Rieger, Laura

    2017-01-01

    Deep Taylor Decomposition is a method used to explain neural network decisions. When applying this method to non-dominant classifications, the resulting explanation does not reflect important features for the chosen classification. We propose that this is caused by the dense layers and propose...

  6. Theism and Inference to the Best Explanation

    NARCIS (Netherlands)

    Holten, W. van

    2002-01-01

    In this paper the author critically examines the explanatory role of theistic belief. Although talk of religious beliefs as explanations is commonly employed in the context of religious epistemology, it may also serve to simply characterise one of the functions of religious views of life. It is

  7. Theism and inference to the Best Explanation

    NARCIS (Netherlands)

    Holten, Wilko van

    2002-01-01

    In this paper the author critically examines the explanatory role of theistic belief. Although talk of religious beliefs as explanations is commonly employed in the context of religious epistemology, it may also serve to simply characterise one of the functions of religious views of life. It is

  8. Electronic healthcare information security

    CERN Document Server

    Dube, Kudakwashe; Shoniregun, Charles A

    2010-01-01

    The ever-increasing healthcare expenditure and pressing demand for improved quality and efficiency of patient care services are driving innovation in healthcare information management. The domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy. ""Electronic Healthcare Information Security"" explores the challenges of e-healthcare information and security policy technologies. It evaluates the effectiveness of security and privacy implementation systems for anonymization methods and techniqu

  9. A randomized controlled trial of a brief intervention for illicit drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health-care settings in four countries.

    Science.gov (United States)

    Humeniuk, Rachel; Ali, Robert; Babor, Thomas; Souza-Formigoni, Maria Lucia O; de Lacerda, Roseli Boerngen; Ling, Walter; McRee, Bonnie; Newcombe, David; Pal, Hemraj; Poznyak, Vladimir; Simon, Sara; Vendetti, Janice

    2012-05-01

    This study evaluated the effectiveness of a brief intervention (BI) for illicit drugs (cannabis, cocaine, amphetamine-type stimulants and opioids) linked to the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST screens for problem or risky use of 10 psychoactive substances, producing a score for each substance that falls into either a low-, moderate- or high-risk category. Prospective, randomized controlled trial in which participants were either assigned to a 3-month waiting-list control condition or received brief motivational counselling lasting an average of 13.8 minutes for the drug receiving the highest ASSIST score. Primary health-care settings in four countries: Australia, Brazil, India and the United States. A total of 731 males and females scoring within the moderate-risk range of the ASSIST for cannabis, cocaine, amphetamine-type stimulants or opioids. ASSIST-specific substance involvement scores for cannabis, stimulants or opioids and ASSIST total illicit substance involvement score at baseline and 3 months post-randomization. Omnibus analyses indicated that those receiving the BI had significantly reduced scores for all measures, compared with control participants. Country-specific analyses showed that, with the exception of the site in the United States, BI participants had significantly lower ASSIST total illicit substance involvement scores at follow-up compared with the control participants. The sites in India and Brazil demonstrated a very strong brief intervention effect for cannabis scores (P Brazil (P illicit substance use and related risks is effective, at least in the short term, and the effect generalizes across countries. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

  10. Licensed Healthcare Facilities

    Data.gov (United States)

    California Natural Resource Agency — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

  11. Impact of telephone nursing education program for equity in healthcare

    OpenAIRE

    H?glund, Anna T.; Carlsson, Marianne; Holmstr?m, Inger K.; Kaminsky, Elenor

    2016-01-01

    Background The Swedish Healthcare Act prescribes that healthcare should be provided according to needs and with respect for each person?s human dignity. The goal is equity in health for the whole population. In spite of this, studies have revealed that Swedish healthcare is not always provided equally. This has also been observed in telephone nursing. Therefore, the aim of the present study was to investigate if and how an educational intervention can improve awareness of equity in healthcare...

  12. Explanation for the Mystical Practice III.

    Directory of Open Access Journals (Sweden)

    Květoslav Minařík

    2016-11-01

    Full Text Available Concentration on feet and legs as a whole, with a special focus on their flesh, has an effect on the development of the intellect and deepening of the sensory discernment, because right here, in the legs, in the flesh of the body, the basis of the inner life is situated. The same concentration with a special focus on their bones – and in particular to the bones of knees – eliminates the instability of the usual attention; it is used to stabilize the entire inner life. The current article is a continuation of Explanation for the Mystical Practice I. and Explanation for the Mystical Practice II., published in the previous editions of Spirituality Studies.

  13. An Explanation of Economic Change and Development

    OpenAIRE

    Fusari, Angelo

    2014-01-01

    The contribution to the explanation of economic change that this paper sets out is centered on a core of interconnected endogenous variables, mainly innovation, radical uncertainty and entrepreneurship, which current economic analyses consider only in part and separately, sometimes as endogenous but for the most as exogenous. The article (and the formalized model) suppose that the functioning of the economy is not disturbed by the operation of pathological factors mainly concer...

  14. Explanation-based learning in infancy.

    Science.gov (United States)

    Baillargeon, Renée; DeJong, Gerald F

    2017-10-01

    In explanation-based learning (EBL), domain knowledge is leveraged in order to learn general rules from few examples. An explanation is constructed for initial exemplars and is then generalized into a candidate rule that uses only the relevant features specified in the explanation; if the rule proves accurate for a few additional exemplars, it is adopted. EBL is thus highly efficient because it combines both analytic and empirical evidence. EBL has been proposed as one of the mechanisms that help infants acquire and revise their physical rules. To evaluate this proposal, 11- and 12-month-olds (n = 260) were taught to replace their current support rule (that an object is stable when half or more of its bottom surface is supported) with a more sophisticated rule (that an object is stable when half or more of the entire object is supported). Infants saw teaching events in which asymmetrical objects were placed on a base, followed by static test displays involving a novel asymmetrical object and a novel base. When the teaching events were designed to facilitate EBL, infants learned the new rule with as few as two (12-month-olds) or three (11-month-olds) exemplars. When the teaching events were designed to impede EBL, however, infants failed to learn the rule. Together, these results demonstrate that even infants, with their limited knowledge about the world, benefit from the knowledge-based approach of EBL.

  15. Self-Explanation, An Instructional Strategy to Foster Clinical Reasoning in Medical Students

    Directory of Open Access Journals (Sweden)

    Martine Chamberland

    2015-12-01

    Full Text Available Clinical reasoning is a critical and complex skill that medical students have to develop in the course of their training. Although research on medical expertise has successfully examined the different components of that skill, designing educational interventions that support the development of clinical reasoning in students remains a challenge for medical educators. The theory of medical expertise describes how students׳ medical knowledge develops and is progressively restructured during their training and in particular through clinical exposure to patient problems. Instructional strategies to foster students’ learning from practice with clinical cases are scarce. This article describes the use of self-explanation as such a strategy. Self-explanation is an active learning technique of proven effectiveness in other domains which consists of having students explaining to themselves information on to-be-learned materials. The mechanisms through which self-explanation fosters learning are described. Self-explanation promotes knowledge development and revision of mental representations through elaboration on new information, organisation and integration of new knowledge into existing cognitive structures and monitoring of the learning process. Subsequently, the article shows how self-explanation has recently been investigated in medicine as an instructional strategy to support students׳ clinical reasoning. Available studies have demonstrated that students׳ diagnostic performance improves when they use self-explanation while solving clinical problems of a less familiar clinical topic. Unfamiliarity seems to trigger more self-explanations and to stimulate students to reactivate relevant biomedical knowledge, which could lead to the development of more coherent representations of diseases. The benefit of students׳ self-explanation is increased when it is combined with listening to residents׳ self-explanation examples and with prompts. The

  16. Ultimate and proximate explanations of strong reciprocity.

    Science.gov (United States)

    Vromen, Jack

    2017-08-23

    Strong reciprocity (SR) has recently been subject to heated debate. In this debate, the "West camp" (West et al. in Evol Hum Behav 32(4):231-262, 2011), which is critical of the case for SR, and the "Laland camp" (Laland et al. in Science, 334(6062):1512-1516, 2011, Biol Philos 28(5):719-745, 2013), which is sympathetic to the case of SR, seem to take diametrically opposed positions. The West camp criticizes advocates of SR for conflating proximate and ultimate causation. SR is said to be a proximate mechanism that is put forward by its advocates as an ultimate explanation of human cooperation. The West camp thus accuses advocates of SR for not heeding Mayr's original distinction between ultimate and proximate causation. The Laland camp praises advocates of SR for revising Mayr's distinction. Advocates of SR are said to replace Mayr's uni-directional view on the relation between ultimate and proximate causes by the bi-directional one of reciprocal causation. The paper argues that both the West camp and the Laland camp misrepresent what advocates of SR are up to. The West camp is right that SR is a proximate cause of human cooperation. But rather than putting forward SR as an ultimate explanation, as the West camp argues, advocates of SR believe that SR itself is in need of ultimate explanation. Advocates of SR tend to take gene-culture co-evolutionary theory as the correct meta-theoretical framework for advancing ultimate explanations of SR. Appearances notwithstanding, gene-culture coevolutionary theory does not imply Laland et al.'s notion of reciprocal causation. "Reciprocal causation" suggests that proximate and ultimate causes interact simultaneously, while advocates of SR assume that they interact sequentially. I end by arguing that the best way to understand the debate is by disambiguating Mayr's ultimate-proximate distinction. I propose to reserve "ultimate" and "proximate" for different sorts of explanations, and to use other terms for distinguishing

  17. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories.

    Science.gov (United States)

    Kwasnicka, Dominika; Dombrowski, Stephan U; White, Martin; Sniehotta, Falko

    2016-09-01

    Behaviour change interventions are effective in supporting individuals in achieving temporary behaviour change. Behaviour change maintenance, however, is rarely attained. The aim of this review was to identify and synthesise current theoretical explanations for behaviour change maintenance to inform future research and practice. Potentially relevant theories were identified through systematic searches of electronic databases (Ovid MEDLINE, Embase, PsycINFO). In addition, an existing database of 80 theories was searched, and 25 theory experts were consulted. Theories were included if they formulated hypotheses about behaviour change maintenance. Included theories were synthesised thematically to ascertain overarching explanations for behaviour change maintenance. Initial theoretical themes were cross-validated. One hundred and seventeen behaviour theories were identified, of which 100 met the inclusion criteria. Five overarching, interconnected themes representing theoretical explanations for behaviour change maintenance emerged. Theoretical explanations of behaviour change maintenance focus on the differential nature and role of motives, self-regulation, resources (psychological and physical), habits, and environmental and social influences from initiation to maintenance. There are distinct patterns of theoretical explanations for behaviour change and for behaviour change maintenance. The findings from this review can guide the development and evaluation of interventions promoting maintenance of health behaviours and help in the development of an integrated theory of behaviour change maintenance.

  18. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories

    Science.gov (United States)

    Kwasnicka, Dominika; Dombrowski, Stephan U; White, Martin; Sniehotta, Falko

    2016-01-01

    ABSTRACT Background: Behaviour change interventions are effective in supporting individuals in achieving temporary behaviour change. Behaviour change maintenance, however, is rarely attained. The aim of this review was to identify and synthesise current theoretical explanations for behaviour change maintenance to inform future research and practice. Methods: Potentially relevant theories were identified through systematic searches of electronic databases (Ovid MEDLINE, Embase, PsycINFO). In addition, an existing database of 80 theories was searched, and 25 theory experts were consulted. Theories were included if they formulated hypotheses about behaviour change maintenance. Included theories were synthesised thematically to ascertain overarching explanations for behaviour change maintenance. Initial theoretical themes were cross-validated. Findings: One hundred and seventeen behaviour theories were identified, of which 100 met the inclusion criteria. Five overarching, interconnected themes representing theoretical explanations for behaviour change maintenance emerged. Theoretical explanations of behaviour change maintenance focus on the differential nature and role of motives, self-regulation, resources (psychological and physical), habits, and environmental and social influences from initiation to maintenance. Discussion: There are distinct patterns of theoretical explanations for behaviour change and for behaviour change maintenance. The findings from this review can guide the development and evaluation of interventions promoting maintenance of health behaviours and help in the development of an integrated theory of behaviour change maintenance. PMID:26854092

  19. Negotiating explanations: doctor-patient communication with patients with medically unexplained symptoms-a qualitative analysis.

    Science.gov (United States)

    den Boeft, Madelon; Huisman, Daniëlle; Morton, LaKrista; Lucassen, Peter; van der Wouden, Johannes C; Westerman, Marjan J; van der Horst, Henriëtte E; Burton, Christopher D

    2017-02-01

    Patients with medically unexplained physical symptoms (MUPS) seek explanations for their symptoms, but often find general practitioners (GPs) unable to deliver these. Different methods of explaining MUPS have been proposed. Little is known about how communication evolves around these explanations. To examine the dialogue between GPs and patients related to explanations in a community-based clinic for MUPS. We categorized dialogue types and dialogue outcomes. Patients were ≥18 years with inclusion criteria for moderate MUPS: ≥2 referrals to specialists, ≥1 functional syndrome/symptoms, ≥10 on the Patient Health Questionnaire-15 and GP's judgement that symptoms were unexplained. We analysed transcripts of 112 audio-recorded consultations (39 patients and 5 GPs) from two studies on the Symptoms Clinic Intervention, a consultation intervention for MUPS in primary care. We used constant comparative analysis to code and classify dialogue types and outcomes. We extracted 115 explanation sequences. We identified four dialogue types, differing in the extent to which the GP or patient controlled the dialogue. We categorized eight outcomes of the sequences, ranging from acceptance to rejection by the patient. The most common outcome was holding (conversation suspended in an unresolved state), followed by acceptance. Few explanations were rejected by the patient. Co-created explanations by patient and GP were most likely to be accepted. We developed a classification of dialogue types and outcomes in relation to explanations offered by GPs for MUPS patients. While it requires further validation, it provides a framework, which can be used for teaching, evaluation of practice and research. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Explanation and observability of diffraction in time

    International Nuclear Information System (INIS)

    Torrontegui, E.; Muga, J. G.; Munoz, J.; Ban, Yue

    2011-01-01

    Diffraction in time (DIT) is a fundamental phenomenon in quantum dynamics due to time-dependent obstacles and slits. It is formally analogous to diffraction of light, and is expected to play an increasing role in the design of coherent matter wave sources, as in the atom laser, to analyze time-of-flight information and emission from ultrafast pulsed excitations, and in applications of coherent matter waves in integrated atom-optical circuits. We demonstrate that DIT emerges robustly in quantum waves emitted by an exponentially decaying source and provide a simple explanation of the phenomenon, as an interference of two characteristic velocities. This allows for its controllability and optimization.

  1. A hadronic explanation of the lepton anomaly

    DEFF Research Database (Denmark)

    Mertsch, Philipp; Sarkar, Subir

    2014-01-01

    The rise in the positron fraction, observed by PAMELA, Fermi-LAT and most recently by AMS-02, has created a lot of interest, fuelled by speculations about an origin in dark matter annihilation in the Galactic halo. However, other channels, e.g. antiprotons or gamma-rays, now severely constrain dark....... This mechanism is guaranteed if hadronic CRs are present and would also lead to observable signatures in other secondary channels like the boron-to-carbon or antiproton-to-proton ratios. If such features were borne out by upcoming AMS-02 data, this would rule out other explanations....

  2. An explanation of the Hiroshima activation dilemma

    International Nuclear Information System (INIS)

    Rhoades, W.A.; Barnes, J.M.; Santoro, R.T.

    1994-01-01

    A 1987 study of the radiation from the World War II nuclear weapons applied state-of-the-art data and computer techniques, providing an important advance in reliability of the results. Still, a disturbing disagreement remained between slow-neutron activation measurements and calculations for the Hiroshima event. Newer data have confirmed the validity of the discrepancy. This work examines various potential explanations. Of those examined, only an enhancement to the weapon neutron leakage spectrum in the vicinity of the 2.3 MeV oxygen cross section window can fit the data accurately

  3. Explanation and practice on ISO 9000

    International Nuclear Information System (INIS)

    Kwon, Dong Myeong

    2001-01-01

    This book reveals introduction on revision of ISO 9000:2000 with full account and contents of revision and change method change into ISO 9001:2000, the basic principle on ISO 9000:2000 and improvement and aim, definition on explanation, method for detail term, demand for ISO/KS A 9001:2000, quality management system development and transition way, standardization for quality management, manual of quality and making procedure and guide, case of quality manual and procedure and guide and ISO 9001:2000 / KS A 9001:2001 an English-Korean translation.

  4. Missed opportunities in child healthcare

    Directory of Open Access Journals (Sweden)

    Linda Jonker

    2014-08-01

    Objectives: This article describes the experiences of mothers that utilised comprehensive child health services in the Cape Metropolitan area of South Africa. Services included treatment for diseases; preventative interventions such as immunisation; and promotive interventions, such as improvement in nutrition and promotion of breastfeeding. Method: A qualitative, descriptive phenomenological approach was applied to explore the experiences and perceptions of mothers and/or carers utilising child healthcare services. Thirty percent of the clinics were selected purposively from the total population. A convenience purposive non-probability sampling method was applied to select 17 mothers who met the criteria and gave written consent. Interviews were conducted and recorded digitally using an interview guide. The data analysis was done using Tesch’s eight step model. Results: Findings of the study indicated varied experiences. Not all mothers received information about the Road to Health book or card. According to the mothers, integrated child healthcare services were not practised. The consequences were missed opportunities in immunisation, provision of vitamin A, absence of growth monitoring, feeding assessment and provision of nutritional advice. Conclusion: There is a need for simple interventions such as oral rehydration, early recognition and treatment of diseases, immunisation, growth monitoring and appropriate nutrition advice. These services were not offered diligently. Such interventions could contribute to reducing the incidence of child morbidity and mortality.

  5. Missed opportunities in child healthcare

    Directory of Open Access Journals (Sweden)

    Linda Jonker

    2014-01-01

    Full Text Available Background: Various policies in health, such as Integrated Management of Childhood Illnesses, were introduced to enhance integrated service delivery in child healthcare. During clinical practice the researcher observed that integrated services may not be rendered.Objectives: This article describes the experiences of mothers that utilised comprehensive child health services in the Cape Metropolitan area of South Africa. Services included treatment for diseases; preventative interventions such as immunisation; and promotive interventions, such as improvement in nutrition and promotion of breastfeeding.Method: A qualitative, descriptive phenomenological approach was applied to explore the experiences and perceptions of mothers and/or carers utilising child healthcare services. Thirty percent of the clinics were selected purposively from the total population. A convenience purposive non-probability sampling method was applied to select 17 mothers who met the criteria and gave written consent. Interviews were conducted and recorded digitally using an interview guide. The data analysis was done using Tesch’s eight step model.Results: Findings of the study indicated varied experiences. Not all mothers received information about the Road to Health book or card. According to the mothers, integrated child healthcare services were not practised. The consequences were missed opportunities in immunisation, provision of vitamin A, absence of growth monitoring, feeding assessment and provision of nutritional advice.Conclusion: There is a need for simple interventions such as oral rehydration, early recognition and treatment of diseases, immunisation, growth monitoring and appropriate nutrition advice. These services were not offered diligently. Such interventions could contribute to reducing the incidence of child morbidity and mortality.

  6. Atomic energy in healthcare

    International Nuclear Information System (INIS)

    Gupta, Sudeep; Rangarajan, Venkatesh; Thakur, Meenakshi; Parmar, Vani; Jalali, Rakesh; Ashgar, Ali; Pramesh, C.S.; Shrivastava, Shyam; Badwe, Rajendra

    2013-01-01

    One of the socially important non-power programmes of the DAE is in the beneficial use of radiation and related techniques for healthcare. The diagnosis and therapy aspects of radiation based healthcare are discussed in this article. (author)

  7. Communicating with Healthcare Professionals

    Science.gov (United States)

    ... at follow-up appointments by talking with your healthcare team about your concerns, asking questions and getting ... from the time you spend with all your healthcare providers, not just your doctor. Use the skills ...

  8. An Explanation of the Missing Flux from Boyajian's Mysterious Star

    Energy Technology Data Exchange (ETDEWEB)

    Foukal, Peter [192 Willow Road, Nahant, MA 01908 (United States)

    2017-06-10

    A previously unremarkable star in the constellation Cygnus has, in the past year, become known as the most mysterious object in our Galaxy. Boyajian’s star exhibits puzzling episodes of sporadic, deep dimming discovered in photometry with the Kepler Mission. Proposed explanations have focused on its obscuration by colliding exoplanets, exocomets, and even intervention of alien intelligence. These hypotheses have considered only phenomena external to the star because the radiative flux missing in the dimmings was believed to exceed the star’s storage capacity. We point out that modeling of variations in solar luminosity indicates that convective stars can store the required fluxes. It also suggests explanations for (a) a reported time-profile asymmetry of the short, deep dimmings and (b) a slower, decadal scale dimming reported from archival and Kepler photometry. Our findings suggest a broader range of explanations of Boyajian’s star that may produce new insights into stellar magneto-convection.

  9. Antimicrobial resistance and biological governance: explanations for policy failure.

    Science.gov (United States)

    Wallinga, D; Rayner, G; Lang, T

    2015-10-01

    The paper reviews the state of policy on antimicrobial use and the growth of antimicrobial resistance (AMR). AMR was anticipated at the time of the first use of antibiotics by their originators. For decades, reports and scientific papers have expressed concern about AMR at global and national policy levels, yet the problem, first exposed a half-century ago, worsened. The paper considers the explanations for this policy failure and the state of arguments about ways forward. These include: a deficit of economic incentivisation; complex interventions in behavioural dynamics; joint and separate shifts in medical and animal health regimes; consumerism; belief in technology; and a narrative that in a 'war on bugs' nature can be beaten by human ingenuity. The paper suggests that these narratives underplay the biological realities of the human-animal-biosphere being in constant flux, an understanding which requires an ecological public health analysis of AMR policy development and failure. The paper suggests that effective policy change requires simultaneous actions across policy levels. No single solution is possible, since AMR is the result of long-term human intervention which has accelerated certain trends in the evolution of a microbial ecosystem shared by humans, animals and other biological organisms inhabiting that ecosystem. Viewing the AMR crisis today through an ecological public health lens has the advantage of reuniting the social-ecological and bio-ecological perspectives which have been separated within public health. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  10. Promoting Vicarious Learning of Physics Using Deep Questions with Explanations

    Science.gov (United States)

    Craig, Scotty D.; Gholson, Barry; Brittingham, Joshua K.; Williams, Joah L.; Shubeck, Keith T.

    2012-01-01

    Two experiments explored the role of vicarious "self" explanations in facilitating student learning gains during computer-presented instruction. In Exp. 1, college students with low or high knowledge on Newton's laws were tested in four conditions: (a) monologue (M), (b) questions (Q), (c) explanation (E), and (d) question + explanation (Q + E).…

  11. Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

    Science.gov (United States)

    Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

    2013-01-01

    Background Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. Methods One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. Results The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). Conclusion The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB. PMID:24098461

  12. Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa.

    Science.gov (United States)

    Claassens, Mareli M; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J; Enarson, Donald A; Beyers, Nulda; Borgdorff, Martien W

    2013-01-01

    Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.

  13. Healthcare. Executive Summary

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…

  14. The status of functional explanation in psychology: reduction and mechanistic explanation

    NARCIS (Netherlands)

    Gervais, H.; Looren De Jong, H.

    2013-01-01

    The validity of functional explanations as they are commonly used in psychology has recently come under attack. Kim's supervenience argument purports to prove that higher-level generalizations have no causal powers of their own, and hence are explanatorily irrelevant. In a nutshell, the

  15. Evaluation of Explanation Interfaces in Recommender Systems

    Directory of Open Access Journals (Sweden)

    Sergio Cleger-Tamayo

    2017-05-01

    Full Text Available Explaining interfaces become a useful tool in systems that have a lot of content to evaluate by users. The different interfaces represent a help for the undecided users or those who consider systems as boxed black smart. These systems present recommendations to users based on different learning models. In this paper, we present the different objectives of the explanation interfaces and some of the criteria that you can evaluate, as well as a proposal of metrics to obtain results in the experiments. Finally, we showed the main results of a study with real users and their interaction with e-commerce systems. Among the main results, highlight the positive impact in relation to the time of interaction with the applications and acceptance of the recommendations received.

  16. An explanation of the mysterious quasars

    International Nuclear Information System (INIS)

    Borissov, O.

    1977-01-01

    The article presents details of a convincing new theory submitted by Russian scientists, concerning the physical nature of quasars. These were discovered in 1963 and for over ten years no satisfactory theory has been forthcoming to explain their seemingly incompatible properties or the associated phenomena. These very distant objects are believed to be sources of the most powerful electromagnetic emission. From the new theory expounded it is concluded that for the first time since their discovery a satisfactory explanation of their nature has been reached. From this it is hoped that the mechanism of energy generation by quasars may ultimately be understood and, though on a much reduced scale, contribute to the solution of energy problems on earth. (R.J.J.)

  17. Bayesianism and inference to the best explanation

    Directory of Open Access Journals (Sweden)

    Valeriano IRANZO

    2008-01-01

    Full Text Available Bayesianism and Inference to the best explanation (IBE are two different models of inference. Recently there has been some debate about the possibility of “bayesianizing” IBE. Firstly I explore several alternatives to include explanatory considerations in Bayes’s Theorem. Then I distinguish two different interpretations of prior probabilities: “IBE-Bayesianism” (IBE-Bay and “frequentist-Bayesianism” (Freq-Bay. After detailing the content of the latter, I propose a rule for assessing the priors. I also argue that Freq-Bay: (i endorses a role for explanatory value in the assessment of scientific hypotheses; (ii avoids a purely subjectivist reading of prior probabilities; and (iii fits better than IBE-Bayesianism with two basic facts about science, i.e., the prominent role played by empirical testing and the existence of many scientific theories in the past that failed to fulfil their promises and were subsequently abandoned.

  18. Complexity and demographic explanations of cumulative culture.

    Science.gov (United States)

    Querbes, Adrien; Vaesen, Krist; Houkes, Wybo

    2014-01-01

    Formal models have linked prehistoric and historical instances of technological change (e.g., the Upper Paleolithic transition, cultural loss in Holocene Tasmania, scientific progress since the late nineteenth century) to demographic change. According to these models, cumulation of technological complexity is inhibited by decreasing--while favoured by increasing--population levels. Here we show that these findings are contingent on how complexity is defined: demography plays a much more limited role in sustaining cumulative culture in case formal models deploy Herbert Simon's definition of complexity rather than the particular definitions of complexity hitherto assumed. Given that currently available empirical evidence doesn't afford discriminating proper from improper definitions of complexity, our robustness analyses put into question the force of recent demographic explanations of particular episodes of cultural change.

  19. Complexity and demographic explanations of cumulative culture.

    Directory of Open Access Journals (Sweden)

    Adrien Querbes

    Full Text Available Formal models have linked prehistoric and historical instances of technological change (e.g., the Upper Paleolithic transition, cultural loss in Holocene Tasmania, scientific progress since the late nineteenth century to demographic change. According to these models, cumulation of technological complexity is inhibited by decreasing--while favoured by increasing--population levels. Here we show that these findings are contingent on how complexity is defined: demography plays a much more limited role in sustaining cumulative culture in case formal models deploy Herbert Simon's definition of complexity rather than the particular definitions of complexity hitherto assumed. Given that currently available empirical evidence doesn't afford discriminating proper from improper definitions of complexity, our robustness analyses put into question the force of recent demographic explanations of particular episodes of cultural change.

