Managing patients with heart failure: a qualitative study of multidisciplinary teams with specialist heart failure nurses.

Science.gov (United States)

Glogowska, Margaret; Simmonds, Rosemary; McLachlan, Sarah; Cramer, Helen; Sanders, Tom; Johnson, Rachel; Kadam, Umesh T; Lasserson, Daniel S; Purdy, Sarah

2015-09-01

The purpose of this study was to explore the perceptions and experiences of health care clinicians working in multidisciplinary teams that include specialist heart failure nurses when caring for the management of heart failure patients. We used a qualitative in-depth interview study nested in a broader ethnographic study of unplanned admissions in heart failure patients (HoldFAST). We interviewed 24 clinicians across primary, secondary, and community care in 3 locations in the Midlands, South Central, and South West of England. Within a framework of the role and contribution of the heart failure specialist nurse, our study identified 2 thematic areas that the clinicians agreed still represent particular challenges when working with heart failure patients. The first was communication with patients, in particular explaining the diagnosis and helping patients to understand the condition. The participants recognized that such communication was most effective when they had a long-term relationship with patients and families and that the specialist nurse played an important part in achieving this relationship. The second was communication within the team. Multidisciplinary input was especially needed because of the complexity of many patients and issues around medications, and the participants believed the specialist nurse may facilitate team communication. The study highlights the role of specialist heart failure nurses in delivering education tailored to patients and facilitating better liaison among all clinicians, particularly when dealing with the management of comorbidities and drug regimens. The way in which specialist nurses were able to be caseworkers for their patients was perceived as a method of ensuring coordination and continuity of care. © 2015 Annals of Family Medicine, Inc.

Implementation of an interprofessional communication and collaboration intervention to improve care capacity for heart failure management in long-term care.

Science.gov (United States)

Boscart, Veronique M; Heckman, George A; Huson, Kelsey; Brohman, Lisa; Harkness, Karen I; Hirdes, John; McKelvie, Robert S; Stolee, Paul

2017-09-01

Heart failure affects up to 20% of nursing home residents and is associated with high morbidity, mortality, and transfers to acute care. A major barrier to heart failure management in nursing home settings is limited interprofessional communication. Guideline-based heart failure management programs in nursing homes can reduce hospitalisation rates, though sustainability is limited when interprofessional communication is not addressed. A pilot intervention, 'Enhancing Knowledge and Interprofessional Care for Heart Failure', was implemented on two units in two conveniently selected nursing homes to optimise interprofessional care processes amongst the care team. A core heart team was established, and participants received tailored education focused on heart failure management principles and communication processes, as well as weekly mentoring. Our previous work provided evidence for this intervention's acceptability and implementation fidelity. This paper focuses on the preliminary impact of the intervention on staff heart failure knowledge, communication, and interprofessional collaboration. To determine the initial impact of the intervention on selected staff outcomes, we employed a qualitative design, using a social constructivist interpretive framework. Findings indicated a perceived increase in team engagement, interprofessional collaboration, communication, knowledge about heart failure, and improved clinical outcomes. Individual interviews with staff revealed innovative ways to enhance communication, supporting one another with knowledge and engagement in collaborative practices with residents and families. Engaging teams, through the establishment of core heart teams, was successful to develop interprofessional communication processes for heart failure management. Further steps to be undertaken include assessing the sustainability and effectiveness of this approach with a larger sample.

Team-Based Care for Managing Cardiac Comorbidities in Heart Failure.

Science.gov (United States)

Bellam, Naveen; Kelkar, Anita A; Whellan, David J

2015-07-01

The need for HF management is predicted to increase as the HF population ages. Balancing HF and the multiple cardiac comorbidities remains difficult for any single provider, but becomes Fig. 6. Five-year rates of death or urgent heart transplantation by deciles of total cholesterol in heart failure. (From Horwich TB, Fonarow GC, Hamilton MA, et al. Low serum total cholesterol is associated with marked increase in mortality in advanced heart failure. J Card Fail 2002;8(4):222; with permission.) easier with the involvement of a team. Collaboration between physicians, nurses, nurse practitioners, physician assistants, pharmacists, and other health care workers reduces the burden of care coordination and simultaneously improves delivery of care. Team-based approaches increase cost-effectiveness, reduce hospitalization rates, and equally important, give patients more resources and support, which research shows may ultimately improve compliance and outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Canadian contribution to the European Union Home Team program for ITER

International Nuclear Information System (INIS)

Murdoch, D.K.; Blevins, J.D.; Gierszewski, P.; Matsugu, R.