  20. Auditory Verbal Hallucinations in Schizophrenia From a Levels of Explanation Perspective.

    Science.gov (United States)

    Hugdahl, Kenneth; Sommer, Iris E

    2018-02-15

    In the present article, we present a "Levels of Explanation" (LoE) approach to auditory verbal hallucinations (AVHs) in schizophrenia. Mental phenomena can be understood at different levels of explanation, including cultural, clinical, cognitive, brain imaging, cellular, and molecular levels. Current research on AVHs is characterized by accumulation of data at all levels, but with little or no interaction of findings between levels. A second advantage with a Levels of Explanation approach is that it fosters interdisciplinarity and collaboration across traditional borders, facilitating a real breakthrough in future research. We exemplify a Levels of Explanation approach with data from 3 levels where findings at 1 level provide predictions for another level. More specifically, we show how functional neuroimaging data at the brain level correspond with behavioral data at the cognitive level, and how data at these 2 levels correspond with recent findings of changes in neurotransmitter function at the cellular level. We further discuss implications for new therapeutic interventions, and the article is ended by suggestion how future research could incorporate genetic influences on AVHs at the molecular level of explanation by providing examples for animal work.

  1. Do healthcare administrators care less about health?

    Science.gov (United States)

    Fleenor, C P; Weis, W L

    1983-01-01

    In a recent study conducted by the authors, Seattle-area managers disclosed a high incidence of discrimination against smokers at the hiring point, and expressed strong preferences for further restrictions on smoking in the workplace. Surprisingly, of the six management groups represented in the study, only healthcare administrators were acquiescent toward the presumed rights of smokers as employees. This anomaly, as well as other insights drawn from the research, is discussed in the article. Reader explanations to the apparent contradiction presented here are invited.

  2. Taste, Salt Consumption, and Local Explanations around Hypertension in a Rural Population in Northern Peru

    OpenAIRE

    Pesantes, M. Amalia; Diez-Canseco, Francisco; Bernab?-Ortiz, Antonio; Ponce-Lucero, Vilarmina; Miranda, J. Jaime

    2017-01-01

    Interventions to promote behaviors to reduce sodium intake require messages tailored to local understandings of the relationship between what we eat and our health. We studied local explanations about hypertension, the relationship between local diet, salt intake, and health status, and participants? opinions about changing food habits. This study provided inputs for a social marketing campaign in Peru promoting the use of a salt substitute containing less sodium than regular salt. Qualitativ...

  3. Theoretical explanations for maintenance of behaviour change: a systematic review of behaviour theories

    OpenAIRE

    Kwasnicka, Dominika; Dombrowski, Stephan U; White, Martin; Sniehotta, Falko

    2016-01-01

    ABSTRACT Background: Behaviour change interventions are effective in supporting individuals in achieving temporary behaviour change. Behaviour change maintenance, however, is rarely attained. The aim of this review was to identify and synthesise current theoretical explanations for behaviour change maintenance to inform future research and practice. Methods: Potentially relevant theories were identified through systematic searches of electronic databases (Ovid MEDLINE, Embase, PsycINFO). In a...

  4. The intersection of disability and healthcare disparities: a conceptual framework.

    Science.gov (United States)

    Meade, Michelle A; Mahmoudi, Elham; Lee, Shoou-Yih

    2015-01-01

    healthcare among individuals with disabilities. The Model of Healthcare Disparities and Disability (MHDD) provides a framework for conceptualizing how healthcare disparities impact disability and specifically, how a mismatch between personal and environmental factors may result in reduced healthcare access and quality, which in turn may lead to reduced functioning, activity and participation among individuals with impairments and chronic health conditions. Researchers, health providers, policy makers and community advocate groups who are engaged in devising interventions aimed at reducing healthcare disparities would benefit from the discussions. Implications for Rehabilitation Evaluates the main models of healthcare disparity and disability to create an integrated framework. Provides a comprehensive conceptual model of healthcare disparity that specifically targets issues related to individuals with disabilities. Conceptualizes how personal and environmental factors interact to produce disparities in access to healthcare and healthcare quality. Recognizes and targets modifiable factors to reduce disparities between and within individuals with disabilities.

  5. The matchmaking paradox: a statistical explanation

    International Nuclear Information System (INIS)

    Eliazar, Iddo I; Sokolov, Igor M

    2010-01-01

    Medical surveys regarding the number of heterosexual partners per person yield different female and male averages-a result which, from a physical standpoint, is impossible. In this paper we term this puzzle the 'matchmaking paradox', and establish a statistical model explaining it. We consider a bipartite graph with N male and N female nodes (N >> 1), and B bonds connecting them (B >> 1). Each node is associated a random 'attractiveness level', and the bonds connect to the nodes randomly-with probabilities which are proportionate to the nodes' attractiveness levels. The population's average bonds-per-nodes B/N is estimated via a sample average calculated from a survey of size n (n >> 1). A comprehensive statistical analysis of this model is carried out, asserting that (i) the sample average well estimates the population average if and only if the attractiveness levels possess a finite mean; (ii) if the attractiveness levels are governed by a 'fat-tailed' probability law then the sample average displays wild fluctuations and strong skew-thus providing a statistical explanation to the matchmaking paradox.

  6. Why healthcare providers merge.

    Science.gov (United States)

    Postma, Jeroen; Roos, Anne-Fleur

    2016-04-01

    In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in the literature by conducting a survey study on mergers among 848 Dutch healthcare executives, of which 35% responded (resulting in a study sample of 239 executives). A total of 65% of the respondents was involved in at least one merger between 2005 and 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increasing competition, more pressure from purchasers, growing financial risks, de-institutionalisation of long-term care and decentralisation of healthcare services to municipalities. Our empirical study shows that healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Also efficiency and financial reasons are important drivers of merger activity in healthcare. We find that motives for merger are related to changes in health policies, in particular to the increasing pressure from competitors, insurers and municipalities.

  7. Healthcare financing in Croatia

    Directory of Open Access Journals (Sweden)

    Nevenka Kovač

    2013-12-01

    Full Text Available Healthcare financing system is of crucial importance for the functioning of any healthcare system, especially because there is no country in the world that is able to provide all its residents with access to all the benefits afforded by modern medicine. Lack of resources in general and rising healthcare expenditures are considered a difficult issue to solve in Croatia as well. Since Croatia gained its independence, its healthcare system has undergone a number of reforms, the primary objective of which was to optimize healthcare services to the actual monetary capacity of the Croatian economy. The objectives of the mentioned re - forms were partially achieved. The solutions that have been offered until now, i.e. consolidation measures undertaken in the last 10 years were necessary; however, they have not improved the operating conditions. There is still the issue of the deficit from the previous years, i.e. outstanding payments, the largest in the last decade. Analysis of the performance of healthcare institutions in 2011 shows that the decision makers will have to take up a major challenge of finding a solution to the difficulties the Croatian healthcare system has been struggling with for decades, causing a debt of 7 billion kuna. At the same time, they will need to uphold the basic principles of the Healthcare Act, i.e. to provide access to healthcare and ensure its continuity, comprehensiveness and solidarity, keeping in mind that the National Budget Act and Fiscal Responsibility Act have been adopted.

  8. Practical interventional radiology

    International Nuclear Information System (INIS)

    Lammer, J.; Schreyer, H.

    1991-01-01

    The book is intended as a practical guide and manual for interventional radiology applications. Main emphasis is placed on the performance of the various techniques, with explanations of the various steps to be taken, illustrated by drawings or pictures. Indications, contra-indications and clinical achievements are given in brief. There is one chapter each for the following techniques: angioplasty - intra-arterial fibrinolysis - vascular stents - neuroembolisation - embolisation of other vessels - biliary interventions - abscess drainage - nephrostomy and ureteral manipulations -percutaneous fine-needle biopsy - vena cava filters - interventional radiology in infants. (orig.)

  9. Pupils' evaluation and generation of evidence and explanation in argumentation.

    Science.gov (United States)

    Glassner, Amnon; Weinstock, Michael; Neuman, Yair

    2005-03-01

    Studies on argument have found that participants tend to prefer explanations to evidence. This apparent bias toward explanation has been qualified recently by research that has found it to diminish with the availability of evidence. This study examines the use of explanation versus evidence in the context of argumentation with reference to the goals of particular argument situations. Seventy-nine eighth-grade pupils at a regular, urban middle school. The pupils read argumentation scenarios, each having the stated goal of either explaining or proving a claim. The pupils rated the degree to which each of two provided assertions (one a theoretical explanation, and the other evidence-based) helped achieve the goal of the argument. On a second task, the pupils chose which of the two assertions should be more effective in achieving the argument goal. On the third task, the pupils generated either an explanation or evidence for each of the argumentation scenarios. Pupils demonstrated sensitivity to the relative epistemic strength of explanation and evidence. They rated explanations as more advantageous in achieving the explanation goal, and evidence as more advantageous in achieving the proof goal. Conversely, however, when asked to generate or recall an explanation or evidence, pupils produced more explanations than evidence independent of the argumentation goal. The study refines the definition of argumentation context to include specific goals. Pupils were sensitive to the context of the argumentation situation (e.g.goals, availability of evidence). However, they appeared to have a disposition toward explanation when asked to produce an explanation or evidence-based justification.

  10. Stormy Weather in Healthcare

    DEFF Research Database (Denmark)

    Clemensen, Jane; Jakobsen, Pernille Ravn; Myhre Jensen, Charlotte

    2017-01-01

    and healthcare professionals, by a dominant paradigm. We suggest a shift in focus from valuing the neo-liberal approach, to focus on care by linking an Ecology of Care (EoC) approach to the healthcare context, as EoC can be used as a complementary philosophy to help change the paradigm and thereby secure...

  11. Healthcare. State Report

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report projects education requirements linked to forecasted job growth in healthcare by state and the District of Columbia from 2010 through 2020. It complements a larger national report which projects educational demand for healthcare for the same time period. The national report shows that with or without Obamacare, the United States will…

  12. Harm reduction principles for healthcare settings

    Directory of Open Access Journals (Sweden)

    Mary Hawk

    2017-10-01

    Full Text Available Abstract Background Harm reduction refers to interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely. The vast majority of the harm reduction literature focuses on the harms of drug use and on specific harm reduction strategies, such as syringe exchange, rather than on the harm reduction philosophy as a whole. Given that a harm reduction approach can address other risk behaviors that often occur alongside drug use and that harm reduction principles have been applied to harms such as sex work, eating disorders, and tobacco use, a natural evolution of the harm reduction philosophy is to extend it to other health risk behaviors and to a broader healthcare audience. Methods Building on the extant literature, we used data from in-depth qualitative interviews with 23 patients and 17 staff members from an HIV clinic in the USA to describe harm reduction principles for use in healthcare settings. Results We defined six principles of harm reduction and generalized them for use in healthcare settings with patients beyond those who use illicit substances. The principles include humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination. For each of these principles, we present a definition, a description of how healthcare providers can deliver interventions informed by the principle, and examples of how each principle may be applied in the healthcare setting. Conclusion This paper is one of the firsts to provide a comprehensive set of principles for universal harm reduction as a conceptual approach for healthcare provision. Applying harm reduction principles in healthcare settings may improve clinical care outcomes given that the quality of the provider-patient relationship is known to impact health outcomes and treatment adherence. Harm reduction can be a universal precaution applied to all individuals regardless of

  13. Harm reduction principles for healthcare settings.

    Science.gov (United States)

    Hawk, Mary; Coulter, Robert W S; Egan, James E; Fisk, Stuart; Reuel Friedman, M; Tula, Monique; Kinsky, Suzanne

    2017-10-24

    Harm reduction refers to interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely. The vast majority of the harm reduction literature focuses on the harms of drug use and on specific harm reduction strategies, such as syringe exchange, rather than on the harm reduction philosophy as a whole. Given that a harm reduction approach can address other risk behaviors that often occur alongside drug use and that harm reduction principles have been applied to harms such as sex work, eating disorders, and tobacco use, a natural evolution of the harm reduction philosophy is to extend it to other health risk behaviors and to a broader healthcare audience. Building on the extant literature, we used data from in-depth qualitative interviews with 23 patients and 17 staff members from an HIV clinic in the USA to describe harm reduction principles for use in healthcare settings. We defined six principles of harm reduction and generalized them for use in healthcare settings with patients beyond those who use illicit substances. The principles include humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination. For each of these principles, we present a definition, a description of how healthcare providers can deliver interventions informed by the principle, and examples of how each principle may be applied in the healthcare setting. This paper is one of the firsts to provide a comprehensive set of principles for universal harm reduction as a conceptual approach for healthcare provision. Applying harm reduction principles in healthcare settings may improve clinical care outcomes given that the quality of the provider-patient relationship is known to impact health outcomes and treatment adherence. Harm reduction can be a universal precaution applied to all individuals regardless of their disclosure of negative health behaviors, given that health

  14. Migrants' access to healthcare

    DEFF Research Database (Denmark)

    Norredam, Marie

    2011-01-01

    There are strong pragmatic and moral reasons for receiving societies to address access to healthcare for migrants. Receiving societies have a pragmatic interest in sustaining migrants' health to facilitate integration; they also have a moral obligation to ensure migrants' access to healthcare...... according to international human rights principles. The intention of this thesis is to increase the understanding of migrants' access to healthcare by exploring two study aims: 1) Are there differences in migrants' access to healthcare compared to that of non-migrants? (substudy I and II); and 2) Why...... are there possible differences in migrants' access to healthcare compared to that of non-migrants? (substudy III and IV). The thesis builds on different methodological approaches using both register-based retrospective cohort design, cross-sectional design and survey methods. Two different measures of access were...

  15. Primary Teachers' Particle Ideas and Explanations of Physical Phenomena: Effect of an In-Service Training Course

    Science.gov (United States)

    Papageorgiou, George; Stamovlasis, Dimitrios; Johnson, Phil Michael

    2010-01-01

    This paper presents a study concerning Greek primary school teachers' (n = 162) ideas about the particulate nature of matter and their explanations of physical phenomena. The study took place during an in-service training course where the effectiveness of a specially designed intervention was tested. A key feature was an approach based on the…

  16. The Limits of Materialism: Auspicious for Teleological Explanation?

    Science.gov (United States)

    Athearn, Daniel

    2012-09-01

    The idea that scientific explanation runs up against certain inherent limits beyond which the field is open for other kinds of explanation is based on flawed assumptions. Modern physical knowledge, as I read it, does contain at least one important implication for theology having to do with how "Creation" is understood, if indeed the term remains usable and suitable.

  17. Mind and Meaning: Piaget and Vygotsky on Causal Explanation.

    Science.gov (United States)

    Beilin, Harry

    1996-01-01

    Piaget's theory has been characterized as descriptive and not explanatory, not qualifying as causal explanation. Piaget was consistent in showing how his theory was both explanatory and causal. Vygotsky also endorsed causal-genetic explanation but, on the basis of knowledge of only Piaget's earliest works, he claimed that Piaget's theory was not…

  18. Strategic Explanations for a Diagnostic Consultation System. Technical Report #8.

    Science.gov (United States)

    Hasling, Diane Warner; And Others

    This paper examines the problem of automatic explanation of reasoning, or the ability of a program to discuss what it is doing in some understandable way, particularly as part of an expert system. An introduction presents a general framework in which to view explanation and reviews some of the research in this area. This is followed by a…

  19. 5 CFR 1201.101 - Explanation and definitions.

    Science.gov (United States)

    2010-01-01

    ... definitions. (a) Explanation. An ex parte communication is an oral or written communication between a decision... outcome of a proceeding before the Board. (2) Decision-making official means any judge, officer or other... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Explanation and definitions. 1201.101...

  20. Teacher Explanation of Physics Concepts: A Video Study

    Science.gov (United States)

    Geelan, David

    2013-01-01

    Video recordings of Year 11 physics lessons were analyzed to identify key features of teacher explanations. Important features of the explanations used included teachers' ability to move between qualitative and quantitative modes of discussion, attention to what students require to succeed in high stakes examinations, thoughtful use of…

  1. Exploring Dominant Types of Explanations Built by General Chemistry Students

    Science.gov (United States)

    Talanquer, Vicente

    2010-01-01

    The central goal of our study was to explore the nature of the explanations generated by science and engineering majors with basic training in chemistry to account for the colligative properties of solutions. The work was motivated by our broader interest in the characterisation of the dominant types of explanations that science college students…

  2. Explanation and teleology in Aristotle's Philosophy of Nature

    NARCIS (Netherlands)

    Leunissen, Mariska Elisabeth Maria Philomena Johannes

    2007-01-01

    This dissertation explores Aristotle’s use of teleology as a principle of explanation, especially as it is used in the natural treatises. Its main purposes are, first, to determine the function, structure, and explanatory power of teleological explanations in four of Aristotle’s natural treatises,

  3. Generative Mechanistic Explanation Building in Undergraduate Molecular and Cellular Biology

    Science.gov (United States)

    Southard, Katelyn M.; Espindola, Melissa R.; Zaepfel, Samantha D.; Bolger, Molly S.

    2017-01-01

    When conducting scientific research, experts in molecular and cellular biology (MCB) use specific reasoning strategies to construct mechanistic explanations for the underlying causal features of molecular phenomena. We explored how undergraduate students applied this scientific practice in MCB. Drawing from studies of explanation building among…

  4. How to Program a Domain Independent Tracer for Explanations

    Science.gov (United States)

    Ishizaka, Alessio; Lusti, Markus

    2006-01-01

    Explanations are essential in the teaching process. Tracers are one possibility to provide students with explanations in an intelligent tutoring system. Their development can be divided into four steps: (a) the definition of the trace model; (b) the extraction of the information from this model; (c) the analysis and abstraction of the extracted…

  5. Structural Equations and Causal Explanations: Some Challenges for Causal SEM

    Science.gov (United States)

    Markus, Keith A.

    2010-01-01

    One common application of structural equation modeling (SEM) involves expressing and empirically investigating causal explanations. Nonetheless, several aspects of causal explanation that have an impact on behavioral science methodology remain poorly understood. It remains unclear whether applications of SEM should attempt to provide complete…

  6. "Ratio via Machina": Three Standards of Mechanistic Explanation in Sociology

    Science.gov (United States)

    Aviles, Natalie B.; Reed, Isaac Ariail

    2017-01-01

    Recently, sociologists have expended much effort in attempts to define social mechanisms. We intervene in these debates by proposing that sociologists in fact have a choice to make between three standards of what constitutes a good mechanistic explanation: substantial, formal, and metaphorical mechanistic explanation. All three standards are…

  7. Healthcare professionals' perceptions of the value and impact of the arts in healthcare settings: A critical review of the literature.

    Science.gov (United States)

    Wilson, Ceri; Bungay, Hilary; Munn-Giddings, Carol; Boyce, Melanie

    2016-04-01

    Internationally there is growing interest in the use of the arts in the healthcare context evidenced by the number of research studies reported in the nursing and medical literature. Establishing successful projects in healthcare environments will to some extent be reliant on the cooperation of staff working in these settings: healthcare professionals and their cultural values will be the lynchpin in the relationship between the artists organising the activities and the patients. This review appraises healthcare professionals' perceptions of the value of the arts in healthcare settings, and the impact of the arts on healthcare professionals. A critical review of the literature between 2004 and 2014 was undertaken. The following databases were searched: MedLine, CINAHL, AMED, Web of Science and ASSIA. Searches included words from three categories: arts activities; healthcare settings, and healthcare providers. Studies were included if they were written in English, explored the attitudes of healthcare professionals on the use of the arts in healthcare settings or the impact of arts activities on healthcare staff. Studies conducted in community venues and/or reporting on arts therapies (art, drama or music) were excluded. An initial 52 studies were identified and following screening for relevance and quality 27 articles were reviewed. Arts interventions were diverse and included music listening, visual arts, reading and creative writing, and dance. Despite some methodological limitations of the reviewed studies it was found that the majority of staff believed that engaging in arts interventions has a positive impact on patients' health and well-being. The findings suggest that arts interventions are perceived to have an impact on patients' stress, mood, pain levels, and sleep. Furthermore, staff believed that the arts can enhance communication between staff and patients, helping to build rapport and strengthen interactions. The majority of reported staff outcomes were

  8. An prediction and explanation of 'climatic swing

    Science.gov (United States)

    Barkin, Yury

    2010-05-01

    core-mantle system and their changes in the time have an important role and value for style and intensity of warming and cooling. References [1] Barkin Yu.V. (2002) An explanation of endogenous activity of planets and satellites and its cyclisity. Isvestia sekcii nauk o Zemle Rossiiskoi akademii ectestvennykh nauk. Vyp. 9, М., VINITI, pp. 45-97. In Russian. [2] Barkin Yu.V. (2004) Dynamics of the Earth shells and variations of paleoclimate. Proceedings of Milutin Milankovitch Anniversary Symposium "Paleoclimate and the Earth climate system" (Belgrade, Serbia, 30 August - 2 September, 2004). Belgrade, Serbian Academy of Sciences and Art, pp. 161-164. [3] Barkin Yu.V. (2007) Inversion of periodic and trend variations of climate in opposite hemispheres of the Earth and their mechanism. Proceedings of IUGG XXIV General Assembly, Perugia, Italy 2007: Earth: Our Changing Planet (Perugia, Italy, July 2-13, 2007) (P) - IAPSO, JPS001 "Interannual and Interdecadal Climate Variability", p. 1674. www. iugg2007perugia.it. [4] Barkin Yu.V. (2008) Secular polar drift of the core in present epoch: geodynamical and geophysical consequences and confirmations. General and regional problems of tectonics and geodynamics. Materials of XLI Tectonic Conference. V. 1. -M.:GEOS. p. 55-59. In Russian. [5] Barkin Yu.V. (2009) An explanation of secular variations of a gravity at stations Ny-Alesund, Medicine, Churchill and Syowa. Materials of the International Conference: «Yu.P. Bulashevich's fifth scientific readings. A deep structure. Geodynamics. A thermal field of the Earth. Interpretation of geophysical fields» (Ekaterinburg, 6 - 10 July, 2009). pp. 27-31. In Russian. [6] Barkin Yu.V. (2005) Oscillations of the Earth core, new oceanic tides and dynamical consequences. Materials of XI International Scientific Conference "Structure, geodynamics and mineral genetic processes in lithosphere" (September, 20-22 2005, Syktyvkar, Russia), Publisher of Geology Institute of Komi SC of Ural Section

  9. Development and Evaluation of a Psychosocial Intervention for Children and Teenagers Experiencing Diabetes (DEPICTED: a protocol for a cluster randomised controlled trial of the effectiveness of a communication skills training programme for healthcare professionals working with young people with type 1 diabetes

    Directory of Open Access Journals (Sweden)

    Lowes Lesley

    2010-02-01

    Full Text Available Abstract Background Diabetes is the third most common chronic condition in childhood and poor glycaemic control leads to serious short-term and life-limiting long-term complications. In addition to optimal medical management, it is widely recognised that psychosocial and educational factors play a key role in improving outcomes for young people with diabetes. Recent systematic reviews of psycho-educational interventions recognise the need for new methods to be developed in consultation with key stakeholders including patients, their families and the multidisciplinary diabetes healthcare team. Methods/design Following a development phase involving key stakeholders, a psychosocial intervention for use by paediatric diabetes staff and not requiring input from trained psychologists has been developed, incorporating a communication skills training programme for health professionals and a shared agenda-setting tool. The effectiveness of the intervention will be evaluated in a cluster-randomised controlled trial (RCT. The primary outcome, to be measured in children aged 4-15 years diagnosed with type 1 diabetes for at least one year, is the effect on glycaemic control (HbA1c during the year after training of the healthcare team is completed. Secondary outcomes include quality of life for patients and carers and cost-effectiveness. Patient and carer preferences for service delivery will also be assessed. Twenty-six paediatric diabetes teams are participating in the trial, recruiting a total of 700 patients for evaluation of outcome measures. Half the participating teams will be randomised to receive the intervention at the beginning of the trial and remaining centres offered the training package at the end of the one year trial period. Discussion The primary aim of the trial is to determine whether a communication skills training intervention for specialist paediatric diabetes teams will improve clinical and psychological outcomes for young people with

  10. Strategies for healthcare information systems

    NARCIS (Netherlands)

    Stegwee, R.A.; Spil, Antonius A.M.

    2001-01-01

    Information technologies of the past two decades have created significant fundamental changes in the delivery of healthcare services by healthcare provider organizations. Many healthcare organizations have been in search of ways and strategies to keep up with continuously emerging information

  11. Recommended Vaccines for Healthcare Workers

    Science.gov (United States)

    ... Vaccination Resources for Healthcare Professionals Recommended Vaccines for Healthcare Workers Recommend on Facebook Tweet Share Compartir On ... for More Information Resources for Those Vaccinating HCWs Healthcare workers (HCWs) are at risk for exposure to ...

  12. The role of short messaging service in supporting the delivery of healthcare: An umbrella systematic review.

    Science.gov (United States)

    Househ, Mowafa

    2016-06-01

    Short messaging service (SMS) messages may present a convenient and cost-effective method to support healthcare interventions. This work assesses the effects of short messaging service on various healthcare interventions found in systematic reviews. The search strategy was based on two key concepts: short messaging service and healthcare delivery. The initial search was conducted in December 2012 and was updated in June 2013. Of the 550 identified references, 13 systematic reviews met the inclusion criteria, of which 8 were published in peer-reviewed journals and 5 were retrieved from the Cochrane library. Data analysis shows that low to moderate research evidence exists on the benefits of short messaging service interventions for appointment reminders, promoting health in developing countries and preventive healthcare. In many interventions, however, there were a few studies that were of high quality, and most of the studies were rated from low to moderate quality or had no rating at all. Healthcare organizations, policy makers, or clinicians using short messaging service messages to support healthcare interventions should (1) implement interventions that have been found to work in healthcare settings, (2) continue evaluating short messaging service interventions that have not been adequately assessed, and (3) improve collaboration between various healthcare entities to develop studies targeted at specific populations to evaluate the long-term impact of short messaging service on healthcare outcomes. © The Author(s) 2014.

  13. Turnover among healthcare professionals.

    Science.gov (United States)

    Wood, Ben D

    2009-01-01

    Turnover among healthcare professionals is a costly consequence. The existing body of knowledge on healthcare professional turnover is correlated with job satisfaction levels. A landmark study differentiated 2 areas of job satisfaction categories: satisfiers and dissatisfiers (intrinsic and extrinsic motivators). The aim of this article is to examine existing research on precursors of turnover, such as burnout behaviors experienced by healthcare professionals, job satisfaction levels, employee organizational commitment, health complications which precede turnover, some current strategies to reduce turnover, and some effects CEO turnover has on employee turnover intentions.

  14. Framework for systematic identification of ethical aspects of healthcare technologies: the SBU approach.

    Science.gov (United States)

    Heintz, Emelie; Lintamo, Laura; Hultcrantz, Monica; Jacobson, Stella; Levi, Ragnar; Munthe, Christian; Tranæus, Sofia; Östlund, Pernilla; Sandman, Lars

    2015-01-01

    Assessment of ethical aspects of a technology is an important component of health technology assessment (HTA). Nevertheless, how the implementation of ethical assessment in HTA is to be organized and adapted to specific regulatory and organizational settings remains unclear. The objective of this study is to present a framework for systematic identification of ethical aspects of health technologies. Furthermore, the process of developing and adapting the framework to a specific setting is described. The framework was developed based on an inventory of existing approaches to identification and assessment of ethical aspects in HTA. In addition, the framework was adapted to the Swedish legal and organizational healthcare context, to the role of the HTA agency and to the use of non-ethicists. The framework was reviewed by a group of ethicists working in the field as well as by a wider set of interested parties including industry, interest groups, and other potential users. The framework consists of twelve items with sub-questions, short explanations, and a concluding overall summary. The items are organized into four different themes: the effects of the intervention on health, its compatibility with ethical norms, structural factors with ethical implications, and long term ethical consequences of using the intervention. In this study, a framework for identifying ethical aspects of health technologies is proposed. The general considerations and methodological approach to this venture will hopefully inspire and present important insights to organizations in other national contexts interested in making similar adaptations.

  15. Healthcare Associated Infections - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infections (HAI) measures - national data. These measures are developed by Centers for Disease Control and Prevention (CDC) and collected...

  16. Healthcare Associated Infections - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infection (HAI) measures - provider data. These measures are developed by Centers for Disease Control and Prevention (CDC) and collected...

  17. Healthcare Associated Infections - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Healthcare-Associated Infections (HAI) measures - state data. These measures are developed by Centers for Disease Control and Prevention (CDC) and collected...

  18. Vaccines for preventing hepatitis B in healthcare workers (an updated protocol)

    DEFF Research Database (Denmark)

    Borch, Anders; Kolster, Chastine; Gluud, Christian

    2017-01-01

    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of hepatitis B vaccines in healthcare workers.......This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of hepatitis B vaccines in healthcare workers....

  19. Generating Explanations for Internet-based Business Games

    Directory of Open Access Journals (Sweden)

    Martin Fischer

    2007-06-01

    Full Text Available It is widely established debriefing in business games is important and influences the students' learning performance. Most games only support game statistics instead of explaining solution paths. We suggest the automatic generation of explanations for internet-mediated business games to improve the debriefing quality. As a proof of concept we developed a prototype of an internet-based auction game embedding an open simulation model and an automatic explanation component helping students and teachers to analyse the decision making process. This paper describes the usefulness of automated explanations and the underlying generic software architecture.

  20. Healthcare leadership's diversity paradox.

    Science.gov (United States)

    Silver, Reginald

    2017-02-06

    Purpose The purpose of this research study was to obtain healthcare executives' perspectives on diversity in executive healthcare leadership. The study focused on identifying perspectives about diversity and its potential impact on the access of healthcare services by people of color. The study also identified perspectives about factors that influence the attainment of executive healthcare roles by people of color. Design/methodology/approach A convenience sample of healthcare executives was obtained. The executives identified themselves as belonging to one of two subgroups, White healthcare executives or executives of color. Participants were interviewed telephonically in a semi-structured format. The interviews were transcribed and entered into a qualitative software application. The data were codified and important themes were identified. Findings The majority of the study participants perceive that diversity of the executive healthcare leadership team is important. There were differences in perspective among the subgroups as it relates to solutions to improve access to healthcare by people of color. There were also differences in perspective among the subgroups, as it relates to explaining the underrepresentation of people of color in executive healthcare leadership roles. Research limitations/implications This research effort benefited from the subject matter expertise of 24 healthcare executives from two states. Expansion of the number of survey participants and broadening the geographical spread of where participants were located may have yielded more convergence and/or more divergence in perspectives about key topics. Practical implications The findings from this research study serve to add to the existing body of literature on diversity in executive healthcare leadership. The findings expand on the importance of key elements in contemporary literature such as diversity, cultural competency and perspectives about the need for representation of people of

  1. The Just War Tradition: A Model for Healthcare Ethics.

    Science.gov (United States)

    Connolly, Chaplain John D

    2018-06-01

    Healthcare ethics committees, physicians, surgeons, nurses, families, and patients themselves are constantly under pressure to make appropriate medically ethical decisions concerning patient care. Various models for healthcare ethics decisions have been proposed throughout the years, but by and large they are focused on making the initial ethical decision. What follows is a proposed model for healthcare ethics that considers the most appropriate decisions before, during, and after any intervention. The Just War Tradition is a model that is thorough in its exploration of the ethics guiding a nation to either engage in or refuse to engage in combatant actions. In recent years, the Just War Tradition has expanded beyond the simple consideration of going to war or not to include how the war is conducted and what the post-war phase would look like ethically. This paper is an exploration of a healthcare ethics decision making model using the tenets of the Just War Tradition as a framework. It discusses the initial consult level of decision making prior to any medical intervention, then goes further in considering the ongoing ethical paradigm during medical intervention and post intervention. Thus, this proposal is a more holistic approach to healthcare ethics decision making that encourages healthcare ethics committees to consider alternate models and ways of processing so that ultimately what is best for patient, family, staff, and the environment is all taken into consideration.

  2. Gender differences in attitudes toward nuclear power: a multivariate explanation

    International Nuclear Information System (INIS)

    Baxter, R.K.

    1987-01-01

    The purpose of this study was to examine gender differences in attitudes toward nuclear power and to discover what factors account for these differences. The marginality explanation for these differences suggest that women have less-favorable attitudes toward nuclear power because they are less concerned about energy supplies and economic growth and are less convinced of the benefits of nuclear power for society than are men. The irrationality explanation holds that women are less favorable toward nuclear power because they are less knowledgeable about this technology than are men. The lay-rationality explanation argues that people form attitudes toward nuclear power which are consistent with their relevant beliefs, attitudes and values; thus, this explanation suggests that women's unfavorable attitudes toward nuclear power stem from greater concern about environmental protection, exposing society to risk, and lower faith in science and technology. Data for this study were collected via a mail questionnaire administered to a state wide sample of Washington residents (n= 696)

  3. 32 CFR 516.3 - Explanation of abbreviations and terms.

    Science.gov (United States)

    2010-07-01

    ... Glossary contains explanations of abbreviations and terms. (b) The masculine gender has been used throughout this regulation for simplicity and consistency. Any reference to the masculine gender is intended...

  4. Phase space overpopulation at CERN and possible explanations

    International Nuclear Information System (INIS)

    Pratt, S.

    1998-01-01

    By combining information from correlations from Pb+Pb collisions at CERN, one comes to the conclusion that pionic phase space is significantly overpopulated compared to expectations based on chemical equilibrium. A variety of explanations will be addressed. (author)

  5. Social class, sense of control, and social explanation.

    Science.gov (United States)

    Kraus, Michael W; Piff, Paul K; Keltner, Dacher

    2009-12-01

    Lower social class is associated with diminished resources and perceived subordinate rank. On the basis of this analysis, the authors predicted that social class would be closely associated with a reduced sense of personal control and that this association would explain why lower class individuals favor contextual over dispositional explanations of social events. Across 4 studies, lower social class individuals, as measured by subjective socioeconomic status (SES), endorsed contextual explanations of economic trends, broad social outcomes, and emotion. Across studies, the sense of control mediated the relation between subjective SES and contextual explanations, and this association was independent of objective SES, ethnicity, political ideology, and self-serving biases. Finally, experimentally inducing a higher sense of control attenuated the tendency for lower subjective SES individuals to make more contextual explanations (Study 4). Implications for future research on social class as well as theoretical distinctions between objective SES and subjective SES are discussed.

  6. Reasoning with alternative explanations in physics: The cognitive accessibility rule

    Science.gov (United States)

    Heckler, Andrew F.; Bogdan, Abigail M.

    2018-06-01

    A critical component of scientific reasoning is the consideration of alternative explanations. Recognizing that decades of cognitive psychology research have demonstrated that relative cognitive accessibility, or "what comes to mind," strongly affects how people reason in a given context, we articulate a simple "cognitive accessibility rule", namely that alternative explanations are considered less frequently when an explanation with relatively high accessibility is offered first. In a series of four experiments, we test the cognitive accessibility rule in the context of consideration of alternative explanations for six physical scenarios commonly found in introductory physics curricula. First, we administer free recall and recognition tasks to operationally establish and distinguish between the relative accessibility and availability of common explanations for the physical scenarios. Then, we offer either high or low accessibility explanations for the physical scenarios and determine the extent to which students consider alternatives to the given explanations. We find two main results consistent across algebra- and calculus-based university level introductory physics students for multiple answer formats. First, we find evidence that, at least for some contexts, most explanatory factors are cognitively available to students but not cognitively accessible. Second, we empirically verify the cognitive accessibility rule and demonstrate that the rule is strongly predictive, accounting for up to 70% of the variance of the average student consideration of alternative explanations across scenarios. Overall, we find that cognitive accessibility can help to explain biases in the consideration of alternatives in reasoning about simple physical scenarios, and these findings lend support to the growing number of science education studies demonstrating that tasks relevant to science education curricula often involve rapid, automatic, and potentially predictable processes and

  7. Dynamical explanation for the high water abundance detected in Orion

    International Nuclear Information System (INIS)

    Elitzur, M.

    1979-01-01

    Shock wave chemistry is suggested as the likely explanation for the high water abundance which has been recently detected in Orion by Phyllips et al. The existence of such a shock and its inferred properties are in agreement with other observations of Orion such as the broad velocity feature and H 2 vibration emission. Shock waves are proposed as the likely explanation for high water abundances observed in other sources such as the strong H 2 O masers

  8. Educational intervention on medication reviews aiming to reduce acute healthcare consumption in elderly patients with potentially inappropriate medicines-A pragmatic open-label cluster-randomized controlled trial in primary care

    DEFF Research Database (Denmark)

    Schmidt-Mende, K; Andersen, M; Wettermark, B

    2017-01-01

    consisted of educational outreach visits with feedback on prescribing and the development of a working procedure on MRs. Follow-up was 9 months. Outcomes were assessed in an administrative health care database. The combined primary outcome was unplanned hospital admission and/or emergency department visit...... after an educational intervention in primary care. The reasons for the lack of effect could be a suboptimal intervention, limitations in outcome measures, and the use of administrative data to monitor outcomes.......PURPOSE: Potentially inappropriate medicines (PIMs) may cause 10% of unplanned admissions in elderly people. We performed an educational intervention in primary care to reduce acute health care consumption and PIMs through the promotion of medication reviews (MRs) in elderly patients. METHODS...

  9. Impact of telephone nursing education program for equity in healthcare.

    Science.gov (United States)

    Höglund, Anna T; Carlsson, Marianne; Holmström, Inger K; Kaminsky, Elenor

    2016-09-21

    The Swedish Healthcare Act prescribes that healthcare should be provided according to needs and with respect for each person's human dignity. The goal is equity in health for the whole population. In spite of this, studies have revealed that Swedish healthcare is not always provided equally. This has also been observed in telephone nursing. Therefore, the aim of the present study was to investigate if and how an educational intervention can improve awareness of equity in healthcare among telephone nurses. The study had a quasi-experimental design, with one intervention group and one control group. A base-line measurement was performed before an educational intervention and a follow-up measurement was made afterwards in both groups, using a study specific questionnaire in which fictive persons of different age, gender and ethnicity were assessed concerning, e.g., power over one's own life, quality of life and experience of discrimination. The educational intervention consisted of a web-based lecture, literature and a seminar, covering aspects of inequality in healthcare related to gender, age and ethnicity, and gender and intersectionality theories as explaining models for these conditions. The results showed few significant differences before and after the intervention in the intervention group. Also in the control group few significant differences were found in the second measurement, although no intervention was performed in that group. The reason might be that the instrument used was not sensitive enough to pick up an expected raised awareness of equity in healthcare, or that solely the act of filling out the questionnaire can create a sort of intervention effect. Fictive persons born in Sweden and of young age were assessed to have a higher Good life-index than the fictive persons born outside Europe and of higher age in all assessments. The results are an imperative that equity in healthcare still needs to be educated and discussed in different healthcare

  10. Towards an Explanation Generation System for Robots: Analysis and Recommendations

    Directory of Open Access Journals (Sweden)

    Ben Meadows

    2016-10-01

    Full Text Available A fundamental challenge in robotics is to reason with incomplete domain knowledge to explain unexpected observations and partial descriptions extracted from sensor observations. Existing explanation generation systems draw on ideas that can be mapped to a multidimensional space of system characteristics, defined by distinctions, such as how they represent knowledge and if and how they reason with heuristic guidance. Instances in this multidimensional space corresponding to existing systems do not support all of the desired explanation generation capabilities for robots. We seek to address this limitation by thoroughly understanding the range of explanation generation capabilities and the interplay between the distinctions that characterize them. Towards this objective, this paper first specifies three fundamental distinctions that can be used to characterize many existing explanation generation systems. We explore and understand the effects of these distinctions by comparing the capabilities of two systems that differ substantially along these axes, using execution scenarios involving a robot waiter assisting in seating people and delivering orders in a restaurant. The second part of the paper uses this study to argue that the desired explanation generation capabilities corresponding to these three distinctions can mostly be achieved by exploiting the complementary strengths of the two systems that were explored. This is followed by a discussion of the capabilities related to other major distinctions to provide detailed recommendations for developing an explanation generation system for robots.

  11. Re-orienting discussions of scientific explanation: A functional perspective.

    Science.gov (United States)

    Woody, Andrea I

    2015-08-01

    Philosophy of science offers a rich lineage of analysis concerning the nature of scientific explanation, but the vast majority of this work, aiming to provide an analysis of the relation that binds a given explanans to its corresponding explanandum, presumes the proper analytic focus rests at the level of individual explanations. There are, however, other questions we could ask about explanation in science, such as: What role(s) does explanatory practice play in science? Shifting focus away from explanations, as achievements, toward explaining, as a coordinated activity of communities, the functional perspective aims to reveal how the practice of explanatory discourse functions within scientific communities given their more comprehensive aims and practices. In this paper, I outline the functional perspective, argue that taking the functional perspective can reveal important methodological roles for explanation in science, and consequently, that beginning here provides resources for developing more adequate responses to traditional concerns. In particular, through an examination of the ideal gas law, I emphasize the normative status of explanations within scientific communities and discuss how such status underwrites a compelling rationale for explanatory power as a theoretical virtue. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Students' affordance of teleologic explanations and antrhropomorphic language in eliciting concepts in physics

    Directory of Open Access Journals (Sweden)

    Romiro Gordo Bautista

    2015-03-01

    Full Text Available This study ascertains the students’ affordance of teleologic explanations and anthropomorphic language in eliciting concepts in Physics as influenced by their age and learning exposure and experience. Using Explicative-Reductive Method of Descriptive Research, this study focused on the determinants of students’ affordance of teleologic-anthropomorphic reasoning to select concepts in Physics: Kinematics, Dynamics, Statics and Introduction to Thermodynamics.  It was found out that the respondents had intermittently committed teleologic-anthropomorphic languages across age and nature of their secondary education. Furthermore, teleologic-anthropomorphic languages were found correctible by classroom interventions as indicated by the test results on age and curricular exposure.

  13. The implementation of mindfulness in healthcare systems: a theoretical analysis.

    Science.gov (United States)

    Demarzo, M M P; Cebolla, A; Garcia-Campayo, J

    2015-01-01

    Evidence regarding the efficacy of mindfulness-based interventions (MBIs) is increasing exponentially; however, there are still challenges to their integration in healthcare systems. Our goal is to provide a conceptual framework that addresses these challenges in order to bring about scholarly dialog and support health managers and practitioners with the implementation of MBIs in healthcare. This is an opinative narrative review based on theoretical and empirical data that address key issues in the implementation of mindfulness in healthcare systems, such as the training of professionals, funding and costs of interventions, cost effectiveness and innovative delivery models. We show that even in the United Kingdom, where mindfulness has a high level of implementation, there is a high variability in the access to MBIs. In addition, we discuss innovative approaches based on "complex interventions," "stepped-care" and "low intensity-high volume" concepts that may prove fruitful in the development and implementation of MBIs in national healthcare systems, particularly in Primary Care. In order to better understand barriers and opportunities for mindfulness implementation in healthcare systems, it is necessary to be aware that MBIs are "complex interventions," which require innovative approaches and delivery models to implement these interventions in a cost-effective and accessible way. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Healthcare is primary

    Directory of Open Access Journals (Sweden)

    Raman Kumar

    2015-01-01

    Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

  15. Machine Learning for Healthcare: On the Verge of a Major Shift in Healthcare Epidemiology.

    Science.gov (United States)

    Wiens, Jenna; Shenoy, Erica S

    2018-01-06

    The increasing availability of electronic health data presents a major opportunity in healthcare for both discovery and practical applications to improve healthcare. However, for healthcare epidemiologists to best use these data, computational techniques that can handle large complex datasets are required. Machine learning (ML), the study of tools and methods for identifying patterns in data, can help. The appropriate application of ML to these data promises to transform patient risk stratification broadly in the field of medicine and especially in infectious diseases. This, in turn, could lead to targeted interventions that reduce the spread of healthcare-associated pathogens. In this review, we begin with an introduction to the basics of ML. We then move on to discuss how ML can transform healthcare epidemiology, providing examples of successful applications. Finally, we present special considerations for those healthcare epidemiologists who want to use and apply ML. © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  16. How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

    Science.gov (United States)

    Bronkhorst, Babette

    2017-08-01

    Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

  17. The Cuban National Healthcare System: Characterization of primary healthcare services.

    Directory of Open Access Journals (Sweden)

    Keli Regina DAL PRÁ

    2015-10-01

    Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

  18. Improving Healthcare Logistics Processes

    DEFF Research Database (Denmark)

    Feibert, Diana Cordes

    logistics processes in hospitals and aims to provide theoretically and empirically based evidence for improving these processes to both expand the knowledge base of healthcare logistics and provide a decision tool for hospital logistics managers to improve their processes. Case studies were conducted...... processes. Furthermore, a method for benchmarking healthcare logistics processes was developed. Finally, a theoretically and empirically founded framework was developed to support managers in making an informed decision on how to improve healthcare logistics processes. This study contributes to the limited...... literature concerned with the improvement of logistics processes in hospitals. Furthermore, the developed framework provides guidance for logistics managers in hospitals on how to improve their processes given the circumstances in which they operate....

  19. Competing Logics and Healthcare

    Science.gov (United States)

    Saks, Mike

    2018-01-01

    This paper offers a short commentary on the editorial by Mannion and Exworthy. The paper highlights the positive insights offered by their analysis into the tensions between the competing institutional logics of standardization and customization in healthcare, in part manifested in the conflict between managers and professionals, and endorses the plea of the authors for further research in this field. However, the editorial is criticized for its lack of a strong societal reference point, the comparative absence of focus on hybridization, and its failure to highlight structural factors impinging on the opposing logics in a broader neo-institutional framework. With reference to the Procrustean metaphor, it is argued that greater stress should be placed on the healthcare user in future health policy. Finally, the case of complementary and alternative medicine is set out which – while not explicitly mentioned in the editorial – most effectively concretizes the tensions at the heart of this analysis of healthcare. PMID:29626406

  20. Conization and healthcare use

    DEFF Research Database (Denmark)

    Frederiksen, Maria E.; Vázquez-Prada Baillet, Miguel; Jensen, Pernille T.

    2017-01-01

    The aim of this study was to assess whether negative psychological consequences of conization reported in questionnaire studies translated into increased use of the healthcare services that could relieve such symptoms. This was a population-based register study comparing women undergoing conization......, healthcare use increased significantly from the 'before' to the 'after' period. For contacts with GPs and hospitals, the increase was significantly larger for the conization group than for the control group, but this could be attributed to the standard postconization follow-up process. In the 'before' period......, women who later had a conization used fewer drugs than women of the control-group, but their drug use increased similarly over time. The conization event did not result in an increased use of the healthcare services that could relieve potential negative side effects. However, women who underwent...

  1. Queueing for healthcare.

    Science.gov (United States)

    Palvannan, R Kannapiran; Teow, Kiok Liang

    2012-04-01

    Patient queues are prevalent in healthcare and wait time is one measure of access to care. We illustrate Queueing Theory-an analytical tool that has provided many insights to service providers when designing new service systems and managing existing ones. This established theory helps us to quantify the appropriate service capacity to meet the patient demand, balancing system utilization and the patient's wait time. It considers four key factors that affect the patient's wait time: average patient demand, average service rate and the variation in both. We illustrate four basic insights that will be useful for managers and doctors who manage healthcare delivery systems, at hospital or department level. Two examples from local hospitals are shown where we have used queueing models to estimate the service capacity and analyze the impact of capacity configurations, while considering the inherent variation in healthcare.

  2. Characteristics of healthcare wastes

    International Nuclear Information System (INIS)

    Diaz, L.F.; Eggerth, L.L.; Enkhtsetseg, Sh.; Savage, G.M.

    2008-01-01

    A comprehensive understanding of the quantities and characteristics of the material that needs to be managed is one of the most basic steps in the development of a plan for solid waste management. In this case, the material under consideration is the solid waste generated in healthcare facilities, also known as healthcare waste. Unfortunately, limited reliable information is available in the open literature on the quantities and characteristics of the various types of wastes that are generated in healthcare facilities. Thus, sound management of these wastes, particularly in developing countries, often is problematic. This article provides information on the quantities and properties of healthcare wastes in various types of facilities located in developing countries, as well as in some industrialized countries. Most of the information has been obtained from the open literature, although some information has been collected by the authors and from reports available to the authors. Only data collected within approximately the last 15 years and using prescribed methodologies are presented. The range of hospital waste generation (both infectious and mixed solid waste fractions) varies from 0.016 to 3.23 kg/bed-day. The relatively wide variation is due to the fact that some of the facilities surveyed in Ulaanbaatar include out-patient services and district health clinics; these facilities essentially provide very basic services and thus the quantities of waste generated are relatively small. On the other hand, the reported amount of infectious (clinical, yellow bag) waste varied from 0.01 to 0.65 kg/bed-day. The characteristics of the components of healthcare wastes, such as the bulk density and the calorific value, have substantial variability. This literature review and the associated attempt at a comparative analysis point to the need for worldwide consensus on the terms and characteristics that describe wastes from healthcare facilities. Such a consensus would greatly

  3. An evolving systems-based methodology for healthcare planning.

    Science.gov (United States)

    Warwick, Jon; Bell, Gary

    2007-01-01

    Healthcare planning seems beset with problems at all hierarchical levels. These are caused by the 'soft' nature of many of the issues present in healthcare planning and the high levels of complexity inherent in healthcare services. There has, in recent years, been a move to utilize systems thinking ideas in an effort to gain a better understanding of the forces at work within the healthcare environment and these have had some success. This paper argues that systems-based methodologies can be further enhanced by metrication and modeling which assist in exploring the changed emergent behavior of a system resulting from management intervention. The paper describes the Holon Framework as an evolving systems-based approach that has been used to help clients understand complex systems (in the education domain) that would have application in the analysis of healthcare problems.

  4. DGNB certified Healthcare Centres

    DEFF Research Database (Denmark)

    Brunsgaard, Camilla; Larsen, Tine Steen

    2015-01-01

    for sustainability and wants a certification. This research investigates the decision‐making and design process (DMaDP) behind four DGNB certified Healthcare Centres (HCC) in Northern Jutland in Denmark. In general, knowledge about the DMaDP is important. However it is important to know what part DGNB plays...... a dialog about DGNB and energy concept is important even before anyone start sketching. Experiences with the different approaches will be further outlined in the paper.Future research has the intention to collect further knowledge about DGNB and DMaDP in practise. This project was limited to Healthcare...

  5. Costing Practices in Healthcare

    DEFF Research Database (Denmark)

    Chapman, Christopher; Kern, Anja; Laguecir, Aziza

    2014-01-01

    .e., Diagnosis Related Group (DRG) systems, and costing practices. DRG-based payment systems strongly influence costing practices in multiple ways. In particular, setting DRG tariffs requires highly standardized costing practices linked with specific skill sets from management accountants and brings other...... jurisdictions (e.g., clinical coding) to bear on costing practice. These factors contribute to the fragmentation of the jurisdiction of management accounting.......The rising cost of healthcare is a globally pressing concern. This makes detailed attention to the way in which costing is carried out of central importance. This article offers a framework for considering the interdependencies between a dominant element of the contemporary healthcare context, i...

  6. The health of healthcare, Part II: patient healthcare has cancer.

    Science.gov (United States)

    Waldman, Deane

    2013-01-01

    In this article, we make the etiologic diagnosis for a sick patient named Healthcare: the cancer of greed. When we explore the two forms of this cancer--corporate and bureaucratic--we find the latter is the greater danger to We the Patients. The "treatments" applied to patient Healthcare by the Congressional "doctors" have consistently made the patient worse, not better. At the core of healthcare's woes is the government's diversion of money from healthcare services to healthcare bureaucracy. As this is the root cause, it is what we must address in order to cure, not sedate or palliate, patient Healthcare.

  7. Generative mechanistic explanation building in undergraduate molecular and cellular biology

    Science.gov (United States)

    Southard, Katelyn M.; Espindola, Melissa R.; Zaepfel, Samantha D.; Bolger, Molly S.

    2017-09-01

    When conducting scientific research, experts in molecular and cellular biology (MCB) use specific reasoning strategies to construct mechanistic explanations for the underlying causal features of molecular phenomena. We explored how undergraduate students applied this scientific practice in MCB. Drawing from studies of explanation building among scientists, we created and applied a theoretical framework to explore the strategies students use to construct explanations for 'novel' biological phenomena. Specifically, we explored how students navigated the multi-level nature of complex biological systems using generative mechanistic reasoning. Interviews were conducted with introductory and upper-division biology students at a large public university in the United States. Results of qualitative coding revealed key features of students' explanation building. Students used modular thinking to consider the functional subdivisions of the system, which they 'filled in' to varying degrees with mechanistic elements. They also hypothesised the involvement of mechanistic entities and instantiated abstract schema to adapt their explanations to unfamiliar biological contexts. Finally, we explored the flexible thinking that students used to hypothesise the impact of mutations on multi-leveled biological systems. Results revealed a number of ways that students drew mechanistic connections between molecules, functional modules (sets of molecules with an emergent function), cells, tissues, organisms and populations.

  8. Hierarchy, causation and explanation: ubiquity, locality and pluralism

    Science.gov (United States)

    Love, Alan C.

    2012-01-01

    The ubiquity of top-down causal explanations within and across the sciences is prima facie evidence for the existence of top-down causation. Much debate has been focused on whether top-down causation is coherent or in conflict with reductionism. Less attention has been given to the question of whether these representations of hierarchical relations pick out a single, common hierarchy. A negative answer to this question undermines a commonplace view that the world is divided into stratified ‘levels’ of organization and suggests that attributions of causal responsibility in different hierarchical representations may not have a meaningful basis for comparison. Representations used in top-down and bottom-up explanations are primarily ‘local’ and tied to distinct domains of science, illustrated here by protein structure and folding. This locality suggests that no single metaphysical account of hierarchy for causal relations to obtain within emerges from the epistemology of scientific explanation. Instead, a pluralist perspective is recommended—many different kinds of top-down causation (explanation) can exist alongside many different kinds of bottom-up causation (explanation). Pluralism makes plausible why different senses of top-down causation can be coherent and not in conflict with reductionism, thereby illustrating a productive interface between philosophical analysis and scientific inquiry. PMID:23386966

  9. Social marketing in healthcare

    Directory of Open Access Journals (Sweden)

    Radha Aras

    2011-08-01

    Full Text Available BackgroundSocial marketing is an important tool in the delivery ofhealthcare services. For any healthcare programme orproject to be successful, community/consumer participationis required. The four principles of social marketing can guidepolicymakers and healthcare providers to successfully planand implement health programmes.AimTo review the existing literature in order to project thebenefits of social marketing in healthcare.MethodA search of periodical literature by the author involvingsocial marketing and marketing concepts in health wascarried out. Items were identified initially through healthorientedindexing services such as Medline, Health STARand Cinahl, using the identifiers “social marketing“ and“marketing in health”. An extensive search was also carriedout on educational database ERIC.ResultsA literature review of various studies on social marketingindicated that the selection of the right product (accordingto the community need at the right place, with the rightstrategy for promotion and at the right price yields goodresults. However, along with technical sustainability(product, price, promotion and place, financialsustainability, institutional sustainability and marketsustainability are conducive factors for the success of socialmarketing.ConclusionThe purpose of this literature review was to ascertain thelikely effectiveness of social marketing principles andapproaches and behaviour change communication towardshealth promotion.It is important for all healthcare workers to understand andrespond to the public’s desires and needs and routinely useconsumer research to determine how best to help thepublic to solve problems and realise aspirations. Socialmarketing can optimise public health by facilitatingrelationship-building with consumers and making their liveshealthier.

  10. Organizational excellence in healthcare

    NARCIS (Netherlands)

    Does, R.J.M.M.; van den Heuvel, J.; Foley, K.J.; Hermel, P.