1998-01-01

Canadian participation in R and D and design tasks for the ITER project is predominantly in the fuel cycle, remote handling and safety fields. These tasks are carried out in Canada by Ontario Hydro, research institutes, industry and universities. In addition, Canada provides the services of a number of specialist engineers and scientists in key positions at the three ITER work sites and in the European Home Team. The Canadian contribution, which is coordinated by the Canadian Fusion Fuels Technology Project (CFFTP), forms an integral part of the European Union Home Team program. The key components of the Canadian contribution are described. (author)

Home field advantage: new stadium construction and team performance in professional sports.

Science.gov (United States)

Watson, Jack C; Krantz, Andrew J

2003-12-01

To identify the relations between new stadiums and home team performance and attendance for professional baseball (MLB) (n=14), basketball (NBA) (n=13), and football (NFL) (n=25) teams in the USA since 1950 dependent t tests assessed significance of increases in attendance in both MLB and the NBA and a significantly improved home winning percentage in MLB following the building of new stadiums. Implications include a better understanding of the rationales used by owners, fans, and players for building new stadiums.

[Regional geriatric team--a model for cooperation between nursing homes and hospitals].

Science.gov (United States)

Sellaeg, Wenche Frogn

2005-04-21

Few studies describe and evaluate the use of ambulatory geriatric teams in nursing homes. This article gives an account of a model in which a multidisciplinary group from the local hospital has been visiting 17 communities in Norway twice a year for 11 years. The ambulatory geriatric team includes a geriatrician, a geriatric nurse, a physiotherapist and an occupational therapist. Their aim is to raise the quality of geriatric assessment and care and to enhance the cooperation between the hospital and the nursing homes in the communities. The team members are doing a comprehensive geriatric assessment of some of the patients; they assess cases for further referral, and examine patients with declining functioning with a view to rehabilitation. The team provides instruction in various aspects of geriatrics to community care professionals. Much time is devoted to discussions on problems raised by the staff, such as management of patients with dementia-related behavioural problems, and to provide feedback to staff-members. The team liaise between hospitals, nursing homes and community care services in the communities in order to enhance communication between the professionals involved. An evaluation of the team was done on behalf of the National Institute of Health through a postal questionnaire which was returned by 223 doctors, nurses and allied health care professionals. The results indicate that visits by the ambulatory team improve the knowledge of doctors and allied professionals about diseases in the elderly; 92% reported that they now felt they were doing a better job.

Using Technology, Clinical Workflow Redesign, and Team Solutions to Achieve the Patient Centered Medical Home

Science.gov (United States)

2011-01-01

Redesign, and Team Solutions to Achieve the Patient Centered Medical Home LTC Nicole Kerkenbush, MHA, MN Army Medical Department, Office of the...TITLE AND SUBTITLE Using Technology, Clinical Workflow Redesign, and Team Solutions to Achieve the Patient Centered Medical Home 5a. CONTRACT...Describe how these tools are being used to implement the Patient Centered Medical Home care model 2 2011 MHS Conference MEDCOM AHLTA Provider Satisfaction

Heart Rate Monitoring in Team Sports—A Conceptual Framework for Contextualizing Heart Rate Measures for Training and Recovery Prescription

Directory of Open Access Journals (Sweden)

Christoph Schneider

2018-05-01

Full Text Available A comprehensive monitoring of fitness, fatigue, and performance is crucial for understanding an athlete's individual responses to training to optimize the scheduling of training and recovery strategies. Resting and exercise-related heart rate measures have received growing interest in recent decades and are considered potentially useful within multivariate response monitoring, as they provide non-invasive and time-efficient insights into the status of the autonomic nervous system (ANS and aerobic fitness. In team sports, the practical implementation of athlete monitoring systems poses a particular challenge due to the complex and multidimensional structure of game demands and player and team performance, as well as logistic reasons, such as the typically large number of players and busy training and competition schedules. In this regard, exercise-related heart rate measures are likely the most applicable markers, as they can be routinely assessed during warm-ups using short (3–5 min submaximal exercise protocols for an entire squad with common chest strap-based team monitoring devices. However, a comprehensive and meaningful monitoring of the training process requires the accurate separation of various types of responses, such as strain, recovery, and adaptation, which may all affect heart rate measures. Therefore, additional information on the training context (such as the training phase, training load, and intensity distribution combined with multivariate analysis, which includes markers of (perceived wellness and fatigue, should be considered when interpreting changes in heart rate indices. The aim of this article is to outline current limitations of heart rate monitoring, discuss methodological considerations of univariate and multivariate approaches, illustrate the influence of different analytical concepts on assessing meaningful changes in heart rate responses, and provide case examples for contextualizing heart rate measures using