    2008-01-01

    Healthcare, as any other service operation, requires systematic innovation efforts to remain competitive, cost efficient and up to date. In this paper, we outline a methodology and present how principles of two improvement programs, i.e., Lean Thinking and Six Sigma, can be combined to provide an

  11. Coproduction of healthcare service.

    Science.gov (United States)

    Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

    2016-07-01

    Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  12. Healthcare liquid waste management.

    Science.gov (United States)

    Sharma, D R; Pradhan, B; Pathak, R P; Shrestha, S C

    2010-04-01

    The management of healthcare liquid waste is an overlooked problem in Nepal with stern repercussions in terms of damaging the environment and affecting the health of people. This study was carried out to explore the healthcare liquid waste management practices in Kathmandu based central hospitals of Nepal. A descriptive prospective study was conducted in 10 central hospitals of Kathmandu during the period of May to December 2008. Primary data were collected through interview, observation and microbiology laboratory works and secondary data were collected by records review. For microbiological laboratory works,waste water specimens cultured for the enumeration of total viable counts using standard protocols. Evidence of waste management guidelines and committees for the management of healthcare liquid wastes could not be found in any of the studied hospitals. Similarly, total viable counts heavily exceeded the standard heterotrophic plate count (p=0.000) with no significant difference in such counts in hospitals with and without treatment plants (p=0.232). Healthcare liquid waste management practice was not found to be satisfactory. Installation of effluent treatment plants and the development of standards for environmental indicators with effective monitoring, evaluation and strict control via relevant legal frameworks were realized.

  13. Building National Healthcare Infrastructure

    DEFF Research Database (Denmark)

    Jensen, Tina Blegind; Thorseng, Anne

    2017-01-01

    This case chapter is about the evolution of the Danish national e-health portal, sundhed.dk, which provides patient-oriented digital services. We present how the organization behind sundhed.dk succeeded in establishing a national healthcare infrastructure by (1) collating and assembling existing...

  14. Infrastructures for healthcare

    DEFF Research Database (Denmark)

    Langhoff, Tue Odd; Amstrup, Mikkel Hvid; Mørck, Peter

    2018-01-01

    The Danish General Practitioners Database has over more than a decade developed into a large-scale successful information infrastructure supporting medical research in Denmark. Danish general practitioners produce the data, by coding all patient consultations according to a certain set of classif...... synergy into account, if not to risk breaking down the fragile nature of otherwise successful information infrastructures supporting research on healthcare....

  15. Healthcare waste management: current practices in selected healthcare facilities, Botswana.

    Science.gov (United States)

    Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

    2008-01-01

    Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

  16. Social marketing in healthcare.

    Science.gov (United States)

    Aras, Radha

    2011-01-01

    Social marketing is an important tool in the delivery of healthcare services. For any healthcare programme or project to be successful, community/consumer participation is required. The four principles of social marketing can guide policymakers and healthcare providers to successfully plan and implement health programmes. To review the existing literature in order to project the benefits of social marketing in healthcare. A search of periodical literature by the author involving social marketing and marketing concepts in health was carried out. Items were identified initially through health-oriented indexing services such as Medline, Health STAR and Cinahl, using the identifiers "social marketing" and "marketing in health". An extensive search was also carried out on educational database ERIC. A literature review of various studies on social marketing indicated that the selection of the right product (according to the community need) at the right place, with the right strategy for promotion and at the right price yields good results. However, along with technical sustainability (product, price, promotion and place), financial sustainability, institutional sustainability and market sustainability are conducive factors for the success of social marketing. The purpose of this literature review was to ascertain the likely effectiveness of social marketing principles and approaches and behaviour change communication towards health promotion. It is important for all healthcare workers to understand and respond to the public's desires and needs and routinely use consumer research to determine how best to help the public to solve problems and realise aspirations. Social marketing can optimise public health by facilitating relationship-building with consumers and making their lives healthier.

  17. The One-Child Policy, Elder Care, and LGB Chinese: A Social Policy Explanation for Family Pressure.

    Science.gov (United States)

    Hildebrandt, Timothy

    2018-01-03

    Lesbian, gay, and bisexual (LGB) people in China consistently report family pressure as the greatest challenge they face in their daily lives. This problem has been explained primarily by highlighting sociocultural factors. While such explanations are important to understanding family pressure, they do not easily lead to actionable policy interventions to relieve it. This article suggests a new way of looking at family pressure by positing a social policy explanation. In particular, it reveals how both the one-child policy and elder care reforms have strong heteronormative biases that negatively and disproportionately affect LGB people, and it explores social policy interventions that may help address them. Beyond the China case, the article seeks to open up new avenues for research into how sexuality could be better accounted for in analyses of social policies and considered in broader discussions on defamilization and welfare state reform.

  18. On the nature of explanation: A PDP approach

    Science.gov (United States)

    Churchland, Paul M.

    1990-06-01

    Neural network models of sensory processing and associative memory provide the resources for a new theory of what explanatory understanding consists in. That theory finds the theoretically important factors to reside not at the level of propositions and the relations between them, but at the level of the activation patterns across large populations of neurons. The theory portrays explanatory understanding, perceptual recognition, and abductive inference as being different instances of the same more general sort of cognitive achievement, viz. prototype activation. It thus effects a unification of the theories of explanation, perception, and ampliative inference. It also finds systematic unity in the wide diversity of types of explanation (causal, functional, mathematical, intentional, reductive, etc.), a chronic problem for theories of explanation in the logico-linguistic tradition. Finally, it is free of the many defects, both logical and psychological, that plague models in that older tradition.

  19. Making context explicit for explanation and incremental knowledge acquisition

    Energy Technology Data Exchange (ETDEWEB)

    Brezillon, P. [Univ. Paris (France)

    1996-12-31

    Intelligent systems may be improved by making context explicit in problem solving. This is a lesson drawn from a study of the reasons why a number of knowledge-based systems (KBSs) failed. We discuss the interest to make context explicit in explanation generation and incremental knowledge acquisition, two important aspects of intelligent systems that aim to cooperate with users. We show how context can be used to better explain and incrementally acquire knowledge. The advantages of using context in explanation and incremental knowledge acquisition are discussed through SEPIT, an expert system for supporting diagnosis and explanation through simulation of power plants. We point out how the limitations of such systems may be overcome by making context explicit.

  20. Towards to An Explanation for Conceptual Change: A Mechanistic Alternative

    Science.gov (United States)

    Rusanen, Anna-Mari

    2014-07-01

    Conceptual change is one of the most studied fields in science education and psychology of learning. However, there are still some foundational issues in conceptual change research on which no clear consensus has emerged. Firstly, there is no agreement on what changes in belief and concept systems constitute conceptual change and what changes do not. Secondly, there is no consensus on what the specific mechanisms of conceptual change are. Thirdly, there is no common explanatory framework of how to explain conceptual change. In this paper a sketch for explanations of conceptual change is outlined. According to this account, the explanation for conceptual change requires (1) a description for the information processing task and (2) a sufficiently accurate and detailed description of the cognitive mechanisms responsible for the task. The scope and limits of this type of explanation are discussed.

  1. Factors Influencing Healthcare Service Quality

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Mosadeghrad

    2014-07-01

    Full Text Available Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality.

  2. Architecture of personal healthcare information system in ubiquitous healthcare

    NARCIS (Netherlands)

    Bhardwaj, S.; Sain, M.; Lee, H.-J.; Chung, W.Y.; Slezak, D.; et al., xx

    2009-01-01

    Due to recent development in Ubiquitous Healthcare now it’s time to build such application which can work independently and with less interference of Physician. In this paper we are try to build the whole architecture of personal Healthcare information system for ubiquitous healthcare which also

  3. Is the bias for function-based explanations culturally universal? Children from China endorse teleological explanations of natural phenomena

    Science.gov (United States)

    Schachner, Adena; Zhu, Liqi; Li, Jing; Kelemen, Deborah

    2017-01-01

    Young children in Western cultures tend to endorse teleological (function-based) explanations broadly across many domains, even when scientifically unwarranted. For instance, in contrast to Western adults, they explicitly endorse the idea that mountains were created for climbing, just like hats were created for warmth. Is this bias a product of culture, or a product of universal aspects of human cognition? In two studies, we explored whether adults and children in Mainland China, a highly secular, non-Western culture, show a bias for teleological explanations. When explaining both object properties (Exp. 1) and origins (Exp. 2), we found evidence that they do. While Chinese adults restricted teleological explanations to scientifically warranted cases, Chinese children endorsed them more broadly, extending them across different kinds of natural phenomena. This bias decreased with rising grade level across first, second and fourth grade. Overall, these data provide evidence that children’s bias for teleological explanations is not solely a product of Western Abrahamic cultures. Instead, it extends to other cultures including the East Asian secular culture of modern-day China. This suggests that the bias for function-based explanations may be driven by universal aspects of human cognition. PMID:28110152

  4. Testing the Transivity Explanation of the Allais Paradox

    DEFF Research Database (Denmark)

    Groes, Ebbe; Jacobsen, Hans Jørgen; Sloth, Birgitte

    1999-01-01

    This paper uses a two-dimensional version of a standard common consequence experiment to test the intransitivity explanation of Allais-paradox-type violations of expected utility theory. We compare the common consequence effect of two choice problems differing only with respect to whether...... intransitivity as an explanation of the Allais Paradox. The question whether violations of expected utility are mainly due to intransitivity or to violation of independence is important since it is exactly on this issue the main new decision theories differ...

  5. Why healthcare workers are sick of TB

    Directory of Open Access Journals (Sweden)

    Arne von Delft

    2015-03-01

    Full Text Available Dr Thato Mosidi never expected to be diagnosed with tuberculosis (TB, despite widely prevalent exposure and very limited infection control measures. The life-threatening diagnosis of primary extensively drug-resistant TB (XDR-TB came as an even greater shock. The inconvenient truth is that, rather than being protected, Dr Mosidi and thousands of her healthcare colleagues are at an increased risk of TB and especially drug-resistant TB. In this viewpoint paper we debunk the widely held false belief that healthcare workers are somehow immune to TB disease (TB-proof and explore some of the key factors contributing to the pervasive stigmatization and subsequent non-disclosure of occupational TB. Our front-line workers are some of the first to suffer the consequences of a progressively more resistant and fatal TB epidemic, and urgent interventions are needed to ensure the safety and continued availability of these precious healthcare resources. These include the rapid development and scale-up of improved diagnostic and treatment options, strengthened infection control measures, and focused interventions to tackle stigma and discrimination in all its forms. We call our colleagues to action to protect themselves and those they care for.

  6. Barriers to healthcare for transgender individuals.

    Science.gov (United States)

    Safer, Joshua D; Coleman, Eli; Feldman, Jamie; Garofalo, Robert; Hembree, Wylie; Radix, Asa; Sevelius, Jae

    2016-04-01

    Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them. Current research emphasizes sexual minorities' self-report of barriers, rather than using direct methods. The biggest barrier to healthcare reported by transgender individuals is lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers. National research priorities should include rigorous determination of the capacity of the US healthcare system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical workforce across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers, and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps.

  7. Cultural diversity training for UK healthcare professionals: a comprehensive nationwide cross-sectional survey.

    Science.gov (United States)

    Bentley, Paul; Jovanovic, Ana; Sharma, Pankaj

    2008-10-01

    Healthcare inequalities within the UK based on patients' ethnicity have been found over the last five years in a large number of medical specialties. One possible explanation for this lies in ignorance of ethnic minority healthcare needs among professionals. Cultural diversity programmes have been shown to improve patient outcomes including compliance, yet these are not as yet requirements for any UK healthcare professionals with the exception of psychiatrists. This paper documents the frequency, regional variation, characteristics and motivations for cultural diversity training through a questionnaire survey of the educational leads of every UK medical school, postgraduate deanery and schools of nursing, physiotherapy, occupational therapy, speech and language therapy, and pharmacy. The results showed a wide variation in teaching practices between healthcare professions and geographical regions. This study provides evidence for the need for national guidelines to incorporate cultural competency training by all UK healthcare professional training bodies.

  8. centred healthcare in South Africa

    African Journals Online (AJOL)

    2016-07-15

    Puchalski) was one of the editors of the Oxford textbook on spirituality in ..... and in some cases provide up to 70% of all healthcare services. A hallmark of ..... including the business world, education, healthcare, the arts, ecology ...

  9. Lean six sigma in healthcare.

    Science.gov (United States)

    de Koning, Henk; Verver, John P S; van den Heuvel, Jaap; Bisgaard, Soren; Does, Ronald J M M

    2006-01-01

    Healthcare, as with any other service operation, requires systematic innovation efforts to remain competitive, cost efficient, and up-to-date. This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare. Controlling healthcare cost increases, improving quality, and providing better healthcare are some of the benefits of this approach.

  10. Healthcare worker and family caregiver hand hygiene in Bangladeshi healthcare facilities: results from the Bangladesh National Hygiene Baseline Survey.

    Science.gov (United States)

    Horng, L M; Unicomb, L; Alam, M-U; Halder, A K; Shoab, A K; Ghosh, P K; Opel, A; Islam, M K; Luby, S P

    2016-11-01

    Healthcare facility hand hygiene impacts patient care, healthcare worker safety, and infection control, but low-income countries have few data to guide interventions. To conduct a nationally representative survey of hand hygiene infrastructure and behaviour in Bangladeshi healthcare facilities to establish baseline data to aid policy. The 2013 Bangladesh National Hygiene Baseline Survey examined water, sanitation, and hand hygiene across households, schools, restaurants and food vendors, traditional birth attendants, and healthcare facilities. We used probability proportional to size sampling to select 100 rural and urban population clusters, and then surveyed hand hygiene infrastructure in 875 inpatient healthcare facilities, observing behaviour in 100 facilities. More than 96% of facilities had 'improved' water sources, but environmental contamination occurred frequently around water sources. Soap was available at 78-92% of handwashing locations for doctors and nurses, but just 4-30% for patients and family. Only 2% of 4676 hand hygiene opportunities resulted in recommended actions: using alcohol sanitizer or washing both hands with soap, then drying by air or clean cloth. Healthcare workers performed recommended hand hygiene in 9% of 919 opportunities: more after patient contact (26%) than before (11%). Family caregivers frequently washed hands with only water (48% of 2751 opportunities), but with little soap (3%). Healthcare workers had more access to hand hygiene materials and performed better hand hygiene than family, but still had low adherence. Increasing hand hygiene materials and behaviour could improve infection control in Bangladeshi healthcare facilities. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Nursing burnout interventions: what is being done?

    Science.gov (United States)

    Henry, Barbara J

    2014-04-01

    Many studies have documented high prevalence of burnout and compassion fatigue in oncology nurses. Burnout has detrimental effects on nurses, patients, and healthcare organizations. However, burnout interventions have been shown to improve the physical and mental health of nurses, patient satisfaction, and the organizational bottom line by reducing associated costs of burnout. Although treatment centers may prevent and correct burnout in oncology nurses by providing various interventions, few articles focus on those interventions. This article compiles and describes interventions that will serve as a reference to nurses and healthcare organization leaders interested in implementing similar programs.

  12. Innovation Concepts in Healthcare

    CERN Multimedia

    CERN. Geneva

    2010-01-01

    AbstractDemographic change and advances in medical science pose increased challenges to healthcare systems globally: The economic basis is aging and thus health is becoming more and more a productivity factor. At the same time, with today’s new communication possibilities the demand and expectations of effective medical treatment have been increased. This presentation will illustrate the need for the “industrialization” of healthcare in order to achieve highest results at limited budgets. Thereby, industrialization is not meaning the medical treatment based on the assembly line approach. Rather it is to recognize the cost of medical care as an investment with respective expectations on the return of the investment. Innovations in imaging and pharmaceutical products as well as in processes - that lead to similar medical results, but with lower efforts - are keys in such scenarios.BiographyProf. Dr. Hermann Requardt, 54, is a member of the Managing Board of Siemens AG and Chief Executive Officer of the He...

  13. Developing a standardized healthcare cost data warehouse.

    Science.gov (United States)

    Visscher, Sue L; Naessens, James M; Yawn, Barbara P; Reinalda, Megan S; Anderson, Stephanie S; Borah, Bijan J

    2017-06-12

    Research addressing value in healthcare requires a measure of cost. While there are many sources and types of cost data, each has strengths and weaknesses. Many researchers appear to create study-specific cost datasets, but the explanations of their costing methodologies are not always clear, causing their results to be difficult to interpret. Our solution, described in this paper, was to use widely accepted costing methodologies to create a service-level, standardized healthcare cost data warehouse from an institutional perspective that includes all professional and hospital-billed services for our patients. The warehouse is based on a National Institutes of Research-funded research infrastructure containing the linked health records and medical care administrative data of two healthcare providers and their affiliated hospitals. Since all patients are identified in the data warehouse, their costs can be linked to other systems and databases, such as electronic health records, tumor registries, and disease or treatment registries. We describe the two institutions' administrative source data; the reference files, which include Medicare fee schedules and cost reports; the process of creating standardized costs; and the warehouse structure. The costing algorithm can create inflation-adjusted standardized costs at the service line level for defined study cohorts on request. The resulting standardized costs contained in the data warehouse can be used to create detailed, bottom-up analyses of professional and facility costs of procedures, medical conditions, and patient care cycles without revealing business-sensitive information. After its creation, a standardized cost data warehouse is relatively easy to maintain and can be expanded to include data from other providers. Individual investigators who may not have sufficient knowledge about administrative data do not have to try to create their own standardized costs on a project-by-project basis because our data

  14. [Healthcare value chain: a model for the Brazilian healthcare system].

    Science.gov (United States)

    Pedroso, Marcelo Caldeira; Malik, Ana Maria

    2012-10-01

    This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and services; financial; and information.

  15. Systems healthcare: a holistic paradigm for tomorrow.

    Science.gov (United States)

    Fiandaca, Massimo S; Mapstone, Mark; Connors, Elenora; Jacobson, Mireille; Monuki, Edwin S; Malik, Shaista; Macciardi, Fabio; Federoff, Howard J

    2017-12-19

    Systems healthcare is a holistic approach to health premised on systems biology and medicine. The approach integrates data from molecules, cells, organs, the individual, families, communities, and the natural and man-made environment. Both extrinsic and intrinsic influences constantly challenge the biological networks associated with wellness. Such influences may dysregulate networks and allow pathobiology to evolve, resulting in early clinical presentation that requires astute assessment and timely intervention for successful mitigation. Herein, we describe the components of relevant biological systems and the nature of progression from at-risk to manifest disease. We illustrate the systems approach by examining two relevant clinical examples: Alzheimer's and cardiovascular diseases. The implications of systems healthcare management are examined through the lens of economics, ethics, policy and the law. Finally, we propose the need to develop new educational paradigms to enhance the training of the health professional in an era of systems medicine.

  16. The Importance of Qualitative Research for Causal Explanation in Education

    Science.gov (United States)

    Maxwell, Joseph A.

    2012-01-01

    The concept of causation has long been controversial in qualitative research, and many qualitative researchers have rejected causal explanation as incompatible with an interpretivist or constructivist approach. This rejection conflates causation with the positivist "theory" of causation, and ignores an alternative understanding of causation,…

  17. Why have socio-economic explanations between favoured over ...

    African Journals Online (AJOL)

    explanations trump cultural ones in the South African HIV aetiological literature? In this article, we explore how three factors (a belief in monogamy as a universal norm, HIV's emergence in a time of the construction of non-racialism, and a simplified understanding of HIV epidemiology) have intersected to produce this bias ...

  18. Infant Preferences for Attractive Faces: A Cognitive Explanation.

    Science.gov (United States)

    Rubenstein, Adam J.; Kalakanis, Lisa; Langlois, Judith H.

    1999-01-01

    Four studies assessed a cognitive explanation for development of infants' preference for attractive faces: cognitive averaging and preferences for mathematically averaged faces, or prototypes. Findings indicated that adults and 6-month olds prefer prototypical, mathematically averaged faces and that 6-month olds can abstract the central tendency…

  19. Children Balance Theories and Evidence in Exploration, Explanation, and Learning

    Science.gov (United States)

    Bonawitz, Elizabeth Baraff; van Schijndel, Tessa J. P.; Friel, Daniel; Schulz, Laura

    2012-01-01

    We look at the effect of evidence and prior beliefs on exploration, explanation and learning. In Experiment 1, we tested children both with and without differential prior beliefs about balance relationships (Center Theorists, mean: 82 months; Mass Theorists, mean: 89 months; No Theory children, mean: 62 months). Center and Mass Theory children who…

  20. Children balance theories and evidence in exploration, explanation, and learning

    NARCIS (Netherlands)

    Bonawitz, E.B.; van Schijndel, T.J.P.; Friel, D.; Schulz, L.

    2012-01-01

    We look at the effect of evidence and prior beliefs on exploration, explanation and learning. In Experiment 1, we tested children both with and without differential prior beliefs about balance relationships (Center Theorists, mean: 82 months; Mass Theorists, mean: 89 months; No Theory children,

  1. Explanations of Freud's Psychoanalysis Theories on the Lives and ...

    African Journals Online (AJOL)

    This paper examines some of the various explanations of Freud's theories on a selected number of Western Artist and their works. It highlights the impact of his findings on the authenticity of the concept as regards, dreams, the Oedipus complex and imagery. Its objective is to prove that a number of Western European artist ...

  2. Psychosocial explanations of complaints in Dutch general practice

    NARCIS (Netherlands)

    Joosten, A; Mazeland, H; Meyboom-de Jong, B

    BACKGROUND: Dutch GPs are frequently consulted by patients presenting physical complaints which have a psychosocial cause. Until now, this type of complaint has often been the subject of study, but the way in which psychosocial explanations for complaints are broached and discussed has not yet been

  3. Prediction and explanation over DL-Lite data streams

    CSIR Research Space (South Africa)

    Klarman, S

    2013-12-01

    Full Text Available the popular DL-Lite family, and study the logic foundations of prediction and explanation over DL-Lite data streams, i.e., reasoning from finite segments of streaming data to conjectures about the content of the streams in the future or in the past. We propose...

  4. Social selection is a powerful explanation for prosociality.

    Science.gov (United States)

    Nesse, Randolph M

    2016-01-01

    Cultural group selection helps explain human cooperation, but social selection offers a complementary, more powerful explanation. Just as sexual selection shapes extreme traits that increase matings, social selection shapes extreme traits that make individuals preferred social partners. Self-interested partner choices create strong and possibly runaway selection for prosocial traits, without requiring group selection, kin selection, or reciprocity.

  5. Phase space overpopulation at CERN and possible explanations

    International Nuclear Information System (INIS)

    Pratt, S.

    1999-01-01

    Complete text of publication follows. By combining information from correlations from Pb+Pb collisions at CERN, one comes to the conclusion that pionic phase space is significantly overpopulated compared to expectations based on chemical equilibrium. A variety of explanations will be addressed. (author)

  6. A skin-picking disorder case report: a psychopathological explanation

    Directory of Open Access Journals (Sweden)

    Ângela Ribeiro

    2015-06-01

    Full Text Available We describe the case of a 44-year-old woman, without known previous psychiatric history, hospitalized after a significant hemorrhage caused by self-inflicted deep facial dermal lesions (with muscle exposition. Psychopathological possible explanations of this case, as in similar reviewed ones, are related to frustration, aggression, and impulsivity.

  7. Social class, psychosocial factors and disease : from deception towards explanation.

    NARCIS (Netherlands)

    Ranchor, Adelita Vijaynti

    1994-01-01

    This thesis deals with the question of the extent to which socioeconomic status (sas) is related to disease. The main focus is the explanation of this relation, applying a muitifactor approach aimed at the integration of socioeconomic, psychosocial factors and health-related behavior. ... Zie:

  8. Scientific explanations in Greek upper secondary physics textbooks

    Science.gov (United States)

    Velentzas, Athanasios; Halkia, Krystallia

    2018-01-01

    In this study, an analysis of the structure of scientific explanations included in physics textbooks of upper secondary schools in Greece was completed. In scientific explanations for specific phenomena found in the sample textbooks, the explanandum is a logical consequence of the explanans, which in all cases include at least one scientific law (and/or principle, model or rule) previously presented, as well as statements concerning a specific case or specific conditions. The same structure is also followed in most of the cases in which the textbook authors explain regularities (i.e. laws, rules) as consequences of one or more general law or principle of physics. Finally, a number of the physics laws and principles presented in textbooks are not deduced as consequences from other, more general laws, but they are formulated axiomatically or inductively derived and the authors argue for their validity. Since, as it was found, the scientific explanations presented in the textbooks used in the study have similar structures to the explanations in internationally known textbooks, the findings of the present work may be of interest not only to science educators in Greece, but also to the community of science educators in other countries.

  9. Education's impact on explanations of radical right-wing voting

    NARCIS (Netherlands)

    Lubbers, M.; Tolsma, J.

    2011-01-01

    One of the reactions to the large demographic changes in Europe due to migration has been the rise of radical right-wing parties. Previous research has shown that education is one of the most relevant explanations of this voting behaviour. By pooling the European Social Surveys from 2002, 2004, 2006

  10. Designing Automated Guidance to Promote Productive Revision of Science Explanations

    Science.gov (United States)

    Tansomboon, Charissa; Gerard, Libby F.; Vitale, Jonathan M.; Linn, Marcia C.

    2017-01-01

    Supporting students to revise their written explanations in science can help students to integrate disparate ideas and develop a coherent, generative account of complex scientific topics. Using natural language processing to analyze student written work, we compare forms of automated guidance designed to motivate productive revision and help…

  11. A Self-Categorization Explanation for Opinion Consensus Perceptions

    Science.gov (United States)

    Zhang, Jinguang; Reid, Scott A.

    2013-01-01

    The public expression of opinions (and related communicative activities) hinges upon the perception of opinion consensus. Current explanations for opinion consensus perceptions typically focus on egocentric and other biases, rather than functional cognitions. Using self-categorization theory we showed that opinion consensus perceptions flow from…

  12. Political drivers of epidemic response: foreign healthcare workers and the 2014 Ebola outbreak.

    Science.gov (United States)

    Nohrstedt, Daniel; Baekkeskov, Erik

    2018-01-01

    This study demonstrates that countries responded quite differently to calls for healthcare workers (HCWs) during the Ebola epidemic in West Africa in 2014. Using a new dataset on the scale and timing of national pledges and the deployment of HCWs to states experiencing outbreaks of the virus disease (principally, Guinea, Liberia, and Sierra Leone), it shows that few foreign nations deployed HCWs early, some made pledges but then fulfilled them slowly, and most sent no HCWs at all. To aid understanding of such national responses, the paper reviews five theoretical perspectives that offer potentially competing or complementary explanations of foreign government medical assistance for international public health emergencies. The study systematically validates that countries varied greatly in whether and when they addressed HCW deployment needs during the Ebola crisis of 2014, and offers suggestions for a theory-driven inquiry to elucidate the logics of foreign interventions in critical infectious disease epidemics. © 2018 The Author(s). Disasters © Overseas Development Institute, 2018.

  13. Regional Healthcare Effectiveness

    Directory of Open Access Journals (Sweden)

    Olga Vladimirovna Kudelina

    2016-03-01

    Full Text Available An evaluation of healthcare systems effectiveness of the regions of the Russian Federation (federal districts was conducted using the Minmax method based on the data available at the United Interdepartmental Statistical Information System. Four groups of components (i.e. availability of resources; use of resources; access to resources and medical effectiveness decomposed into 17 items were analyzed. The resource availability was measured by four indicators, including the provision of doctors, nurses, hospital beds; agencies providing health care to the population. Use of resources was measured by seven indicators: the average hospital stay, days; the average bed occupancy, days; the number of operations per 1 physician surgical; the cost per unit volume of medical care: in outpatient clinics, day hospitals, inpatient and emergency care. Access to the resources was measured by three indicators: the satisfaction of the population by medical care; the capacity of outpatient clinics; the average number of visits to health facility. The medical effectiveness was also measured by three indicators: incidence with the "first-ever diagnosis of malignancy"; life expectancy at birth, years; the number of days of temporary disability. The study of the dynamics of the components and indexes for 2008–2012 allows to indicate a multidirectional influence on the regional healthcare system. In some federal districts (e.g. North Caucasian, the effectiveness decreases due to resource availability, in others (South, North Caucasian — due to the use of resources, in others (Far Eastern, Ural — due to access to resources. It is found that the effectiveness of the healthcare systems of the federal districts differs significantly. In addition, the built matrix proves the variability the of effectiveness (comparison of expenditures and results of healthcare systems of the federal districts of the Russian Federation: the high results can be obtained at high costs

  14. Preventing occupational stress in healthcare workers

    Directory of Open Access Journals (Sweden)

    Jani H. Ruotsalainen

    Full Text Available ABSTRACT: BACKGROUND: Healthcare workers can suffer from occupational stress which may lead to serious mental and physical health problems. OBJECTIVES: To evaluate the effectiveness of work and person-directed interventions in preventing stress at work in healthcare workers. METHODS: Search methods: We searched the Cochrane Depression Anxiety and Neurosis Group trials Specialised Register, MEDLINE, PsychInfo and Cochrane Occupational Health Field database. Selection criteria: Randomised controlled clinical trials (RCT of interventions aimed at preventing psychological stress in healthcare workers. For work-directed interventions interrupted time series and prospective cohort were also eligible. Data collection and analysis: Two authors independently extracted data and assessed trial quality. Meta-analysis and qualitative synthesis were performed where appropriate. MAIN RESULTS: We identified 14 RCTs, three cluster-randomised trials and two crossover trials, including a total of 1,564 participants in intervention groups and 1,248 controls. Two trials were of high quality. Interventions were grouped into 1 person-directed: cognitive-behavioural, relaxation, music-making, therapeutic massage and multicomponent; and 2 work-directed: attitude change and communication, support from colleagues and participatory problem solving and decision-making, and changes in work organisation. There is limited evidence that person-directed interventions can reduce stress (standardised mean difference or SMD -0.85; 95% CI -1.21, -0.49; burnout: Emotional Exhaustion (weighted mean difference or WMD -5.82; 95% CI -11.02, -0.63 and lack of Personal Accomplishment (WMD -3.61; 95% CI -4.65, -2.58; and anxiety: state anxiety (WMD -9.42; 95% CI -16.92, -1.93 and trait anxiety (WMD -6.91; 95% CI -12.80, -1.01. One trial showed that stress remained low a month after intervention (WMD -6.10; 95% CI -8.44, -3.76. Another trial showed a reduction in Emotional Exhaustion (Mean

  15. Using Self-Explanations in the Laboratory to Connect Theory and Practice: The Decision/ Explanation/Observation/Inference Writing Method

    Science.gov (United States)

    Van Duzor, Andrea Gay

    2016-01-01

    While many faculty seek to use student-centered, inquiry-based approaches in teaching laboratories, transitioning from traditional to inquiry instruction can be logistically challenging. This paper outlines use of a laboratory notebook and report writing-to-learn method that emphasizes student self-explanations of procedures and outcomes,…

  16. The historical foundation of conduct disorders : historical context, theoretical explanations, and interventions

    OpenAIRE

    Norberg, Jermund

    2010-01-01

    Conduct disorders became established as a medical diagnosis in 1968. Today they are one of the most frequent reasons why children and adolescence are referred to a mental health clinic. Conduct disorders impact upon the emotional wellbeing of the individual, their social and family relationships, and their academic success at school and their future wellbeing as adults in society. The school makes up a significant part of a child’s life and for children with conduct disorders the school e...

  17. Self-Explanation and Explanatory Feedback in Games: Individual Differences, Gameplay, and Learning

    Science.gov (United States)

    Killingsworth, Stephen S.; Clark, Douglas B.; Adams, Deanne M.

    2015-01-01

    Previous research has demonstrated the efficacy of two explanation-based approaches for increasing learning in educational games. The first involves asking students to explain their answers (self-explanation) and the second involves providing correct explanations (explanatory feedback). This study (1) compared self-explanation and explanatory…

  18. Building partnership to improve migrants’ access to healthcare in Mumbai

    Directory of Open Access Journals (Sweden)

    Nilesh Chandrakant Gawde

    2015-11-01

    Full Text Available Objectives: An intervention to improve migrants’ access to healthcare was piloted in Mumbai with purpose of informing health policy and planning. This paper aims to describe the process of building partnership for improving migrants’ access to healthcare of the pilot intervention including the role played by different stakeholders and the contextual factors affecting the intervention. Methods: The process evaluation was based upon Baranowski and Stables’ framework. their Observations in community and conversations with stakeholders as recorded in daily diaries, minutes of pre-intervention workshops and stakeholder meetings served as data sources. Data were coded using the framework and descriptive summaries of evaluation components were prepared.Results: Recruitment of stakeholders was easier than sustaining their interest. Community representatives led the intervention assisted by government officials. They planned community level interventions to improve access to healthcare which involved predominantly information, education and communication activities for which pre-existing formal and informal social networks and community events were used. Although the intervention reached migrants living with families, single male migrants neither participated nor did the intervention reach them consistently. Contextual factors such as culture differences between migrants and native population and illegality in the nature of the settlement resulting in the exclusion from services were the barriers. Conclusion: Inclusive multi-stakeholder partnership including migrants themselves and using both formal and informal networks in community is a feasible strategy for health education and has potential to improve the migrants’ access to healthcare. However, there are challenges to the partnership process and new strategies to overcome these challenges need to be tested such as peer-led models for involvement of single male migrants. For sustaining such

  19. Building Partnership to Improve Migrants' Access to Healthcare in Mumbai.

    Science.gov (United States)

    Gawde, Nilesh Chandrakant; Sivakami, Muthusamy; Babu, Bontha V

    2015-01-01

    An intervention to improve migrants' access to healthcare was piloted in Mumbai with purpose of informing health policy and planning. This paper aims to describe the process of building partnership for improving migrants' access to healthcare of the pilot intervention, including the role played by different stakeholders and the contextual factors affecting the intervention. The process evaluation was based on Baranowski and Stables' framework. Observations in community and conversations with stakeholders as recorded in daily diaries, minutes of pre-intervention workshops, and stakeholder meetings served as data sources. Data were coded using the framework and descriptive summaries of evaluation components were prepared. Recruitment of stakeholders was easier than sustaining their interest. Community representatives led the intervention assisted by government officials. They planned community-level interventions to improve access to healthcare that involved predominantly information, education, and communication activities for which pre-existing formal and informal social networks and community events were used. Although the intervention reached migrants living with families, single male migrants neither participated nor did the intervention reach them consistently. Contextual factors such as culture differences between migrants and native population and illegality in the nature of the settlement, resulting in the exclusion from services, were the barriers. Inclusive multi-stakeholder partnership, including migrants themselves and using both formal and informal networks in community is a feasible strategy for health education and has potential to improve the migrants' access to healthcare. However, there are challenges to the partnership process and new strategies to overcome these challenges need to be tested such as peer-led models for involvement of single male migrants. For sustaining such efforts and mainstreaming migrants, addressing contextual factors and

  20. Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

    OpenAIRE

    Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

    2016-01-01

    Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

  1. [Types of conflicts and conflict management among Hungarian healthcare workers].

    Science.gov (United States)

    Csupor, Éva; Kuna, Ágnes; Pintér, Judit Nóra; Kaló, Zsuzsa; Csabai, Márta

    2017-04-01

    Efficient communication, conflict management and cooperation are the key factors of a successful patient care. This study is part of an international comparative research. The aim of this study is to unfold conflicts among healthcare workers. 73 healthcare workers were interviewed using a standardized interview protocol. The in-person interviews used the critical incident method. 30 interviews (15 doctors, 15 nurses) were analysed with the Atlas.ti 7 content analysis software. The sources, types, effects of conflicts and conflict management strategies were investigated. The content analysis unfolded the specificities of conflicts in healthcare based on personal experiences. Organizational hierarchy was a substantial source of conflict, especially among physicians, which originates from implicit rules. As a result of the avoiding conflict management the conflicts remain partly unresolved which has negative individual and group effect. Our conceptual framework helps to develop a proper intervention specific to healthcare. Orv. Hetil., 2017, 158(16), 625-632.

  2. Healthcare Policy in Romania. Frameworks and Challenges

    Directory of Open Access Journals (Sweden)

    Buţiu Călina Ana

    2016-07-01

    Full Text Available The objective of the paper is to review some of the healthcare policy issues of Romania and identify those challenges which may be addressed through social intervention. Based on statistical data, documents, reports and applicable laws one will review the health condition of Romanian population and the state of the national health system, and will examine the broad strategies and policies currently under the scrutiny of appropriate ministries. The findings of the study suggest looking at health policies also through the lens of social inclusion.

  3. Email for clinical communication between healthcare professionals.

    Science.gov (United States)

    Goyder, Clare; Atherton, Helen; Car, Mate; Heneghan, Carl J; Car, Josip

    2015-02-20

    Email is one of the most widely used methods of communication, but its use in healthcare is still uncommon. Where email communication has been utilised in health care, its purposes have included clinical communication between healthcare professionals, but the effects of using email in this way are not well known. We updated a 2012 review of the use of email for two-way clinical communication between healthcare professionals. To assess the effects of email for clinical communication between healthcare professionals on healthcare professional outcomes, patient outcomes, health service performance, and service efficiency and acceptability, when compared to other forms of communicating clinical information. We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 9 2013), MEDLINE (OvidSP) (1946 to August 2013), EMBASE (OvidSP) (1974 to August 2013), PsycINFO (1967 to August 2013), CINAHL (EbscoHOST) (1982 to August 2013), and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched November 2013). We used additional search methods: examining reference lists and contacting authors. Randomised controlled trials, quasi-randomised trials, controlled before and after studies, and interrupted time series studies examining interventions in which healthcare professionals used email for communicating clinical information in the form of: 1) unsecured email, 2) secure email, or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered. Two authors independently assessed studies for inclusion, assessed the included studies' risk of bias, and extracted data. We contacted study authors for additional information and have reported all measures as per the study report. The previous version of this review included one randomised controlled

  4. Supporting students' scientific explanations: A case study investigating the synergy focusing on a teacher's practices when providing instruction and using mobile devices

    Science.gov (United States)

    Delen, Ibrahim

    Engage students in constructing scientific practices is a critical component of science instruction. Therefore a number of researchers have developed software programs to help students and teachers in this hard task. The Zydeco group, designed a mobile application called Zydeco, which enables students to collect data inside and outside the classroom, and then use the data to create scientific explanations by using claim-evidence-reasoning framework. Previous technologies designed to support scientific explanations focused on how these programs improve students' scientific explanations, but these programs ignored how scientific explanation technologies can support teacher practices. Thus, to increase our knowledge how different scaffolds can work together, this study aimed to portray the synergy between a teacher's instructional practices (part 1) and using supports within a mobile devices (part 2) to support students in constructing explanations. Synergy can be thought of as generic and content-specific scaffolds working together to enable students to accomplish challenging tasks, such as creating explanations that they would not normally be able to do without the scaffolds working together. Providing instruction (part 1) focused on understanding how the teacher scaffolds students' initial understanding of the claim-evidence-reasoning (CER) framework. The second component of examining synergy (part 2: using mobile devices) investigated how this teacher used mobile devices to provide feedback when students created explanations. The synergy between providing instruction and using mobile devices was investigated by analyzing a middle school teacher's practices in two different units (plants and water quality). Next, this study focused on describing how the level of synergy influenced the quality of students' scientific explanations. Finally, I investigated the role of focused teaching intervention sessions to inform teacher in relation to students' performance. In

  5. Data mining applications in healthcare.

    Science.gov (United States)

    Koh, Hian Chye; Tan, Gerald

    2005-01-01

    Data mining has been used intensively and extensively by many organizations. In healthcare, data mining is becoming increasingly popular, if not increasingly essential. Data mining applications can greatly benefit all parties involved in the healthcare industry. For example, data mining can help healthcare insurers detect fraud and abuse, healthcare organizations make customer relationship management decisions, physicians identify effective treatments and best practices, and patients receive better and more affordable healthcare services. The huge amounts of data generated by healthcare transactions are too complex and voluminous to be processed and analyzed by traditional methods. Data mining provides the methodology and technology to transform these mounds of data into useful information for decision making. This article explores data mining applications in healthcare. In particular, it discusses data mining and its applications within healthcare in major areas such as the evaluation of treatment effectiveness, management of healthcare, customer relationship management, and the detection of fraud and abuse. It also gives an illustrative example of a healthcare data mining application involving the identification of risk factors associated with the onset of diabetes. Finally, the article highlights the limitations of data mining and discusses some future directions.

  6. Dynamical 3-Space: Alternative Explanation of the "Dark Matter Ring"

    Directory of Open Access Journals (Sweden)

    Cahill R. T.

    2007-10-01

    Full Text Available NASA has claimed the discovery of a “Ring of Dark Matter” in the galaxy cluster CL 0024 +17, see Jee M.J. et al. arXiv:0705.2171, based upon gravitational lensing data. Here we show that the lensing can be given an alternative explanation that does not involve “dark matter”. This explanation comes from the new dynamics of 3-space. This dynamics involves two constant G and alpha — the fine structure constant. This dynamics has explained the bore hole anomaly, spiral galaxy flat rotation speeds, the masses of black holes in spherical galaxies, gravitational light bending and lensing, all without invoking “dark matter”, and also the supernova redshift data without the need for “dark energy”.

  7. Nursing Teaching Strategies by Encouraging Students’ Questioning, Argumentation and Explanation

    Directory of Open Access Journals (Sweden)

    Dayse Neri de Souza

    2014-12-01

    Full Text Available Nursing students need to develop competences in the field of explanation, argumentation and questioning as they are pivotal to foster a relationship with their patients and achieve a greater humanisation of care. The objective of this paper is to analyse the perception of 1st-year nursing students with regard to the humanisation of care provided to patients by encouraging them to discuss real-life episodes. The study is qualitative and content analysis used the students’ questions, explanations and argumentation as core discourses. Among other conclusions, results point towards the importance of promoting activities that encourage the different nursing students’ discourses and the ability to understand the humanisation and dehumanisation patterns arising from the real-life episodes used as case study.

  8. Perceptions of healthcare quality in Ghana: Does health insurance status matter?

    Science.gov (United States)

    Duku, Stephen Kwasi Opoku; Nketiah-Amponsah, Edward; Janssens, Wendy; Pradhan, Menno

    2018-01-01

    This study's objective is to provide an alternative explanation for the low enrolment in health insurance in Ghana by analysing differences in perceptions between the insured and uninsured of the non-technical quality of healthcare. It further explores the association between insurance status and perception of healthcare quality to ascertain whether insurance status matters in the perception of healthcare quality. Data from a survey of 1,903 households living in the catchment area of 64 health centres were used for the analysis. Two sample independent t-tests were employed to compare the average perceptions of the insured and uninsured on seven indicators of non-technical quality of healthcare. A generalised ordered logit regression, controlling for socio-economic characteristics and clustering at the health facility level, tested the association between insurance status and perceived quality of healthcare. The perceptions of the insured were found to be significantly more negative than the uninsured and those of the previously insured were significantly more negative than the never insured. Being insured was associated with a significantly lower perception of healthcare quality. Thus, once people are insured, they tend to perceive the quality of healthcare they receive as poor compared to those without insurance. This study demonstrated that health insurance status matters in the perceptions of healthcare quality. The findings also imply that perceptions of healthcare quality may be shaped by individual experiences at the health facilities, where the insured and uninsured may be treated differently. Health insurance then becomes less attractive due to the poor perception of the healthcare quality provided to individuals with insurance, resulting in low demand for health insurance in Ghana. Policy makers in Ghana should consider redesigning, reorganizing, and reengineering the National Healthcare Insurance Scheme to ensure the provision of better quality healthcare

  9. Students' explanations in complex learning of disciplinary programming

    Science.gov (United States)

    Vieira, Camilo

    Computational Science and Engineering (CSE) has been denominated as the third pillar of science and as a set of important skills to solve the problems of a global society. Along with the theoretical and the experimental approaches, computation offers a third alternative to solve complex problems that require processing large amounts of data, or representing complex phenomena that are not easy to experiment with. Despite the relevance of CSE, current professionals and scientists are not well prepared to take advantage of this set of tools and methods. Computation is usually taught in an isolated way from engineering disciplines, and therefore, engineers do not know how to exploit CSE affordances. This dissertation intends to introduce computational tools and methods contextualized within the Materials Science and Engineering curriculum. Considering that learning how to program is a complex task, the dissertation explores effective pedagogical practices that can support student disciplinary and computational learning. Two case studies will be evaluated to identify the characteristics of effective worked examples in the context of CSE. Specifically, this dissertation explores students explanations of these worked examples in two engineering courses with different levels of transparency: a programming course in materials science and engineering glass box and a thermodynamics course involving computational representations black box. Results from this study suggest that students benefit in different ways from writing in-code comments. These benefits include but are not limited to: connecting xv individual lines of code to the overall problem, getting familiar with the syntax, learning effective algorithm design strategies, and connecting computation with their discipline. Students in the glass box context generate higher quality explanations than students in the black box context. These explanations are related to students prior experiences. Specifically, students with

  10. Mechanisms of cold fusion: comprehensive explanations by the Nattoh model

    International Nuclear Information System (INIS)

    Matsumoto, Takaaki

    1995-01-01

    The phenomena of cold fusion seem to be very complicated; inconsistent data between the production rates of heat, neutrons, tritiums and heliums. Our thoughts need to drastically change in order to appropriately understand the mechanisms of cold fusion. Here, a review is described for the Nattoh model, that has been developed extensively to provide comprehensive explanations for the mechanisms of cold fusion. Important experimental findings that prove the model are described. Furthermore several subjects including impacts on other fields are also discussed. (author)

  11. Causation at Different Levels: Tracking the Commitments of Mechanistic Explanations

    DEFF Research Database (Denmark)

    Fazekas, Peter; Kertész, Gergely

    2011-01-01

    connections transparent. These general commitments get confronted with two claims made by certain proponents of the mechanistic approach: William Bechtel often argues that within the mechanistic framework it is possible to balance between reducing higher levels and maintaining their autonomy at the same time...... their autonomy at the same time than standard reductive accounts are, and that what mechanistic explanations are able to do at best is showing that downward causation does not exist....

  12. Diquarks as an explanation for psi's R, and everything else

    Energy Technology Data Exchange (ETDEWEB)

    Pavkovic, M [Stanford Univ., Calif. (USA). School of Medicine

    1976-06-05

    In order to overcome some contradictions and limitations in the charm model without introducing new quantum numbers, a new quark model is required. The letter presents a candidate for such a model. Some tests of the model are discussed including the explanation of the observed behaviour of R=sigma(e/sup +/e/sup -/..-->..hadrons)/sigma(e/sup +/e/sup -/ ..--> mu..sup(+)..mu..sup(-)) and the narrow width of psi's. Moreover some predictions of the model are illustrated.

  13. An Explanation of Nakamoto's Analysis of Double-spend Attacks

    OpenAIRE

    Ozisik, A. Pinar; Levine, Brian Neil

    2017-01-01

    The fundamental attack against blockchain systems is the double-spend attack. In this tutorial, we provide a very detailed explanation of just one section of Satoshi Nakamoto's original paper where the attack's probability of success is stated. We show the derivation of the mathematics relied upon by Nakamoto to create a model of the attack. We also validate the model with a Monte Carlo simulation, and we determine which model component is not perfect.

  14. Preventing occupational stress in healthcare workers.

    Science.gov (United States)

    Ruotsalainen, Jani H; Verbeek, Jos H; Mariné, Albert; Serra, Consol

    2015-04-07

    Healthcare workers can suffer from occupational stress as a result of lack of skills, organisational factors, and low social support at work. This may lead to distress, burnout and psychosomatic problems, and deterioration in quality of life and service provision. To evaluate the effectiveness of work- and person-directed interventions compared to no intervention or alternative interventions in preventing stress at work in healthcare workers. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, NIOSHTIC-2 and Web of Science up to November 2013. Randomised controlled trials (RCTs) of interventions aimed at preventing psychological stress in healthcare workers. For organisational interventions, interrupted time-series and controlled before-and-after (CBA) studies were also eligible. Two review authors independently extracted data and assessed trial quality. We used Standardised Mean Differences (SMDs) where authors of trials used different scales to measure stress or burnout. We combined studies that were similar in meta-analyses. We used the GRADE system to rate the quality of the evidence. In this update, we added 39 studies, making a total of 58 studies (54 RCTs and four CBA studies), with 7188 participants. We categorised interventions as cognitive-behavioural training (CBT) (n = 14), mental and physical relaxation (n = 21), combined CBT and relaxation (n = 6) and organisational interventions (n = 20). Follow-up was less than one month in 24 studies, one to six in 22 studies and more than six months in 12 studies. We categorised outcomes as stress, anxiety or general health.There was low-quality evidence that CBT with or without relaxation was no more effective in reducing stress symptoms than no intervention at one month follow-up in six studies (SMD -0.27 (95% Confidence Interval (CI) -0.66 to 0.13; 332 participants). But at one to six months follow-up in seven studies (SMD -0.38, 95% CI -0.59 to -0

  15. Superfluous neuroscience information makes explanations of psychological phenomena more appealing.

    Science.gov (United States)

    Fernandez-Duque, Diego; Evans, Jessica; Christian, Colton; Hodges, Sara D

    2015-05-01

    Does the presence of irrelevant neuroscience information make explanations of psychological phenomena more appealing? Do fMRI pictures further increase that allure? To help answer these questions, 385 college students in four experiments read brief descriptions of psychological phenomena, each one accompanied by an explanation of varying quality (good vs. circular) and followed by superfluous information of various types. Ancillary measures assessed participants' analytical thinking, beliefs on dualism and free will, and admiration for different sciences. In Experiment 1, superfluous neuroscience information increased the judged quality of the argument for both good and bad explanations, whereas accompanying fMRI pictures had no impact above and beyond the neuroscience text, suggesting a bias that is conceptual rather than pictorial. Superfluous neuroscience information was more alluring than social science information (Experiment 2) and more alluring than information from prestigious "hard sciences" (Experiments 3 and 4). Analytical thinking did not protect against the neuroscience bias, nor did a belief in dualism or free will. We conclude that the "allure of neuroscience" bias is conceptual, specific to neuroscience, and not easily accounted for by the prestige of the discipline. It may stem from the lay belief that the brain is the best explanans for mental phenomena.

  16. An ancient explanation of presbyopia based on binocular vision.

    Science.gov (United States)

    Barbero, Sergio

    2014-06-01

    Presbyopia, understood as the age-related loss of ability to clearly see near objects, was known to ancient Greeks. However, few references to it can be found in ancient manuscripts. A relevant discussion on presbyopia appears in a book called Symposiacs written by Lucius Mestrius Plutarchus around 100 A.C. In this work, Plutarch provided four explanations of presbyopia, associated with different theories of vision. One of the explanations is particularly interesting as it is based on a binocular theory of vision. In this theory, vision is produced when visual rays, emanating from the eyes, form visual cones that impinge on the objects to be seen. Visual rays coming from old people's eyes, it was supposed, are weaker than those from younger people's eyes; so the theory, to be logically coherent, implies that this effect is compensated by the increase in light intensity due to the overlapping, at a certain distance, of the visual cones coming from both eyes. Thus, it benefits the reader to move the reading text further away from the eyes in order to increase the fusion area of both visual cones. The historical hypothesis taking into consideration that the astronomer Hipparchus of Nicaea was the source of Plutarch's explanation of the theory is discussed. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  17. Selective effects of explanation on learning during early childhood.

    Science.gov (United States)

    Legare, Cristine H; Lombrozo, Tania

    2014-10-01

    Two studies examined the specificity of effects of explanation on learning by prompting 3- to 6-year-old children to explain a mechanical toy and comparing what they learned about the toy's causal and non-causal properties with children who only observed the toy, both with and without accompanying verbalization. In Study 1, children were experimentally assigned to either explain or observe the mechanical toy. In Study 2, children were classified according to whether the content of their response to an undirected prompt involved explanation. Dependent measures included whether children understood the toy's functional-mechanical relationships, remembered perceptual features of the toy, effectively reconstructed the toy, and (for Study 2) generalized the function of the toy when constructing a new one. Results demonstrate that across age groups, explanation promotes causal learning and generalization but does not improve (and in younger children can even impair) memory for causally irrelevant perceptual details. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  18. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials.

    Science.gov (United States)

    Chan, An-Wen; Tetzlaff, Jennifer M; Gøtzsche, Peter C; Altman, Douglas G; Mann, Howard; Berlin, Jesse A; Dickersin, Kay; Hróbjartsson, Asbjørn; Schulz, Kenneth F; Parulekar, Wendy R; Krleza-Jeric, Karmela; Laupacis, Andreas; Moher, David

    2013-01-08

    High quality protocols facilitate proper conduct, reporting, and external review of clinical trials. However, the completeness of trial protocols is often inadequate. To help improve the content and quality of protocols, an international group of stakeholders developed the SPIRIT 2013 Statement (Standard Protocol Items: Recommendations for Interventional Trials). The SPIRIT Statement provides guidance in the form of a checklist of recommended items to include in a clinical trial protocol. This SPIRIT 2013 Explanation and Elaboration paper provides important information to promote full understanding of the checklist recommendations. For each checklist item, we provide a rationale and detailed description; a model example from an actual protocol; and relevant references supporting its importance. We strongly recommend that this explanatory paper be used in conjunction with the SPIRIT Statement. A website of resources is also available (www.spirit-statement.org). The SPIRIT 2013 Explanation and Elaboration paper, together with the Statement, should help with the drafting of trial protocols. Complete documentation of key trial elements can facilitate transparency and protocol review for the benefit of all stakeholders.

  19. Pharmacovigilance: Empowering healthcare professionals

    Directory of Open Access Journals (Sweden)

    Mugoša Snežana S.

    2015-01-01

    Full Text Available Introduction: Spontaneous reporting of adverse reactions is of greatest importance for obtaining information about adverse drug reactions (ADRs after granting the marketing authorization. The most important role and also the greatest responsibility belong to healthcare professionals. Their active participation is a prerequisite for the existence of an effective national drug safety monitoring. Methods: This paper examines the legislative framework concerning the pharmacovigilance system in Montenegro. The information was collected from scientific articles and the website of the Agency for Medicines and Medical Devices of Montenegro. Topic: Key segments of pharmacovigilance system are presented, with a special reference to the importance of spontaneous reporting of ADRs, results of spontaneous reporting of ADRs according to the latest Agency's Annual report on the results of spontaneous reporting of adverse reactions to medicines, possible reasons for underreporting ADRs, as well as the new EU regulation on pharmacovigilance. Conclusions: Spontaneous reporting of ADRs remains the cornerstone of pharmacovigilance systems. Hence, continuous education of healthcare professionals is needed, with the aim of improving their awareness of the importance of ADRs and risk factors that lead to them, in order to reduce the incidence of ADRs and to increase the number of reported suspected ADRs.

  20. Improving Healthcare through Lean Management

    DEFF Research Database (Denmark)

    Nielsen, Anders Paarup; Edwards, Kasper

    2011-01-01

    The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare....... The paper concludes by discussing the implications of hypothesis two, three, and four for the successful application of lean management within healthcare. Is it concluded that this requires a transformative and contingent approach to lean management where the universal principles of the lean philosophy...

  1. Early Intervention in Psychosis

    Science.gov (United States)

    McGorry, Patrick D.