Heart Rate Monitoring in Team Sports-A Conceptual Framework for Contextualizing Heart Rate Measures for Training and Recovery Prescription.

Science.gov (United States)

Schneider, Christoph; Hanakam, Florian; Wiewelhove, Thimo; Döweling, Alexander; Kellmann, Michael; Meyer, Tim; Pfeiffer, Mark; Ferrauti, Alexander

2018-01-01

A comprehensive monitoring of fitness, fatigue, and performance is crucial for understanding an athlete's individual responses to training to optimize the scheduling of training and recovery strategies. Resting and exercise-related heart rate measures have received growing interest in recent decades and are considered potentially useful within multivariate response monitoring, as they provide non-invasive and time-efficient insights into the status of the autonomic nervous system (ANS) and aerobic fitness. In team sports, the practical implementation of athlete monitoring systems poses a particular challenge due to the complex and multidimensional structure of game demands and player and team performance, as well as logistic reasons, such as the typically large number of players and busy training and competition schedules. In this regard, exercise-related heart rate measures are likely the most applicable markers, as they can be routinely assessed during warm-ups using short (3-5 min) submaximal exercise protocols for an entire squad with common chest strap-based team monitoring devices. However, a comprehensive and meaningful monitoring of the training process requires the accurate separation of various types of responses, such as strain, recovery, and adaptation, which may all affect heart rate measures. Therefore, additional information on the training context (such as the training phase, training load, and intensity distribution) combined with multivariate analysis, which includes markers of (perceived) wellness and fatigue, should be considered when interpreting changes in heart rate indices. The aim of this article is to outline current limitations of heart rate monitoring, discuss methodological considerations of univariate and multivariate approaches, illustrate the influence of different analytical concepts on assessing meaningful changes in heart rate responses, and provide case examples for contextualizing heart rate measures using simple heuristics. To

Cooperating with a palliative home-care team: expectations and evaluations of GPs and district nurses

DEFF Research Database (Denmark)

Goldschmidt, Dorthe; Groenvold, Mogens; Johnsen, Anna Thit

2005-01-01

BACKGROUND: Palliative home-care teams often cooperate with general practitioners (GPs) and district nurses. Our aim was to evaluate a palliative home-care team from the viewpoint of GPs and district nurses. METHODS: GPs and district nurses received questionnaires at the start of home-care and one...... month later. Questions focussed on benefits to patients, training issues for professionals and cooperation between the home-care team and the GP/ district nurse. A combination of closed- and open-ended questions was used. RESULTS: Response rate was 84% (467/553). Benefits to patients were experienced...... by 91 %, mainly due to improvement in symptom management, 'security', and accessibility of specialists in palliative care. After one month, 57% of the participants reported to have learnt aspects of palliative care, primarily symptom control, and 89% of them found cooperation satisfactory...

Prevalence of heart failure in nursing homes : a systematic literature review

NARCIS (Netherlands)

Daamen, Marielle A. M. J.; Schols, Jos M. G. A.; Jaarsma, Tiny; Hamers, Jan P. H.

Introduction: Heart failure is an important problem in western countries. In nursing home residents heart failure is expected to be highly prevalent. However, accurate diagnosis of heart failure in these patients is often hampered due to atypical findings and concomitant co-morbidity. In order to

Interprofessional team building in the palliative home care setting: Use of a conceptual framework to inform a pilot evaluation.