    2015-01-01

    Abstract Early intervention for potentially serious disorder is a fundamental feature of healthcare across the spectrum of physical illness. It has been a major factor in the reductions in morbidity and mortality that have been achieved in some of the non-communicable diseases, notably cancer and cardiovascular disease. Over the past two decades, an international collaborative effort has been mounted to build the evidence and the capacity for early intervention in the psychotic disorders, notably schizophrenia, where for so long deep pessimism had reigned. The origins and rapid development of early intervention in psychosis are described from a personal and Australian perspective. This uniquely evidence-informed, evidence-building and cost-effective reform provides a blueprint and launch pad to radically change the wider landscape of mental health care and dissolve many of the barriers that have constrained progress for so long. PMID:25919380

  2. Integration of healthcare rehabilitation in chronic conditions

    Directory of Open Access Journals (Sweden)

    Anne Frølich

    2010-02-01

    Full Text Available Introduction: Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities—Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen—collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions. Description of care practice: Four multidisciplinary rehabilitation intervention programmes, one for each chronic condition: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. Conclusion and discussion: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified.

  3. Army Healthcare Enterprise Management System

    National Research Council Canada - National Science Library

    2001-01-01

    .... The complaint alleged that the Army Healthcare Enterprise Management System was not properly competed, potential conflicts of interest existed, and possible contract performance problems existed...

  4. Ethical issues in healthcare financing.

    Science.gov (United States)

    Maharaj, S R; Paul, T J

    2011-07-01

    The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

  5. Children's success at detecting circular explanations and their interest in future learning.

    Science.gov (United States)

    Mills, Candice M; Danovitch, Judith H; Rowles, Sydney P; Campbell, Ian L

    2017-10-01

    These studies explore elementary-school-aged children's ability to evaluate circular explanations and whether they respond to receiving weak explanations by expressing interest in additional learning. In the first study, 6-, 8-, and 10-year-olds (n = 53) heard why questions about unfamiliar animals. For each question, they rated the quality of single explanations and later selected the best explanation between pairs of circular and noncircular explanations. When judging single explanations, 8- and 10-year-olds, and to some extent 6-year-olds, provided higher ratings for noncircular explanations compared to circular ones. When selecting between pairs of explanations, all age groups preferred noncircular explanations to circular ones, but older children did so more consistently than 6-year-olds. Children who recognized the weakness of the single circular explanations were more interested in receiving additional information about the question topics. In Study 2, all three age groups (n = 87) provided higher ratings for noncircular explanations compared to circular ones when listening to responses to how questions, but older children showed a greater distinction in their ratings than 6-year-olds. Moreover, the link between recognizing circular explanations as weak and interest in future learning could not be accounted for solely by individual differences in verbal intelligence. These findings illustrate the developmental trajectory of explanation evaluation and support that recognition of weak explanations is linked to interest in future learning across the elementary years. Implications for education are discussed.

  6. Leading healthcare in complexity.

    Science.gov (United States)

    Cohn, Jeffrey

    2014-12-01

    Healthcare institutions and providers are in complexity. Networks of interconnections from relationships and technology create conditions in which interdependencies and non-linear dynamics lead to surprising, unpredictable outcomes. Previous effective approaches to leadership, focusing on top-down bureaucratic methods, are no longer effective. Leading in complexity requires leaders to accept the complexity, create an adaptive space in which innovation and creativity can flourish and then integrate the successful practices that emerge into the formal organizational structure. Several methods for doing adaptive space work will be discussed. Readers will be able to contrast traditional leadership approaches with leading in complexity. They will learn new behaviours that are required of complexity leaders, along with challenges they will face, often from other leaders within the organization.

  7. Globalization of healthcare.

    Science.gov (United States)

    2012-05-01

    Globalization-the increasing transnational circulation of money, goods, people, ideas, and information worldwide-is generally recognized as one of the most powerful forces shaping our current and future history. How is it affecting healthcare, and in that context, what is the purpose and significance of Global Advances in Health and Medicine (GAHM), publisher of this journal? Our goal is not homogenization but rather to provide an opportunity for integration, convergence, and collaboration across cultures. By respecting and conserving the richness and diversity of each new medicine, we embrace globalization. Globalization is of course not new; it began in the Renaissance and particularly with the 15th- and 16th-century voyages of exploration by Columbus, Magellan, and others. Since the beginning of time, there have been interactions and exchanges among different peoples and cultures. However, the current magnitude of globalization is unprecedented and yet still expanding rapidly.

  8. Globalization of Healthcare

    Science.gov (United States)

    2012-01-01

    Globalization—the increasing transnational circulation of money, goods, people, ideas, and information worldwide—is generally recognized as one of the most powerful forces shaping our current and future history. How is it affecting healthcare, and in that context, what is the purpose and significance of Global Advances in Health and Medicine (GAHM), publisher of this journal? Our goal is not homogenization but rather to provide an opportunity for integration, convergence, and collaboration across cultures. By respecting and conserving the richness and diversity of each new medicine, we embrace globalization. Globalization is of course not new; it began in the Renaissance and particularly with the 15th- and 16th-century voyages of exploration by Columbus, Magellan, and others. Since the beginning of time, there have been interactions and exchanges among different peoples and cultures. However, the current magnitude of globalization is unprecedented and yet still expanding rapidly. PMID:24278809

  9. Healthcare in Pali Buddhism.

    Science.gov (United States)

    Giustarini, Giuliano

    2017-05-02

    This article addresses an apparent paradox found in Pali Buddhist literature: while the "uncompounded" (asaṅkhata) is valued over and above what is "compounded" (saṅkhata), the texts also encourage careful attention to relative (or, physical) health. The mind is the laboratory and the object of a thorough work meant to lead to final liberation from mental affliction and from the cycle of existence, whereas the body is perceived as impure, limited, and intrinsically unsatisfactory. Nonetheless, a disciple of the Buddha is supposed to take care of his/her own and others' physical wellbeing, and monastic equipment includes a set of medicines. "Ultimate health" is the final goal, but conventional healthcare supports the path to nibbāna and represents a value per se. The present article will explore the intricate connection between these two dimensions.

  10. Illness Mapping: A time and cost effective method to estimate healthcare data needed to establish community-based health insurance

    NARCIS (Netherlands)

    E. Binnendijk (Erica); M. Gautham (Meenakshi); R. Koren (Ruth); D.M. Dror (David)

    2012-01-01

    textabstractBackground: Most healthcare spending in developing countries is private out-of-pocket. One explanation for low penetration of health insurance is that poorer individuals doubt their ability to enforce insurance contracts. Community-based health insurance schemes (CBHI) are a solution,

  11. Deaf women: experiences and perceptions of healthcare system access.

    Science.gov (United States)

    Steinberg, Annie G; Wiggins, Erin A; Barmada, Carlin Henry; Sullivan, Vicki Joy

    2002-10-01

    The authors investigated the knowledge, attitudes, and healthcare experiences of Deaf women. Interviews with 45 deaf women who participated in focus groups in American Sign Language were translated, transcribed, and analyzed. Deaf women's understanding of women's health issues, knowledge of health vocabulary in both English and American Sign Language, common health concerns among Deaf women, and issues of access to information, including pathways and barriers, were examined. As a qualitative study, the results of this investigation are limited and should be viewed as exploratory. A lack of health knowledge was evident, including little understanding of the meaning or value of cancer screening, mammography, or Pap smears; purposes of prescribed medications, such as hormone replacement therapy (HRT); or necessity for other medical or surgical interventions. Negative experiences and avoidance or nonuse of health services were reported, largely due to the lack of a common language with healthcare providers. Insensitive behaviors were also described. Positive experiences and increased access to health information were reported with practitioners who used qualified interpreters. Providers who demonstrated minimal signing skills, a willingness to use paper and pen, and sensitivity to improving communication were appreciated. Deaf women have unique cultural and linguistic issues that affect healthcare experiences. Improved access to health information may be achieved with specialized resource materials, improved prevention and targeted intervention strategies, and self-advocacy skills development. Healthcare providers must be trained to become more effective communicators with Deaf patients and to use qualified interpreters to assure access to healthcare for Deaf women.

  12. Challenges and Opportunities in Scaling-Up Nutrition in Healthcare

    Directory of Open Access Journals (Sweden)

    Ian Darnton-Hill

    2015-01-01

    Full Text Available Healthcare continues to be in a state of flux; conventionally, this provides opportunities and challenges. The opportunities include technological breakthroughs, improved economies and increasing availability of healthcare. On the other hand, economic disparities are increasing and leading to differing accessibility to healthcare, including within affluent countries. Nutrition has received an increase in attention and resources in recent decades, a lot of it stimulated by the rise in obesity, type 2 diabetes mellitus and hypertension. An increase in ageing populations also has meant increased interest in nutrition-related chronic diseases. In many middle-income countries, there has been an increase in the double burden of malnutrition with undernourished children and overweight/obese parents and adolescents. In low-income countries, an increased evidence base has allowed scaling-up of interventions to address under-nutrition, both nutrition-specific and nutrition-sensitive interventions. Immediate barriers (institutional, structural and biological and longer-term barriers (staffing shortages where most needed and environmental impacts on health are discussed. Significant barriers remain for the near universal access to healthcare, especially for those who are socio-economically disadvantaged, geographically isolated, living in war zones or where environmental damage has taken place. However, these barriers are increasingly being recognized, and efforts are being made to address them. The paper aims to take a broad view that identifies and then comments on the many social, political and scientific factors affecting the achievement of improved nutrition through healthcare.

  13. [Meanings attributed to management as an explanation for clinician managers' attitudes and professional identity].

    Science.gov (United States)

    Cascón-Pereira, Rosalía; Valverde, Mireia

    2014-01-01

    To understand the process by which clinician managers construct their professional identities and develop their attitudes toward managing. A qualitative study was performed, based on grounded theory, through in-depth interviews with 20 clinician managers selected through theoretical sampling in two public hospitals of Catalonia (Spain), participant observation, and documentation. Clinician managers' role meanings are constructed by comparing their roles with those of senior managers and clinicians. In this process, clinician managers seek to differentiate themselves from senior managers through the meanings constructed. In particular, they use proximity with reality and clinical knowledge as the main sources of differentiation. This study sheds light on why clinician managers develop adverse attitudes to managing and why they define themselves as clinicians rather than as managers. The explanation lies in the construction of the meanings they assign to managing as the basis of their attitudes to this role and professional identity. These findings have some practical implications for healthcare management. Copyright © 2014. Published by Elsevier Espana.

  14. HIV in Japan: Epidemiologic puzzles and ethnographic explanations

    Directory of Open Access Journals (Sweden)

    Anthony S. DiStefano

    2016-12-01

    Full Text Available Japan is widely perceived to have a low level of HIV occurrence; however, its HIV epidemics also have been the subject of considerable misunderstanding globally. I used a ground truthing conceptual framework to meet two aims: first, to determine how accurately official surveillance data represented Japan's two largest epidemics (urban Kansai and Tokyo as understood and experienced on the ground; and second, to identify explanations for why the HIV epidemics were unfolding as officially reported. I used primarily ethnographic methods while drawing upon epidemiology, and compared government surveillance data to observations at community and institutional sites (459 pages of field notes; 175 persons observed, qualitative interviews with stakeholders in local HIV epidemics (n = 32, and document research (n = 116. This revealed seven epidemiologic puzzles involving officially reported trends and conspicuously missing information. Ethnographically grounded explanations are presented for each. These included factors driving the epidemics, which ranged from waning government and public attention to HIV, to gaps in sex education and disruptive leadership changes in public institutions approximately every two years. Factors constraining the epidemics also contributed to explanations. These ranged from subsidized medical treatment for most people living with HIV, to strong partnerships between government and a well-developed, non-governmental sector of HIV interventionists, and protective norms and built environments in the sex industry. Local and regional HIV epidemics were experienced and understood as worse than government reports indicated, and ground-level data often contradicted official knowledge. Results thus call into question epidemiologic trends, including recent stabilization of the national epidemic, and suggest the need for revisions to the surveillance system and strategies that address factors driving and constraining the epidemics. Based

  15. Tutorial dialogues and gist explanations of genetic breast cancer risk.

    Science.gov (United States)

    Widmer, Colin L; Wolfe, Christopher R; Reyna, Valerie F; Cedillos-Whynott, Elizabeth M; Brust-Renck, Priscila G; Weil, Audrey M

    2015-09-01

    The intelligent tutoring system (ITS) BRCA Gist is a Web-based tutor developed using the Shareable Knowledge Objects (SKO) platform that uses latent semantic analysis to engage women in natural-language dialogues to teach about breast cancer risk. BRCA Gist appears to be the first ITS designed to assist patients' health decision making. Two studies provide fine-grained analyses of the verbal interactions between BRCA Gist and women responding to five questions pertaining to breast cancer and genetic risk. We examined how "gist explanations" generated by participants during natural-language dialogues related to outcomes. Using reliable rubrics, scripts of the participants' verbal interactions with BRCA Gist were rated for content and for the appropriateness of the tutor's responses. Human researchers' scores for the content covered by the participants were strongly correlated with the coverage scores generated by BRCA Gist, indicating that BRCA Gist accurately assesses the extent to which people respond appropriately. In Study 1, participants' performance during the dialogues was consistently associated with learning outcomes about breast cancer risk. Study 2 was a field study with a more diverse population. Participants with an undergraduate degree or less education who were randomly assigned to BRCA Gist scored higher on tests of knowledge than those assigned to the National Cancer Institute website or than a control group. We replicated findings that the more expected content that participants included in their gist explanations, the better they performed on outcome measures. As fuzzy-trace theory suggests, encouraging people to develop and elaborate upon gist explanations appears to improve learning, comprehension, and decision making.

  16. Healthcare Systems and Other Applications

    NARCIS (Netherlands)

    van Kasteren, T.L.M.; Kröse, B.J.A.

    2007-01-01

    This Works in Progress department discusses eight projects related to healthcare. The first project aims to aid people with mild dementia. The second project plans to simplify the delivery of healthcare services to the elderly and cognitively disabled, while the third project is developing models

  17. Freeform electronics for advanced healthcare

    KAUST Repository

    Hussain, Muhammad Mustafa

    2017-02-16

    Freeform (physically flexible, stretchable and reconfigurable) electronics can be critical enabler for advanced personalized healthcare. With increased global population and extended average lifetime of mankind, it is more important than ever to integrate advanced electronics into our daily life for advanced personalized healthcare. In this paper, we discuss some critical criteria to design such electronics with enabling applications.

  18. Freeform electronics for advanced healthcare

    KAUST Repository

    Hussain, Muhammad Mustafa; Hussain, Aftab M.; Nassar, Joanna M.; Kutbee, Arwa T.; Gumus, Abdurrahman; Hanna, Amir

    2017-01-01

    Freeform (physically flexible, stretchable and reconfigurable) electronics can be critical enabler for advanced personalized healthcare. With increased global population and extended average lifetime of mankind, it is more important than ever to integrate advanced electronics into our daily life for advanced personalized healthcare. In this paper, we discuss some critical criteria to design such electronics with enabling applications.

  19. Healthcare technology in the home

    DEFF Research Database (Denmark)

    Ballegaard, Stinne Aaløkke

    2011-01-01

    it is relevant to examine the changes induced by this development: How is healthcare technology appropriated and domesticated by users, how does the development affect the role of the patient, and how is the relationship between home patients, family caregivers and healthcare professionals transformed? The role...

  20. Style investing: behavioral explanations of stock market anomalies

    OpenAIRE

    Wouters, T.

    2006-01-01

    Abstract PhD-project The aim of this thesis is to explore the mechanisms of style investing. My project consists of two parts, each with an individual goal: 1. The first objective will be to analyze the implications of the dynamics of value and growth strategies for the US stock market. 2. The second objective will be to find explanations for stock returns by introducing the effects of collective preferences of investors into the dynamics of stock markets. We introduce style popularity as an ...

  1. Coding Scheme for Assessment of Students’ Explanations and Predictions

    Directory of Open Access Journals (Sweden)

    Mihael Gojkošek

    2017-04-01

    Full Text Available In the process of analyzing students’ explanations and predictions for interaction between brightness enhancement film and beam of white light, a need for objective and reliable assessment instrumentarose. Consequently, we developed a codingscheme that was mostly inspired by the rubrics for self-assessment of scientific abilities. In the paper we present the grading categories that were integrated in the coding scheme, and descriptions of criteria used for evaluation of students work. We report the results of reliability analysis of new assessment tool and present some examples of its application.

  2. Radiometric method and abnormal explanation of landslide survey

    International Nuclear Information System (INIS)

    Ye Shulin; Sun Zhanxue; Luo Liangsheng

    2003-01-01

    Radioactivity exploration mechanism of landslide is researched. Radioactive measure technical and its anomaly explanation models of application is introduced. Test verification result of landslide body geological form (boundary and landslide body thickness) in the district of Wanzhou 233 of Chongqing city ancients landslide and the Yunyang new county Zhaiba landslide shows, it can be used in determining the body boundary (reason) line, investigating the underground current direction and landslide body moving direction, explaining that calculation of weathered zone thickness of landslide body. It can also increase the geological effect of landslide exploration in adaption with geology and drilling

  3. Flip-Floppers and Wafflers: Explanations and Repositioning

    DEFF Research Database (Denmark)

    Robison, Joshua

    to this literature by showing that repositioning’s influence on evaluations depends on beliefs citizens make concerning why the policy switch occurred, beliefs that are, in turn, structured by the communication environment surrounding such switches. Specifically, I use two large national survey experiments to show...... that repositioning elites who provide a satisfactory explanation for their change in position escape evaluative harm from their actions and that this occurs even among individuals who lost proximity from the elite’s change in position and among those from a different party as the elite. This study thus has important...

  4. Predictors of Healthcare Service Utilization for Mental Health Reasons

    Directory of Open Access Journals (Sweden)

    Marie-Josée Fleury

    2014-10-01

    Full Text Available This study was designed to identify: (1 predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2 correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care.

  5. Mobile Device Security: Perspectives of Future Healthcare Workers.

    Science.gov (United States)

    Hewitt, Barbara; Dolezel, Diane; McLeod, Alexander

    2017-01-01

    Healthcare data breaches on mobile devices continue to increase, yet the healthcare industry has not adopted mobile device security standards. This increase is disturbing because individuals are often accessing patients' protected health information on personal mobile devices, which could lead to a data breach. This deficiency led the researchers to explore the perceptions of future healthcare workers regarding mobile device security. To determine healthcare students' perspectives on mobile device security, the investigators designed and distributed a survey based on the Technology Threat Avoidance Theory. Three hundred thirty-five students participated in the survey. The data were analyzed to determine participants' perceptions about security threats, effectiveness and costs of safeguards, self-efficacy, susceptibility, severity, and their motivation and actions to secure their mobile devices. Awareness of interventions to protect mobile devices was also examined. Results indicate that while future healthcare professionals perceive the severity of threats to their mobile data, they do not feel personally susceptible. Additionally, participants were knowledgeable about security safeguards, but their knowledge of costs and problems related to the adoption of these measures was mixed. These findings indicate that increasing security awareness of healthcare professionals should be a priority.

  6. Governance mechanisms for healthcare apps

    DEFF Research Database (Denmark)

    Manikas, Konstantinos; Hansen, Klaus Marius; Kyng, Morten

    2014-01-01

    The introduction of the `app store' concept has challenged the way software is distributed and marketed: developers have easier access to customers, while customers have easy access to innovative applications. Apps today are increasingly focusing on more "mission-critical" areas like healthcare...... with the Apple AppStore counting more than 40,000 apps under the category "health & fitness". This rapid development of healthcare apps increases the necessity of governance as, currently, healthcare apps are not thoroughly governed. The U.S. Food and Drug Administration and the European Commission only have...... policies for apps that are medical devices.In this paper, we approach the problem of how to govern healthcare and medical apps by addressing the risks the use of these apps pose, while at the same time inviting for development of new apps. To do so we (i) analyze four cases of healthcare app governance...

  7. Leveraging Digital Innovation in Healthcare

    DEFF Research Database (Denmark)

    Brown, Carol V.; Jensen, Tina Blegind; Aanestad, Margun

    2014-01-01

    Harnessing digital innovations for healthcare delivery has raised high expectations as well as major concerns. Several countries across the globe have made progress in achieving three common goals of lower costs, higher quality, and increased patient access to healthcare services through...... investments in digital infrastructures. New technologies are leveraged to achieve widespread 24x7 disease management, patients’ wellbeing, home-based healthcare and other patient-centric service innovations. Yet, digital innovations in healthcare face barriers in terms of standardization, data privacy...... landscapes in selected countries. Then panelists with expertise in digital data streams, cloud, and mobile computing will present concrete examples of healthcare service innovations that have the potential to address one or more of the global goals. ECIS attendees are invited to join a debate about...

  8. Walking the history of healthcare.

    Science.gov (United States)

    Black, Nick

    2007-12-01

    The history of healthcare is complex, confusing and contested. In Walking London's medical history the story of how health services developed from medieval times to the present day is told through seven walks. The book also aims to help preserve our legacy, as increasingly former healthcare buildings are converted to other uses, and to enhance understanding of the current challenges we face in trying to improve healthcare in the 21st century. Each walk has a theme, ranging from the way hospitals merge or move and the development of primary care to how key healthcare trades became professions and the competition between the church, Crown and City for control of healthcare. While recognising the contributions of the 'great men of medicine', the book takes as much interest in the six ambulance stations built by the London County Council (1915) as the grandest teaching hospitals.

  9. To shatter the glass ceiling in healthcare management: who supports affirmative action and why?

    Science.gov (United States)

    Weil, Peter A; Mattis, Mary C

    2003-11-01

    We examined the findings of a recent national survey of healthcare executives that showed 90% of women but only 53% of men favoured efforts to increase the proportion of women in senior healthcare management positions. Using the theories of relative deprivation and social identity, we tested hypotheses to suggest the background, work characteristics and attitudes about existing discriminatory practices in their own organizations that correlate with respondents' views about affirmative action for women. Some support is evidenced for the two theories and explanations are suggested to account for apparent anomalies.

  10. Data-Driven Healthcare: Challenges and Opportunities for Interactive Visualization.

    Science.gov (United States)

    Gotz, David; Borland, David

    2016-01-01

    The healthcare industry's widespread digitization efforts are reshaping one of the largest sectors of the world's economy. This transformation is enabling systems that promise to use ever-improving data-driven evidence to help doctors make more precise diagnoses, institutions identify at risk patients for intervention, clinicians develop more personalized treatment plans, and researchers better understand medical outcomes within complex patient populations. Given the scale and complexity of the data required to achieve these goals, advanced data visualization tools have the potential to play a critical role. This article reviews a number of visualization challenges unique to the healthcare discipline.

  11. The Difficulties of Reductionistic Explanation of Moral Knowledge

    Directory of Open Access Journals (Sweden)

    SeyyedAli Asghari

    2016-03-01

    Full Text Available Moral reductionist believes that the reality of moral qualities are the same qualities which can be expressed with immoral words. Such an ontological view has an epistemological aspect which states our understanding of moral facts is either our understanding of immoral facts or our deductions of immoral understanding. From moral reductionists and especially the naturalists’ point of view, the ability to explain moral knowledge without resorting to some theories such as moral intuition is considered to be an important advantage and even a strong reason for their view. Therefore, the present paper is going to study the reductionistic explanations about moral knowledge and justifications of moral believes. We have come to the conclusion that among the explanations presented by the naturalists, analytic knowledge has the same problems which have discredited the theory of analytic reductionism. Also, deducing value from non-value is either facing the logical gap of is-must; or if there is a meaningful descriptive-valuable link, we can’t finally come to unconditional moral results.

  12. Misconceptions about optics: An effect of misleading explanations?

    Science.gov (United States)

    Favale, Fabrizio; Bondani, Maria

    2014-07-01

    During our activities of physics dissemination with High School students especially concerning optics, we are used to distribute a questionnaire about colors and image formation by mirrors and lenses. The answers to some questions clearly show misconceptions and naïve ideas about colors, ray tracing, image formation in reflection and refraction. These misconceptions are widespread and do not depend on the gender, the level, and the age of the students: they seem to depend on some wrong ideas and explanatory models that are not changed by the curricular studies at school. In fact, the same errors are present in groups of students before and after taking optics courses at High School. On the other hand we have also found some misleading explanations of the phenomena both in textbooks and websites. Most of the time, errors occur in the explanatory drawings accompanying the text, which are based on some hybrid description of the optical processes: sometimes the description of the path of the ray light is confused with the image reconstruction by the lenses. We think that to partially avoid some errors it is important to use a teaching path centered on the actual path of the rays and not on what eyes see (the vision). Here we present the results of data collected from more than 200 students and some considerations about figures and explanations found in textbooks.

  13. Acceleration of particles by black holes: Kinematic explanation

    International Nuclear Information System (INIS)

    Zaslavskii, O. B.

    2011-01-01

    A new simple and general explanation of the effect of acceleration of particles by black holes to infinite energies in the center of mass frame is suggested. It is based on kinematics of particles moving near the horizon. This effect arises when particles of two kinds collide near the horizon. For massive particles, the first kind represents a particle with the generic energy and angular momentum (I call them ''usual''). Near the horizon, such a particle has a velocity almost equal to that of light in the frame that corotates with a black hole (the frame is static if a black hole is static). The second kind (called ''critical'') consists of particles with the velocity v< c near the horizon due to special relationship between the energy and angular momentum (or charge). As a result, the relative velocity approaches the speed of light c, and the Lorentz factor grows unbound. This explanation applies both to generic rotating black holes and charged ones (even for radial motion of particles). If one of the colliding particles is massless (photon), the critical particle is distinguished by the fact that its frequency is finite near the horizon. The existence (or absence) of the effect is determined depending on competition of two factors--gravitational blue shift for a photon propagating towards a black hole and the Doppler effect due to transformation from the locally nonrotating frame to a comoving one. Classification of all possible types of collisions is suggested depending on whether massive or massless particle is critical or usual.

  14. The Integration of Two Healthcare Systems: A Common Healthcare Problem.

    Science.gov (United States)

    Cassatly, Hannah; Cassatly, Michael

    2015-01-01

    The change in reimbursement mandated by the Affordable Care Act is causing a rapid consolidation of the marketplace as well as the delivery of clinical care in a team-based model. This case report examines the successful joining of two clinical teams concurrent with the merger of two healthcare organizations and discusses some of the difficulties encountered. A subsequent discussion focuses on the resolution: the need for physicians to embrace the team concept of healthcare delivery and for healthcare systems to facilitate this transition with team and leadership coaching.

  15. Mindfulness Interventions.

    Science.gov (United States)

    Creswell, J David

    2017-01-03

    Mindfulness interventions aim to foster greater attention to and awareness of present moment experience. There has been a dramatic increase in randomized controlled trials (RCTs) of mindfulness interventions over the past two decades. This article evaluates the growing evidence of mindfulness intervention RCTs by reviewing and discussing (a) the effects of mindfulness interventions on health, cognitive, affective, and interpersonal outcomes; (b) evidence-based applications of mindfulness interventions to new settings and populations (e.g., the workplace, military, schools); (c) psychological and neurobiological mechanisms of mindfulness interventions; (d) mindfulness intervention dosing considerations; and (e) potential risks of mindfulness interventions. Methodologically rigorous RCTs have demonstrated that mindfulness interventions improve outcomes in multiple domains (e.g., chronic pain, depression relapse, addiction). Discussion focuses on opportunities and challenges for mindfulness intervention research and on community applications.

  16. Balancing influence between actors in healthcare decision making.

    Science.gov (United States)

    Kaplan, Robert M; Babad, Yair M

    2011-04-19

    Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision

  17. Particle physics explanations for ultra-high energy cosmic ray events

    Indian Academy of Sciences (India)

    this talk I briefly summarize several proposed particle physics explanations: a breakdown ... as primaries, and magnetic monopoles with mass below 1010 GeV as primaries. .... these monopoles would be the ultimate test of this explanation.

  18. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

    Science.gov (United States)

    Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

    2015-01-01

    While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. PMID:26178332

  19. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes.

    Science.gov (United States)

    Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

    2015-10-01

    While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. 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.

  20. [Healthcare patient loyalty].

    Science.gov (United States)

    Ameri, Cinzia; Fiorini, Fulvio

    2016-01-01

    If the "old economy" preached standardization of products/services in order to reduce costs, the "new economy" is based on the recognition of the needs and the management of information. It is aimed at providing better and more usable services. One scenario is a national health service with regional management but based on competition between hospitals/companies.This led to a different handling of the user/patient, which has become the center of the health system: marketing seeks to retain the patient, trying to push a client-patient to not change their healthcare service provider. In costs terms, it is more economical to retain a customer rather than acquire a new one: a satisfied customer is also the best sounding board for each company. Customer equity is the management of relations with patients which can result in a greater customer value: it is possible to recognize an equity of the value, of the brand and of the report. Loyalty uses various marketing activities (basic, responsive, responsible, proactive and collaborative): each hospital/company chooses different actions depending on how many resources it plans to invest in loyalty.

  1. Healthcare biotechnology in India.

    Science.gov (United States)

    Srivastava, L M

    2005-01-01

    Biotechnology in India has made great progress in the development of infrastructure, manpower, research and development and manufacturing of biological reagents, biodiagnostics, biotherapeutics, therapeutic and, prophylactic vaccines and biodevices. Many of these indigenous biological reagents, biodiagnostics, therapeutic and prophylactic vaccines and biodevices have been commercialized. Commercially when biotechnology revenue has reached $25 billions in the U.S. alone in 2000 excluding the revenues of biotech companies that were acquired by pharmaceutical companies, India has yet to register a measurable success. The conservative nature and craze of the Indian Industry for marketing imported biotechnology products, lack of Government support, almost non-existing national healthcare system and lack of trained managers for marketing biological and new products seem to be the important factors responsible for poor economic development of biotechnology in India. With the liberalization of Indian economy, more and more imported biotechnology products will enter into the Indian market. The conditions of internal development of biotechnology are not likely to improve in the near future and it is destined to grow only very slowly. Even today biotechnology in India may be called to be in its infancy.

  2. Fake news in healthcare

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-10-01

    Full Text Available No abstract available. Article truncated at 150 words. An article in the National Review by Pascal-Emmanuel Gobry points out that there is considerable waste in healthcare spending (1. He blames much of this on two entitlements-Medicare and employer-sponsored health insurance. He also lays much of the blame on doctors. “Doctors are the biggest villains in American health care. ... As with public-school teachers, we should be able to recognize that a profession as a whole can be pathological even as many individual members are perfectly good actors, and even if many of them are heroes. And just like public-school teachers, the medical profession as a whole puts its own interests ahead of those of the citizens it claims to be dedicated to serve.” Who is Pascal-Emmanuel Gobry and how could he say something so nasty about teachers and my profession? A quick internet search revealed that Mr. Gobry is a fellow at the Ethics & Public Policy Center …

  3. A Framework for Healthcare Planning and Control

    NARCIS (Netherlands)

    Hans, Elias W.; van Houdenhoven, Mark; Hulshof, P.J.H.; Hall, Randolph

    2012-01-01

    Rising expenditures spur healthcare organizations to organize their processes more efficiently and effectively. Unfortunately, healthcare planning and control lags behind manufacturing planning and control. We analyze existing planning and control concepts or frameworks for healthcare operations

  4. Self-Explanation and Explanatory Feedback in Games: Individual Differences, Gameplay, and Learning

    OpenAIRE

    Killingsworth, Stephen; Clark, Douglas; Adams, Deanne

    2015-01-01

    Previous research has demonstrated the efficacy of two explanation-based approaches for increasing learning in educational games. The first involves asking students to explain their answers (self-explanation) and the second involves providing correct explanations (explanatory feedback). This study (1) compared self-explanation and explanatory feedback features embedded into a game designed to teach Newtonian dynamics and (2) investigated relationships between learning and individual differenc...

  5. MARKETING PLANNING IN HEALTHCARE INDUSTRY

    Directory of Open Access Journals (Sweden)

    Bobeica Ana Amaria

    2013-04-01

    Full Text Available The purpose of this paper is to develop a perspective on what is important or critical to the discipline of healthcare marketing by analyzing the marketing plan from the institutional (or organizational perspective. This “salience issue” is complicated by the structural problems in healthcare such as new advertising programs, advances in medical technology, and the escalating costs of care in the recent economic situation of world economic crisis. Reviewing a case study, the paper examines how marketing managers face increasingly difficult management and it emphasizes one more time the importance of marketing in the internal organizational structure. Also it shows the direct connection between the marketing strategy, the Quality of Healthcare and marketing planning in the internal organization of Private Healthcare Practice in Romania. Also it concludes that marketing planning in healthcare has to be very precised in order to achieve some major objectives: customer care, financial stability, equilibrium between stakeholders and shareholders and future improvement in communication to customers. The marketing strategies and programs discussed in this paper follow the analysis of the 4Ps of Healthcare Marketing Services and propose call to action plans and possibilities that might result in a more particular case study analysis of the Romanian Healthcare Market.

  6. Process evaluation for complex interventions in health services research: analysing context, text trajectories and disruptions.

    Science.gov (United States)

    Murdoch, Jamie

    2016-08-19

    Process evaluations assess the implementation and sustainability of complex healthcare interventions within clinical trials, with well-established theoretical models available for evaluating intervention delivery within specific contexts. However, there is a need to translate conceptualisations of context into analytical tools which enable the dynamic relationship between context and intervention implementation to be captured and understood. In this paper I propose an alternative approach to the design, implementation and analysis of process evaluations for complex health interventions through a consideration of trial protocols as textual documents, distributed and enacted at multiple contextual levels. As an example, I conduct retrospective analysis of a sample of field notes and transcripts collected during the ESTEEM study - a cluster randomised controlled trial of primary care telephone triage. I draw on theoretical perspectives associated with Linguistic Ethnography to examine the delivery of ESTEEM through staff orientation to different texts. In doing so I consider what can be learned from examining the flow and enactment of protocols for notions of implementation and theoretical fidelity (i.e. intervention delivered as intended and whether congruent with the intervention theory). Implementation of the triage intervention required staff to integrate essential elements of the protocol within everyday practice, seen through the adoption and use of different texts that were distributed across staff and within specific events. Staff were observed deploying texts in diverse ways (e.g. reinterpreting scripts, deviating from standard operating procedures, difficulty completing decision support software), providing numerous instances of disruption to maintaining intervention fidelity. Such observations exposed tensions between different contextual features in which the trial was implemented, offering theoretical explanations for the main trial findings. The value of

  7. PERCEPTION OF HEALTHCARE PROFESSIONALS REGARDING PRIMARY INTERVENTIONS: PREVENTING DOMESTIC VIOLENCE

    Directory of Open Access Journals (Sweden)

    Adriane Maria Netto de Oliveira

    2015-01-01

    Full Text Available Se objetivó conocer la percepción de los profesionales de los Equipos de Salud Familiar de la zona del Programa de Prevención de la Violencia, sobre las intervenciones primarias con el fin de prevenir la violencia familiar. El estudio está vinculado a la investigación: Intervenciones primaria y secundaria frente a la violencia doméstica desde la perspectiva de los profesionales que trabajan en la Atención Primaria de la Salud. El enfoque fue cualitativo y exploratorio. Los datos fueron recogidos a través de entrevistas semiestructuradas. Los participantes fueron cuatro enfermeras y cuatro médicos. A través del análisis temático, se revelaron tres categorías: conocimiento de las intervenciones primarias de la prevención a la violencia; realización de acciones de intervención primaria para prevenir la violencia – facilidades y dificultades; y importancia de realizar intervenciones primarias y de la atención recibida. Los profesionales conocen las principales intervenciones primarias, mientras que algunos ya se producen en el trabajo multiprofesional.

  8. Healthcare Service Auditing and Intervention in an Emergency ...

    African Journals Online (AJOL)

    A pre- and post-intevention randomized cross-sectional study was carried out from January to February and April to May 2001, respectively, to audit and intervene in the timeliness of health services delivery in an Emergency Paediatric Unit (EPU) of Jos University Teaching Hospital. A structured questionnaire was used to ...

  9. Utilization of Healthcare in the Typhoid Fever Surveillance in Africa Program.

    Science.gov (United States)

    Panzner, Ursula; Pak, Gi Deok; Aaby, Peter; Adu-Sarkodie, Yaw; Ali, Mohammad; Aseffa, Abraham; Baker, Stephen; Bjerregaard-Andersen, Morten; Crump, John A; Deerin, Jessica; Cruz Espinoza, Ligia Maria; Gasmelseed, Nagla; Heriniaina, Jean Noël; Hertz, Julian T; Im, Justin; von Kalckreuth, Vera; Keddy, Karen H; Lankoande, Bruno; Løfberg, Sandra; Meyer, Christian G; Oresto, Michael Munishi; Park, Jin Kyung; Park, Se Eun; Rakotozandrindrainy, Raphaël; Sarpong, Nimako; Soura, Abdramane Bassiahi; Gassama Sow, Amy; Tall, Adama; Teferi, Mekonnen; Worku, Alemayehu; Yeshitela, Biruk; Wierzba, Thomas F; Marks, Florian

    2016-03-15

    Assessing healthcare utilization is important to identify weaknesses of healthcare systems, to outline action points for preventive measures and interventions, and to more accurately estimate the disease burden in a population. A healthcare utilization survey was developed for the Typhoid Fever Surveillance in Africa Program (TSAP) to adjust incidences of salmonellosis determined through passive, healthcare facility-based surveillance. This cross-sectional survey was conducted at 11 sites in 9 sub-Saharan African countries. Demographic data and healthcare-seeking behavior were assessed at selected households. Overall and age-stratified percentages of each study population that sought healthcare at a TSAP healthcare facility and elsewhere were determined. Overall, 88% (1007/1145) and 81% (1811/2238) of the population in Polesgo and Nioko 2, Burkina Faso, respectively, and 63% (1636/2590) in Butajira, Ethiopia, sought healthcare for fever at any TSAP healthcare facility. A far smaller proportion-namely, 20%-45% of the population in Bissau, Guinea-Bissau (1743/3885), Pikine, Senegal (1473/4659), Wad-Medani, Sudan (861/3169), and Pietermaritzburg, South Africa (667/2819); 18% (483/2622) and 9% (197/2293) in Imerintsiatosika and Isotry, Madagascar, respectively; and 4% (127/3089) in Moshi, Tanzania-sought healthcare at a TSAP healthcare facility. Patients with fever preferred to visit pharmacies in Imerintsiatosika and Isotry, and favored self-management of fever in Moshi. Age-dependent differences in healthcare utilization were also observed within and across sites. Healthcare utilization for fever varied greatly across sites, and revealed that not all studied populations were under optimal surveillance. This demonstrates the importance of assessing healthcare utilization. Survey data were pivotal for the adjustment of the program's estimates of salmonellosis and other conditions associated with fever. © The Author 2016. Published by Oxford University Press for the

  10. Complexity leadership: a healthcare imperative.

    Science.gov (United States)

    Weberg, Dan

    2012-01-01

    The healthcare system is plagued with increasing cost and poor quality outcomes. A major contributing factor for these issues is that outdated leadership practices, such as leader-centricity, linear thinking, and poor readiness for innovation, are being used in healthcare organizations. Complexity leadership theory provides a new framework with which healthcare leaders may practice leadership. Complexity leadership theory conceptualizes leadership as a continual process that stems from collaboration, complex systems thinking, and innovation mindsets. Compared to transactional and transformational leadership concepts, complexity leadership practices hold promise to improve cost and quality in health care. © 2012 Wiley Periodicals, Inc.

  11. Sensing behaviour in healthcare design

    DEFF Research Database (Denmark)

    Thorpe, Julia Rosemary; Hysse Forchhammer, Birgitte; Maier, Anja

    2017-01-01

    We are entering an era of distributed healthcare that should fit and respond to individual needs, behaviour and lifestyles. Designing such systems is a challenging task that requires continuous information about human behaviour on a large scale, for which pervasive sensing (e.g. using smartphones...... specifically on activity and location data that can easily be obtained from smartphones or wearables. We further demonstrate how these are applied in healthcare design using an example from dementia care. Comparing a current and proposed scenario exemplifies how integrating sensor-derived information about...... user behaviour can support the healthcare design goals of personalisation, adaptability and scalability, while emphasising patient quality of life....

  12. Home-based Healthcare Technology

    DEFF Research Database (Denmark)

    Verdezoto, Nervo

    of these systems target a specific treatment or condition and might not be sufficient to support the care management work at home. Based on a case study approach, my research investigates home-based healthcare practices and how they can inform future design of home-based healthcare technology that better account......Sustaining daily, unsupervised healthcare activities in non-clinical settings such as the private home can challenge, among others, older adults. To support such unsupervised care activities, an increasingly number of reminders and monitoring systems are being designed. However, most...

  13. Improving healthcare using Lean processes.

    Science.gov (United States)

    Baker, G Ross

    2014-01-01

    For more than a decade, healthcare organizations across Canada have been using Lean management tools to improve care processes, reduce preventable adverse events, increase patient satisfaction and create better work environments. The largest system-wide effort in Canada, and perhaps anywhere, is currently under way in Saskatchewan. The jury is still out on whether Lean efforts in that province, or elsewhere in Canada, are robust enough to transform current delivery systems and sustain new levels of performance. This issue of Healthcare Quarterly features several articles that provide a perspective on Lean methods in healthcare. Copyright © 2014 Longwoods Publishing.

  14. PUBLIC FINANCING OF HEALTHCARE SERVICES

    Directory of Open Access Journals (Sweden)

    Agnieszka Bem

    2013-10-01

    Full Text Available Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ, state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions.

  15. Healthcare Providers' Responses to Narrative Communication About Racial Healthcare Disparities.

    Science.gov (United States)

    Burgess, Diana J; Bokhour, Barbara G; Cunningham, Brooke A; Do, Tam; Gordon, Howard S; Jones, Dina M; Pope, Charlene; Saha, Somnath; Gollust, Sarah E

    2017-10-25

    We used qualitative methods (semi-structured interviews with healthcare providers) to explore: 1) the role of narratives as a vehicle for raising awareness and engaging providers about the issue of healthcare disparities and 2) the extent to which different ways of framing issues of race within narratives might lead to message acceptance for providers' whose preexisting beliefs about causal attributions might predispose them to resist communication about racial healthcare disparities. Individual interviews were conducted with 53 providers who had completed a prior survey assessing beliefs about disparities. Participants were stratified by the degree to which they believed providers contributed to healthcare inequality: low provider attribution (LPA) versus high provider attribution (HPA). Each participant read and discussed two differently framed narratives about race in healthcare. All participants accepted the "Provider Success" narratives, in which interpersonal barriers involving a patient of color were successfully resolved by the provider narrator, through patient-centered communication. By contrast, "Persistent Racism" narratives, in which problems faced by the patient of color were more explicitly linked to racism and remained unresolved, were very polarizing, eliciting acceptance from HPA participants and resistance from LPA participants. This study provides a foundation for and raises questions about how to develop effective narrative communication strategies to engage providers in efforts to reduce healthcare disparities.

  16. Causal explanation, intentionality, and prediction: Evaluating the Criticism of "Deductivism"

    DEFF Research Database (Denmark)

    Koch, Carsten Allan

    2001-01-01

    In a number of influential contributions, Tony Lawson has attacked a view of science that he refers to as deductivism, and criticized economists for implicitly using it in their research. Lawson argues that deductivism is simply the covering-law model, also known as the causal model of scientific...... critisizes the use of universal laws in social science, especially in economics. This view cannot be as easily dismissed as his general criticism of causal explanation. We argue that a number of arguments often used against the existence of (correct) universal laws in the social sciences can be put...... into question. First, it is argued that entities need not be identical, or even remotely alike, to be applicable to the same law. What is necessary is that they have common properties, e.g. mass in physics, and that the law relates to that property (section 6). Second, one might take the so-called model...

  17. Cognitive science as an interface between rational and mechanistic explanation.

    Science.gov (United States)

    Chater, Nick

    2014-04-01

    Cognitive science views thought as computation; and computation, by its very nature, can be understood in both rational and mechanistic terms. In rational terms, a computation solves some information processing problem (e.g., mapping sensory information into a description of the external world; parsing a sentence; selecting among a set of possible actions). In mechanistic terms, a computation corresponds to causal chain of events in a physical device (in engineering context, a silicon chip; in biological context, the nervous system). The discipline is thus at the interface between two very different styles of explanation--as the papers in the current special issue well illustrate, it explores the interplay of rational and mechanistic forces. Copyright © 2014 Cognitive Science Society, Inc.

  18. A flavor-safe composite explanation of $R_K$

    CERN Document Server

    Carmona, Adrian

    2017-05-04

    In these proceedings we discuss a flavor-safe explanation of the anomaly found in $R_K= {\\cal B}(B \\to K \\mu^+ \\mu^-)/{\\cal B}(B \\to K e^+ e^-)$ by LHCb, within the framework of composite Higgs models. We present a model featuring a non-negligible degree of compositeness for all three generations of right-handed leptons, which leads to a violation of lepton-flavor universality in neutral current interactions while other constraints from quark- and lepton-flavor physics are met. Moreoever, the particular embedding of the lepton sector considered in this setup provides a parametrically enhanded contribution to the Higgs mass that can weak considerably the need for ultra-light top partners.

  19. Disordered locality as an explanation for the dark energy

    International Nuclear Information System (INIS)

    Prescod-Weinstein, Chanda; Smolin, Lee

    2009-01-01

    We discuss a novel explanation of the dark energy as a manifestation of macroscopic nonlocality coming from quantum gravity, as proposed by Markopoulou [F. Markopoulou (private communication)]. It has been previously suggested that in a transition from an early quantum geometric phase of the Universe to a low temperature phase characterized by an emergent spacetime metric, locality might have been 'disordered'. This means that there is a mismatch of micro-locality, as determined by the microscopic quantum dynamics and macro-locality as determined by the classical metric that governs the emergent low energy physics. In this paper we discuss the consequences for cosmology by studying a simple extension of the standard cosmological models with disordered locality. We show that the consequences can include a naturally small vacuum energy.

  20. Explanation of significant differences for the TNX groundwater operable unit

    International Nuclear Information System (INIS)

    Palmer, E.R.

    1997-01-01

    This Explanation of Significant Differences (ESD) is being issued by the Department of Energy (DOE), the lead agency for the Savannah River Site (SRS), with concurrence by the Environmental Protection Agency-Region IV (EPA) and South Carolina Department of Health and Environmental Control (SCDHEC) to announce changes in the interim remediation strategy selected for the TNX Groundwater Operable Unit. The TNX Area is located adjacent to the Savannah River in the southwestern portion of SRS. The remedy selected in the Interim Record of Decision (IROD) to achieve the interim action goals was the Hybrid Groundwater Corrective Action (HGCA). The HGCA consisted of a recirculation well system and an air stripper with a series of groundwater extraction wells. The original remediation strategy needs to be modified because the recirculation well system was determined to be ineffective in this area due to geological factors and the nature of the contamination

  1. An Explanation of True Dreams: Aristotle and Jung

    Directory of Open Access Journals (Sweden)

    Ali Sanai

    2016-12-01

    Full Text Available The naturalistic explanation of realized dream (or dreams that come true means that this phenomen will be explained regardless of supernatural agents. Aristotle in Parva naturalia and Jung in his works explained dream visionary. In this article by scrutiny on these thinkers’ theory, we will indicate the naturalistic approach to dream that is far- fetched for followers of metaphysics. In spite of this fact that Aristotle and Jung both belongs to different historical contexts, they have common aspects in terms of naturalistic method; in the universal or broad sense of word, but in terms of content both explain the true dream by the term “coincidence” or accidental conformity between objective events and psychological affairs. It also seems that the notion of Neutral monism in Jung is adaptive to Hylomorphism in Aristotle psychology, and this, provides a path for naturalistic approach to dream as one forms of consciousness.

  2. Theories of International Relations and the Explanation of Foreign Aid

    Directory of Open Access Journals (Sweden)

    PAUSELLI, Gino

    2013-06-01

    Full Text Available 50 years after the publication of the first and influential article in international relations (IR analyzing foreign aid motivations, A theory of foreign aid, by Hans Morgenthau, IR scholarship has not yet accomplished a consistent theoretical body explaining international development cooperation. Most of the empirical studies on foreign aid have been contributions from other disciplines, especially economics. Research from the field of international relations has been mostly descriptive or poorly connected with IR paradigms.This article proposes to analyze motivations of foreign aid allocations decisions of donors. These motivations will be examined from the theoretical perspective of the international relations scholarship. In this way, it is sought to contribute, from the discipline of IR, to the explanation of the process in which developed countries make transfers of resources to developing countries.

  3. Rethinking the health selection explanation for health inequalities.

    Science.gov (United States)

    West, P

    1991-01-01

    As one of several explanations for class differentials in health, health selection has received remarkably little systematic attention in the inequalities debate. It is widely regarded as having (at best) a very minor role in the production of inequalities, and a theoretical debt to social Darwinism. This paper examines the validity of those assumptions in terms of the evidence which has emerged since the publication of the 'Black Report'. It is suggested that it is too easy to write off health selection as of little or no significance, and that reconceptualising the issue within a specifically sociological perspective owing much to labelling theory offers much greater potential for understanding the processes involved. From this perspective, health selection has many of the features of discrimination of the sort that characterises race and sex.

  4. Lean Six Sigma in Healthcare

    NARCIS (Netherlands)

    de Koning, H.; Verver, J.P.S.; van den Heuvel, J.; Bisgaard, S.; Does, R.J.M.M.

    2006-01-01

    Keywords: Cost reduction; efficiency; innovation; quality improvement; service management. Abstract Healthcare, as any other service operation, requires systematic innovation efforts to remain competitive, cost efficient and up to date. In this article, we outline a methodology and present examples

  5. Healthcare costs for new technologies

    International Nuclear Information System (INIS)

    Goyen, Mathias; Debatin, Joerg F.

    2009-01-01

    Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

  6. Business process modeling in healthcare.

    Science.gov (United States)

    Ruiz, Francisco; Garcia, Felix; Calahorra, Luis; Llorente, César; Gonçalves, Luis; Daniel, Christel; Blobel, Bernd

    2012-01-01

    The importance of the process point of view is not restricted to a specific enterprise sector. In the field of health, as a result of the nature of the service offered, health institutions' processes are also the basis for decision making which is focused on achieving their objective of providing quality medical assistance. In this chapter the application of business process modelling - using the Business Process Modelling Notation (BPMN) standard is described. Main challenges of business process modelling in healthcare are the definition of healthcare processes, the multi-disciplinary nature of healthcare, the flexibility and variability of the activities involved in health care processes, the need of interoperability between multiple information systems, and the continuous updating of scientific knowledge in healthcare.

  7. Healthcare costs for new technologies

    Energy Technology Data Exchange (ETDEWEB)

    Goyen, Mathias; Debatin, Joerg F. [University Medical Center Hamburg-Eppendorf, Hamburg (Germany)

    2009-03-15

    Continuous ageing of the population coupled with growing health consciousness and continuous technological advances have fueled the rapid rise in healthcare costs in the United States and Europe for the past several decades. The exact impact of new medical technology on long-term spending growth remains the subject of controversy. By all measures it is apparent that new medical technology is the dominant driver of increases in health-care costs and hence insurance premiums. This paper addresses the impact of medical technology on healthcare delivery systems with regard to medical practice and costs. We first explore factors affecting the growth of medical technology and then attempt to provide a means for assessing the effectiveness of medical technology. Avoidable healthcare cost drivers are identified and related policy issues are discussed. (orig.)

  8. Value judgment of health interventions from different perspectives : arguments and criteria

    NARCIS (Netherlands)

    Vermeulen, Karin M; Krabbe, Paul F M

    Background: The healthcare sector is evolving while life expectancy is increasing. These trends put greater pressure on healthcare resources, prompt healthcare reforms, and demand transparent arguments and criteria to assess the overall value of health interventions. There is no consensus on the

  9. Trust and Privacy in Healthcare

    Science.gov (United States)

    Singleton, Peter; Kalra, Dipak

    This paper considers issues of trust and privacy in healthcare around increased data-sharing through Electronic Health Records (EHRs). It uses a model structured around different aspects of trust in the healthcare organisation’s reasons for greater data-sharing and their ability to execute EHR projects, particularly any associated confidentiality controls. It reflects the individual’s personal circumstances and attitude to use of health records.

  10. Machine learning in healthcare informatics

    CERN Document Server

    Acharya, U; Dua, Prerna

    2014-01-01

    The book is a unique effort to represent a variety of techniques designed to represent, enhance, and empower multi-disciplinary and multi-institutional machine learning research in healthcare informatics. The book provides a unique compendium of current and emerging machine learning paradigms for healthcare informatics and reflects the diversity, complexity and the depth and breath of this multi-disciplinary area. The integrated, panoramic view of data and machine learning techniques can provide an opportunity for novel clinical insights and discoveries.

  11. Healthcare IT and Patient Empowerment

    DEFF Research Database (Denmark)

    Danholt, Peter; Bødker, Keld; Hertzum, Morten

    2004-01-01

    Technology Studies (STS), we address the question of designing IT support for communication and coordination among the heterogeneous network of actors involved in contemporary healthcare work. The paper reports work in progress from a diabetes outpatient clinic at a large Danish hospital. The treatment......This short paper outlines a recently initiated research project that concerns healthcare information systems and patient empowerment. Drawing on various theoretical backgrounds, Participatory Design (PD), Computer Supported Cooperative Work (CSCW), Computer Mediated Communication (CMC), and Science...

  12. Robotics for healthcare. Final report

    OpenAIRE

    Butter, Maurits; Rensma, Arjan; Boxsel, Joey van; Kalisingh, Sandy; Schoone, Marian; Leis, Miriam; Gelderblom, Gert J.; Cremers, Ger; Wilt, Monique de; Kortekaas, Willem; Thielmann, Axel; Cuhls, Kerstin; Sachinopoulou, Anna; Korhonen, Ilkka

    2008-01-01

    For the last two decades the European Commission (EC), and in particular the Directorate General Information Society and Media, has been strongly supporting the application of Information and Communication Technologies (ICT) in healthcare. ICT is an enabling technology which can provide various solutions in the healthcare sector, ranging from electronic patient records and health information networks to intelligent prosthetics and robotised surgery. The EC funded the present study with the ai...

  13. Robotics for healthcare: final report

    OpenAIRE

    Butter, M.; Rensma, A.; Boxsel, J. van; Kalisingh, S.; Schoone, M.; Leis, M.; Gelderblom, G.J.; Cremers, G.; Wilt, M. de; Kortekaas, W.; Thielmaan, A.; Cuhls, K.; Sachinopoulou, A.; Korhonen, I.

    2008-01-01

    For the last two decades the European Commission (EC), and in particular the Directorate General Information Society and Media, has been strongly supporting the application of Information and Communication Technologies (ICT) in healthcare. ICT is an enabling technology which can provide various solutions in the healthcare sector, ranging from electronic patient records and health information networks to intelligent prosthetics and robotised surgery. The EC funded the present study with the ai...

  14. Infrastructuring Multicultural Healthcare Information Systems

    DEFF Research Database (Denmark)

    Dreessen, Katrien; Huybrechts, Liesbeth; Grönvall, Erik

    2017-01-01

    This paper stresses the need for more research in the field of Participatory Design (PD) and in particular into how to design Health Information Technology (HIT) together with care providers and -receivers in multicultural settings. We contribute to this research by describing a case study...... of this study, we point to the need and the ways of taking spatio-historical aspects of a specific healthcare situation into account in the PD of HIT to support multicultural perspectives on healthcare....

  15. New technology markedly improves hand-hygiene performance among healthcare workers after restroom visits.

    Science.gov (United States)

    Møller-Sørensen, H; Korshin, A; Mogensen, T; Høiby, N

    2016-04-01

    The risks to patients from pathogens present on healthcare workers' (HCWs') hands are high; however, compliance with hand hygiene among HCWs is low. We devised a prospective intervention trial of a new hand-hygiene dispensing technology to improve HCWs' compliance with hand hygiene. Baseline hand-hygiene compliance was observed for three months before and after an intervention consisting of implementation of an electronic device that reminds people to comply with hand hygiene after restroom visits. Compliance in hand-hygiene performance after restroom visits increased among HCWs from 66% to 91% after the intervention. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  16. Evaluating Complex Healthcare Systems: A Critique of Four Approaches

    Directory of Open Access Journals (Sweden)

    Heather Boon

    2007-01-01

    Full Text Available The purpose of this paper is to bring clarity to the emerging conceptual and methodological literature that focuses on understanding and evaluating complex or ‘whole’ systems of healthcare. An international working group reviewed literature from interdisciplinary or interprofessional groups describing approaches to the evaluation of complex systems of healthcare. The following four key approaches were identified: a framework from the MRC (UK, whole systems research, whole medical systems research described by NCCAM (USA and a model from NAFKAM (Norway. Main areas of congruence include acknowledgment of the inherent complexity of many healthcare interventions and the need to find new ways to evaluate these; the need to describe and understand the components of complex interventions in context (as they are actually practiced; the necessity of using mixed methods including randomized clinical trials (RCTs (explanatory and pragmatic and qualitative approaches; the perceived benefits of a multidisciplinary team approach to research; and the understanding that methodological developments in this field can be applied to both complementary and alternative medicine (CAM as well as conventional therapies. In contrast, the approaches differ in the following ways: terminology used, the extent to which the approach attempts to be applicable to both CAM and conventional medical interventions; the prioritization of research questions (in order of what should be done first especially with respect to how the ‘definitive’ RCT fits into the process of assessing complex healthcare systems; and the need for a staged approach. There appears to be a growing international understanding of the need for a new perspective on assessing complex healthcare systems.

  17. Designing the future of healthcare.

    Science.gov (United States)

    Fidsa, Gianfranco Zaccai

    2009-01-01

    This paper describes the application of a holistic design process to a variety of problems plaguing current healthcare systems. A design process for addressing complex, multifaceted problems is contrasted with the piecemeal application of technological solutions to specific medical or administrative problems. The goal of this design process is the ideal customer experience, specifically the ideal experience for patients, healthcare providers, and caregivers within a healthcare system. Holistic design is shown to be less expensive and wasteful in the long run because it avoids solving one problem within a complex system at the cost of creating other problems within that system. The article applies this approach to the maintenance of good health throughout life; to the creation of an ideal experience when a person does need medical care; to the maintenance of personal independence as one ages; and to the enjoyment of a comfortable and dignified death. Virginia Mason Medical Center is discussed as an example of a healthcare institution attempting to create ideal patient and caregiver experiences, in this case by applying the principles of the Toyota Production System ("lean manufacturing") to healthcare. The article concludes that healthcare is inherently dedicated to an ideal, that science and technology have brought it closer to that ideal, and that design can bring it closer still.

  18. Six Sigma in healthcare delivery.

    Science.gov (United States)

    Liberatore, Matthew J

    2013-01-01

    The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

  19. LEAN thinking in Finnish healthcare.

    Science.gov (United States)

    Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena

    2016-01-01

    Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

  20. Healthcare Quality: A Concept Analysis.

    Science.gov (United States)

    Allen-Duck, Angela; Robinson, Jennifer C; Stewart, Mary W

    2017-10-01

    Worsening quality indicators of health care shake public trust. Although safety and quality of care in hospitals can be improved, healthcare quality remains conceptually and operationally vague. Therefore, the aim of this analysis is to clarify the concept of healthcare quality. Walker and Avant's method of concept analysis, the most commonly used in nursing literature, provided the framework. We searched general and medical dictionaries, public domain websites, and 5 academic literature databases. Search terms included health care and quality, as well as healthcare and quality. Peer-reviewed articles and government publications published in English from 2004 to 2016 were included. Exclusion criteria were related concepts, discussions about the need for quality care, gray literature, and conference proceedings. Similar attributes were grouped into themes during analysis. Forty-two relevant articles were analyzed after excluding duplicates and those that did not meet eligibility. Following thematic analysis, 4 defining attributes were identified: (1) effective, (2) safe, (3) culture of excellence, and (4) desired outcomes. Based on these attributes, the definition of healthcare quality is the assessment and provision of effective and safe care, reflected in a culture of excellence, resulting in the attainment of optimal or desired health. This analysis proposes a conceptualization of healthcare quality that defines its implied foundational components and has potential to improve the provision of quality care. Theoretical and practice implications presented promote a fuller, more consistent understanding of the components that are necessary to improve the provision of healthcare and steady public trust. © 2017 Wiley Periodicals, Inc.

  1. Serial murder by healthcare professionals.

    Science.gov (United States)

    Yorker, Beatrice Crofts; Kizer, Kenneth W; Lampe, Paula; Forrest, A R W; Lannan, Jacquetta M; Russell, Donna A

    2008-01-01

    The prosecution of Charles Cullen, a nurse who killed at least 40 patients over a 16-year period, highlights the need to better understand the phenomenon of serial murder by healthcare professionals. The authors conducted a LexisNexis search which yielded 90 criminal prosecutions of healthcare providers that met inclusion criteria for serial murder of patients. In addition we reviewed epidemiologic studies, toxicology evidence, and court transcripts, to provide data on healthcare professionals who have been prosecuted between 1970 and 2006. Fifty-four of the 90 have been convicted; 45 for serial murder, four for attempted murder, and five pled guilty to lesser charges. Twenty-four more have been indicted and are either awaiting trial or the outcome has not been published. The other 12 prosecutions had a variety of legal outcomes. Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment. Prosecutions were reported from 20 countries with 40% taking place in the United States. Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals. The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113. These numbers are disturbing and demand that systemic changes in tracking adverse patient incidents associated with presence of a specific healthcare provider be implemented. Hiring practices must shift away from preventing wrongful discharge or denial of employment lawsuits to protecting patients from employees who kill.

  2. Comparative Healthcare: Diabetes Mellitus.

    Directory of Open Access Journals (Sweden)

    Dr Mohammed Ali

    2009-05-01

    Full Text Available In the third in this series of ‘comparative healthcare’ medical practitioners explore the approach to diabetes inBangaldesh and Australia respectively. The social and medical consequences of this chronic conditionare highlighted through the approach to patients at various stages of the disease from two nationalperspectives. An astonishing 7% of the 153 million people are reported to have diabetes in Bangladesh. Manyremain undiagnosed. Delays in diagnosis or management of diabetes have life limiting consequences for thosewho can ill afford private health care in the poorer nation. Screening and early intervention appear to bedenied to many in the developing country. The context is very different with Australians very fortunate to havea coordinated primary health care sector. The outlook for Bangladeshis with uncontrolled diabetes or withtreatable sequela would be unacceptable in Australia. At every stage in the disease trajectory the doctorsemphasise the importance of life style modification, a particular challenge in affluent Australia with its growingincidence of life style related pre morbid conditions in an increasingly sedentary population. A corner stone ofthe support of people with diabetes is the role of nurses and allied health professionals. With a fundedcommitment to multidisciplinary care in the community people with diabetes in Australia have access tosupport closer to home whereas those in Bangladesh remain heavily dependent on specialist, hospital basedservices. One can only speculate how Bangladesh will cope as its population ages and there are an everincreasing proportion of people who require urgent and expensive medical interventions. At the very leastthere is a strong case for greater investment in primary care especially to limit the economic consequences ofdiabetes and other chronic conditions. Finally as in other articles in this series we would like to emphasise that,the views expressed are those of the authors and do

  3. Bothered by abstractness or engaged by cohesion? Experts' explanations enhance novices' deep-learning.

    Science.gov (United States)

    Lachner, Andreas; Nückles, Matthias

    2015-03-01

    Experts' explanations have been shown to better enhance novices' transfer as compared with advanced students' explanations. Based on research on expertise and text comprehension, we investigated whether the abstractness or the cohesion of experts' and intermediates' explanations accounted for novices' learning. In Study 1, we showed that the superior cohesion of experts' explanations accounted for most of novices' transfer, whereas the degree of abstractness did not impact novices' transfer performance. In Study 2, we investigated novices' processing while learning with experts' and intermediates' explanations. We found that novices studying experts' explanations actively self-regulated their processing of the explanations, as they showed mainly deep-processing activities, whereas novices learning with intermediates' explanations were mainly engaged in shallow-processing activities by paraphrasing the explanations. Thus, we concluded that subject-matter expertise is a crucial prerequisite for instructors. Despite the abstract character of experts' explanations, their subject-matter expertise enables them to generate highly cohesive explanations that serve as a valuable scaffold for students' construction of flexible knowledge by engaging them in deep-level processing. PsycINFO Database Record (c) 2015 APA, all rights reserved.

  4. Age of diagnosis of congenital hearing loss: Private v. public healthcare sector.

    Science.gov (United States)

    Butler, I R T; Ceronio, D; Swart, T; Joubert, G

    2015-11-01

    The age of diagnosis of congenital hearing loss is one of the most important determinants of communication outcome. A previous study by the lead author had evaluated the performance of the public health services in Bloemfontein, South Africa (SA), in this regard. This study aimed to examine whether the private health services in the same city were any better. To determine whether the age of diagnosis of congenital hearing loss (CHL) in children seen in the private healthcare sector in Bloemfontein, Free State Province, SA, was lower than that in the public healthcare system in the same city. A comparative study design was utilised and a retrospective database review conducted. Data obtained from this study in the private healthcare sector were compared with data from a previous study in the public healthcare sector using the same study design. Forty-eight children aged private healthcare sector during the study period; 33/47 (70.2%) did not undergo hearing screening at birth. The median age of diagnosis of DHI in the private healthcare sector was 2.24 years, and this was statistically significantly lower than the median age of diagnosis of 3.71 years in the public healthcare sector (pprivate healthcare sector was 3.01 years in children who were not screened at birth, and 1.25 years in those who were screened at birth. This difference was statistically significant (pprivate healthcare sector who were not screened at birth (median 3.01 years) with that in children in the public healthcare sector (median 3.71 years). This difference was statistically significant (pprivate healthcare sector than in the public healthcare sector. With the social and economic benefits of early intervention in cases of DHI well established internationally, SA healthcare providers in both the public and private sectors need to develop screening, diagnostic and (re)habilitation services for children with hearing impairment.

  5. Dysfunctional Effects of a Conflict in a Healthcare Organization.

    Science.gov (United States)

    Raykova, Ekaterina L; Semerjieva, Mariya A; Yordanov, Georgi Y; Cherkezov, Todor D

    2015-01-01

    Conflicts in healthcare settings are quite common events because of the continuous changes and transformations today's healthcare organizations are undergoing and the vigorous interaction between the medical professionals working in them. To survey the opinions of medical professionals about the possible destructive effects of conflicts on them in the workplace. We conducted a direct individual survey of 279 medical employees at four general hospitals. We used a set of questions that reflect the negative effects and consequences of conflict on healthcare professionals as direct or indirect participants. All data were analysed using the descriptive statistics and non-parametric analysis at a significance level for the null hypothesis of p Workplace conflicts contribute a lot to the stress, psychological tension and emotional exhaustion medical professionals are exposed to. The confrontation the conflict brings the participants into acts as a catalyst of the conflict and enhances the manifestation of hostile actions. A conflict generates a situation which has an impact on the behaviour of all participants involved in it giving rise to emotional states such as anger, aggression and reproaches. The destructive consequences resulting from a conflict are seen in the reduced work satisfaction and demotivation to perform the work activity. The contradictions that arise as a result affect negatively the team cooperation and obstruct the collaborative efforts in solving the problems in the healthcare setting. A conflict in a healthcare setting exerts a considerable destructive effect on an employee, therefore it requires prompt identification and effective intervention to minimise its unfavourable outcomes.

  6. Organising healthcare services for persons with an intellectual disability.

    Science.gov (United States)

    Balogh, Robert; McMorris, Carly A; Lunsky, Yona; Ouellette-Kuntz, Helene; Bourne, Laurie; Colantonio, Angela; Gonçalves-Bradley, Daniela C

    2016-04-11

    When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, and more difficulty finding and obtaining healthcare. Organisational interventions are used to reconfigure the structure or delivery of healthcare services. This is the first update of the original review. To assess the effects of organisational interventions of healthcare services for the mental and physical health problems of persons with an intellectual disability. For this update we searched CENTRAL, MEDLINE, EMBASE, CINAHL and other databases, from April 2006 to 4 September 2015. We checked reference lists of included studies and consulted experts in the field. Randomised controlled trials of organisational interventions of healthcare services aimed at improving care of mental and physical health problems of adult persons with an intellectual disability. We employed standard methodological procedures as outlined in the Cochrane Handbook of Systematic Reviews of Interventions, in addition to specific guidance from the Cochrane Effective Practice and Organisation of Care (EPOC) Group. We identified one new trial from the updated searches.Seven trials (347 participants) met the selection criteria. The interventions varied but had common components: interventions that increased the intensity and frequency of service delivery (4 trials, 200 participants), community-based specialist behaviour therapy (1 trial, 63 participants), and outreach treatment (1 trial, 50 participants). Another trial compared two active arms (traditional counselling and integrated intervention for bereavement, 34 participants).The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability; none focused on physical health problems. Four studies assessed the effect of organisational interventions on behavioural problems for persons with an intellectual disability, three assessed care giver burden, and

  7. Towards an oral healthcare framework and policy analysis for Swaziland

    OpenAIRE

    Mndzebele, Samuel

    2010-01-01

    Background and Rationale: A synopsis by the researcher suggested that caries was becoming a public health problem among the youth, hence there was a need for deeper investigations which would lead to possible oral health interventions. Purpose: The purpose of the study was to assess dental care practices and experiences among teenagers in the Northern region of Swaziland. Based on the outcomes and views from health professionals; develop a framework for oral healthcare delivery and ...

  8. Demand for healthcare in India

    Directory of Open Access Journals (Sweden)

    Brijesh C. Purohit

    2013-03-01

    Full Text Available In a developing country like India, allocation of scarce fiscal resources has to be based on a clear understanding of how investments in the heath sector are going to affect demand. Three aspects like overall healthcare demand, consumer decisions to use public and/or private care and role of price/quality influencing poor/rich consumer’s decisions are critical to assessing the equity implications of alternative policies. Our paper addresses these aspects through examining the pattern of healthcare demand in India. Data from the National Family Health Survey are used to model the healthcare choices that individuals make. We consider what these behavioral characteristics imply for public policy. This analysis aims to study disparities between rural and urban areas from all throughout India to five Indian states representing three levels of per capita incomes (all-India average, rich and poor. Results evidence that healthcare demand both in rural and urban areas is a commodity emerging as an essential need. Choices between public or private provider are guided by income and quality variables mainly with regard to public healthcare denoting thus a situation of very limited alternatives in terms of availing private providers. These results emphasize that existing public healthcare facilities do not serve the objective of providing care to the poor in a satisfactory manner in rural areas. Thus, any financing strategy to improve health system and reduce disparities across rich-poor states and rural-urban areas should also take into account not only overcoming inadequacy but also inefficiency in allocation and utilization of healthcare inputs.

  9. The Puerto Rico Healthcare Crisis.

    Science.gov (United States)

    Roman, Jesse

    2015-12-01

    The Commonwealth of Puerto Rico is an organized nonincorporated territory of the United States with a population of more than 3.5 million U.S. citizens. The island has been the focus of much recent attention due to the recent default on its debt (estimated at more than $70 billion), high poverty rates, and increasing unemployment. Less attention, however, has been given to the island's healthcare system, which many believe is on the verge of collapsing. Healthcare makes up 20% of the Puerto Rican economy, and this crisis affects reimbursement rates for physicians while promoting the disintegration of the island's healthcare infrastructure. A major contributor relates to a disparity in federal funding provided to support the island's healthcare system when compared with that provided to the states in the mainland and Hawaii. Puerto Rico receives less federal funding for healthcare than the other 50 states and the District of Columbia even though it pays its share of social security and Medicare taxes. To make matters worse, the U.S. Center for Medicaid and Medicare Services is planning soon to implement another 11% cut in Medical Advantage reimbursements. This disparity in support for healthcare is considered responsible for ∼$25 billion of Puerto Rico's total debt. The impact of these events on the health of Puerto Ricans in the island cannot be entirely predicted, but the loss of healthcare providers and diminished access to care are a certainty, and quality care will suffer, leading to serious implications for those with chronic medical disorders including respiratory disease.

  10. The discourse of causal explanations in school science

    Science.gov (United States)

    Slater, Tammy Jayne Anne

    Researchers and educators working from a systemic functional linguistic perspective have provided a body of work on science discourse which offers an excellent starting point for examining the linguistic aspects of the development of causal discourse in school science, discourse which Derewianka (1995) claimed is critical to success in secondary school. No work has yet described the development of causal language by identifying the linguistic features present in oral discourse or by comparing the causal discourse of native and non-native (ESL) speakers of English. The current research responds to this gap by examining the oral discourse collected from ESL and non-ESL students at the primary and high school grades. Specifically, it asks the following questions: (1) How do the teachers and students in these four contexts develop causal explanations and their relevant taxonomies through classroom interactions? (2) What are the causal discourse features being used by the students in these four contexts to construct oral causal explanations? The findings of the social practice analysis showed that the teachers in the four contexts differed in their approaches to teaching, with the primary school mainstream teacher focusing largely on the hands-on practice , the primary school ESL teacher moving from practice to theory, the high school mainstream teacher moving from theory to practice, and the high school ESL teacher relying primarily on theory. The findings from the quantitative, small corpus approach suggest that the developmental path of cause which has been identified in the writing of experts shows up not only in written texts but also in the oral texts which learners construct. Moreover, this move appears when the discourse of high school ESL and non-ESL students is compared, suggesting a developmental progression in the acquisition of these features by these students. The findings also reveal that the knowledge constructed, as shown by the concept maps created

  11. Physical activity parenting measurement and research: Challenges, explanations, and solutions

    Science.gov (United States)

    Physical activity (PA) parenting research has proliferated over the past decade, with findings verifying the influential role that parents play in children's emerging PA behaviors. This knowledge, however, has not translated into effective family-based PA interventions. During a preconference worksh...

  12. Economic evaluation of interventions designed to reduce Clostridium difficile infection.

    Science.gov (United States)

    Brain, David; Yakob, Laith; Barnett, Adrian; Riley, Thomas; Clements, Archie; Halton, Kate; Graves, Nicholas

    2018-01-01

    Healthcare decision-makers are increasingly expected to balance increasing demand for health services with a finite budget. The role of economic evaluation in healthcare is increasing and this research provides decision-makers with new information about the management of Clostridium difficile infection, from an economic perspective. A model-based economic evaluation was undertaken to identify the most cost-effective healthcare intervention relating to the reduction of Clostridium difficile transmission. Efficacy evidence was synthesised from the literature and was used to inform the effectiveness of both bundled approaches and stand-alone interventions, where appropriate intervention combinations were coupled together. Changes in health outcomes were estimated by combining information about intervention effectiveness and its subsequent impact on quality of life. A bundled approach of improving hand hygiene and environmental cleaning produces the best combination of increased health benefits and cost-savings. It has the highest mean net monetary benefit when compared to all other interventions. This intervention remains the optimal decision under different clinical circumstances, such as when mortality rate and patient length of stay are increased. Bundled interventions offered the best opportunity for health improvements. These findings provide healthcare decision-makers with novel information about the allocation of scarce resources relating to Clostridium difficile. If investments are not made in interventions that clearly yield gains in health outcomes, the allocation and use of scarce healthcare resources is inappropriate and improvements in health outcomes will be forgone.

  13. Economic evaluation of interventions designed to reduce Clostridium difficile infection.

    Directory of Open Access Journals (Sweden)

    David Brain

    Full Text Available Healthcare decision-makers are increasingly expected to balance increasing demand for health services with a finite budget. The role of economic evaluation in healthcare is increasing and this research provides decision-makers with new information about the management of Clostridium difficile infection, from an economic perspective.A model-based economic evaluation was undertaken to identify the most cost-effective healthcare intervention relating to the reduction of Clostridium difficile transmission. Efficacy evidence was synthesised from the literature and was used to inform the effectiveness of both bundled approaches and stand-alone interventions, where appropriate intervention combinations were coupled together. Changes in health outcomes were estimated by combining information about intervention effectiveness and its subsequent impact on quality of life.A bundled approach of improving hand hygiene and environmental cleaning produces the best combination of increased health benefits and cost-savings. It has the highest mean net monetary benefit when compared to all other interventions. This intervention remains the optimal decision under different clinical circumstances, such as when mortality rate and patient length of stay are increased. Bundled interventions offered the best opportunity for health improvements.These findings provide healthcare decision-makers with novel information about the allocation of scarce resources relating to Clostridium difficile. If investments are not made in interventions that clearly yield gains in health outcomes, the allocation and use of scarce healthcare resources is inappropriate and improvements in health outcomes will be forgone.

  14. Mind the gap! Automated concept map feedback supports students in writing cohesive explanations.

    Science.gov (United States)

    Lachner, Andreas; Burkhart, Christian; Nückles, Matthias

    2017-03-01

    Many students are challenged with the demand of writing cohesive explanations. To support students in writing cohesive explanations, we developed a computer-based feedback tool that visualizes cohesion deficits of students' explanations in a concept map. We conducted three studies to investigate the effectiveness of such feedback as well as the underlying cognitive processes. In Study 1, we found that the concept map helped students identify potential cohesion gaps in their drafts and plan remedial revisions. In Study 2, students with concept map feedback conducted revisions that resulted in more locally and globally cohesive, and also more comprehensible, explanations than the explanations of students who revised without concept map feedback. In Study 3, we replicated the findings of Study 2 by and large. More importantly, students who had received concept map feedback on a training explanation 1 week later wrote a transfer explanation without feedback that was more cohesive than the explanation of students who had received no feedback on their training explanation. The automated concept map feedback appears to particularly support the evaluation phase of the revision process. Furthermore, the feedback enabled novice writers to acquire sustainable skills in writing cohesive explanations. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  15. Learning from instructional explanations: effects of prompts based on the active-constructive-interactive framework.

    Science.gov (United States)

    Roelle, Julian; Müller, Claudia; Roelle, Detlev; Berthold, Kirsten

    2015-01-01

    Although instructional explanations are commonly provided when learners are introduced to new content, they often fail because they are not integrated into effective learning activities. The recently introduced active-constructive-interactive framework posits an effectiveness hierarchy in which interactive learning activities are at the top; these are then followed by constructive and active learning activities, respectively. Against this background, we combined instructional explanations with different types of prompts that were designed to elicit these learning activities and tested the central predictions of the active-constructive-interactive framework. In Experiment 1, N = 83 students were randomly assigned to one of four combinations of instructional explanations and prompts. To test the active learning hypothesis, the learners received either (1) complete explanations and engaging prompts designed to elicit active activities or (2) explanations that were reduced by inferences and inference prompts designed to engage learners in constructing the withheld information. Furthermore, in order to explore how interactive learning activities can be elicited, we gave the learners who had difficulties in constructing the prompted inferences adapted remedial explanations with either (3) unspecific engaging prompts or (4) revision prompts. In support of the active learning hypothesis, we found that the learners who received reduced explanations and inference prompts outperformed the learners who received complete explanations and engaging prompts. Moreover, revision prompts were more effective in eliciting interactive learning activities than engaging prompts. In Experiment 2, N = 40 students were randomly assigned to either (1) a reduced explanations and inference prompts or (2) a reduced explanations and inference prompts plus adapted remedial explanations and revision prompts condition. In support of the constructive learning hypothesis, the learners who received

  16. Clinical engagement: improving healthcare together.

    Science.gov (United States)

    Riches, E; Robson, B

    2014-02-01

    Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups. The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians' contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrastructure and an efficient, cost-effective approach to clinical engagement. There are a number of obstacles to achieving successful clinical engagement and these must be addressed as key drivers in its implementation. The implementation of the strategy is supported by an action and resource plan, and its impact will be monitored by a measurement plan to ensure the organisation reviews its approaches towards clinical engagement.

  17. Healthcare waste management in Asia

    International Nuclear Information System (INIS)

    Prem Ananth, A.; Prashanthini, V.; Visvanathan, C.

    2010-01-01

    The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

  18. The Microbiome and Sustainable Healthcare

    Science.gov (United States)

    Dietert, Rodney R.; Dietert, Janice M.

    2015-01-01

    Increasing prevalences, morbidity, premature mortality and medical needs associated with non-communicable diseases and conditions (NCDs) have reached epidemic proportions and placed a major drain on healthcare systems and global economies. Added to this are the challenges presented by overuse of antibiotics and increased antibiotic resistance. Solutions are needed that can address the challenges of NCDs and increasing antibiotic resistance, maximize preventative measures, and balance healthcare needs with available services and economic realities. Microbiome management including microbiota seeding, feeding, and rebiosis appears likely to be a core component of a path toward sustainable healthcare. Recent findings indicate that: (1) humans are mostly microbial (in terms of numbers of cells and genes); (2) immune dysfunction and misregulated inflammation are pivotal in the majority of NCDs; (3) microbiome status affects early immune education and risk of NCDs, and (4) microbiome status affects the risk of certain infections. Management of the microbiome to reduce later-life health risk and/or to treat emerging NCDs, to spare antibiotic use and to reduce the risk of recurrent infections may provide a more effective healthcare strategy across the life course particularly when a personalized medicine approach is considered. This review will examine the potential for microbiome management to contribute to sustainable healthcare. PMID:27417751

  19. Social Medicine: Twitter in Healthcare.

    Science.gov (United States)

    Pershad, Yash; Hangge, Patrick T; Albadawi, Hassan; Oklu, Rahmi

    2018-05-28

    Social media enables the public sharing of information. With the recent emphasis on transparency and the open sharing of information between doctors and patients, the intersection of social media and healthcare is of particular interest. Twitter is currently the most popular form of social media used for healthcare communication; here, we examine the use of Twitter in medicine and specifically explore in what capacity using Twitter to share information on treatments and research has the potential to improve care. The sharing of information on Twitter can create a communicative and collaborative atmosphere for patients, physicians, and researchers and even improve quality of care. However, risks involved with using Twitter for healthcare discourse include high rates of misinformation, difficulties in verifying the credibility of sources, overwhelmingly high volumes of information available on Twitter, concerns about professionalism, and the opportunity cost of using physician time. Ultimately, the use of Twitter in healthcare can allow patients, healthcare professionals, and researchers to be more informed, but specific guidelines for appropriate use are necessary.

  20. Career patterns of healthcare executives.

    Science.gov (United States)

    Fahey, D F; Myrtle, R C

    2001-02-01

    This research examines the job and career changes of healthcare executives and managers working in different segments of the healthcare industry in the western United States. The results suggest that the job and career patterns in the healthcare delivery sector are undergoing significant transformation. One third of the respondents reports that at least one of their last four job changes was involuntary or unplanned. One half of those attempted to make a career change. This study identifies four different executive and management career patterns. The most common was one of multiple career changes. The second pattern was that of a single career change, followed by a 'traditional' career in which one did not seek a career change. The final pattern was characterized as a movement back and forth between two different segments of the healthcare industry. Age, gender, marital status and education were not associated with any specific career pattern. The need to achieve results early in the respondent's career had a strong influence on career patterns. This study confirms the fluidity of career movement and the changing permeability between the various segments of the healthcare industry. It also suggests that career success increasingly will require broad management experience in those different segments.