Science.gov (United States)

Shaw, James; Kearney, Colleen; Glenns, Brenda; McKay, Sandra

2016-01-01

Home-based palliative care is increasingly dependent on interprofessional teams to deliver collaborative care that more adequately meets the needs of clients and families. The purpose of this pilot evaluation was to qualitatively explore the views of an interprofessional group of home care providers (occupational therapists, nurses, personal support work supervisors, community care coordinators, and a team coordinator) regarding a pilot project encouraging teamwork in interprofessional palliative home care services. We used qualitative methods, informed by an interprofessional conceptual framework, to analyse participants' accounts and provide recommendations regarding strategies for interprofessional team building in palliative home health care. Findings suggest that encouraging practitioners to share past experiences and foster common goals for palliative care are important elements of team building in interprofessional palliative care. Also, establishing a team leader who emphasises sharing power among team members and addressing the need for mutual emotional support may help to maximise interprofessional teamwork in palliative home care. These findings may be used to develop and test more comprehensive efforts to promote stronger interprofessional teamwork in palliative home health care delivery.

Effectiveness of Advanced Illness Care Teams for Nursing Home Residents with Dementia

Science.gov (United States)

Chapman, Dennis G.; Toseland, Ronald W.

2007-01-01

This study evaluated the effectiveness of advanced illness care teams (AICTs) for nursing home residents with advanced dementia. The AICTs used a holistic approach that focused on four domains: (1) medical, (2) meaningful activities, (3) psychological, and (4) behavioral. The authors recruited 118 residents in two nursing homes for this study and…

Analysis of team types based on collaborative relationships among doctors, home-visiting nurses and care managers for effective support of patients in end-of-life home care.

Science.gov (United States)

Fujita, Junko; Fukui, Sakiko; Ikezaki, Sumie; Otoguro, Chizuru; Tsujimura, Mayuko

2017-11-01

To define the team types consisting of doctors, home-visiting nurses and care managers for end-of-life care by measuring the collaboration relationship, and to identify the factors related to the team types. A questionnaire survey of 43 teams including doctors, home-visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one-way analysis and multiple comparison analysis. Three team types were classified: the team where the collaborative relationships among all healthcare professionals were good; the team where the collaborative relationships between the doctors and care managers were poor; and the team where the collaborative relationships among all of the professionals were poor. There was a statistically significant association between the team types and the following variables: patient's dementia level, communication tool, professionals' experience of working with other team members, home-visiting nurses' experience of caring for dying patients, care managers' background qualifications, doctor's face-to-face cooperation with other members and home-visiting nurses' collaborative practice. It is suggested that a collaborative relationship would be fostered by more experience of working together, using communication tools and enhancing each professional's collaboration competency. Geriatr Gerontol Int 2017; 17: 1943-1950. © 2017 Japan Geriatrics Society.

Differences between early and late involvement of palliative home care in oncology care: A focus group study with palliative home care teams.

Science.gov (United States)

Dhollander, Naomi; Deliens, Luc; Van Belle, Simon; De Vleminck, Aline; Pardon, Koen

2018-05-01

To date, no randomised controlled trials on the integration of specialised palliative home care into oncology care have been identified. Information on whether existing models of integrated care are applicable to the home care system and how working procedures and skills of the palliative care teams might require adaptation is missing. To gain insight into differences between early and late involvement and the effect on existing working procedures and skills as perceived by palliative home care teams. Qualitative study - focus group interviews. Six palliative home care teams in Flanders, Belgium. Participants included physicians, nurses and psychologists. Differences were found concerning (1) reasons for initiation, (2) planning of care process, (3) focus on future goals versus problems, (4) opportunity to provide holistic care, (5) empowerment of patients and (6) empowerment of professional caregivers. A shift from a medical approach to a more holistic approach is the most noticeable. Being involved earlier also results in a more structured follow-up and in empowering the patient to be part of the decision-making process. Early involvement creates the need for transmural collaboration, which leads to the teams taking on more supporting and coordinating tasks. Being involved earlier leads to different tasks and working procedures and to the need for transmural collaboration. Future research might focus on the development of an intervention model for the early integration of palliative home care into oncology care. To develop this model, components of existing models might need to be adapted or extended.

Home-based nursing interventions improve knowledge of disease and management in patients with heart failure

Directory of Open Access Journals (Sweden)

Karina de Oliveira Azzolin

2015-02-01

Full Text Available OBJECTIVE: to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire.METHODS: in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered.RESULTS: overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001; and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001. The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01, but weak and non significant at visit 4.CONCLUSION: the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument.

Lessons from the Julie N - the value of a strong home team

International Nuclear Information System (INIS)

Ferland, J.M.

1998-01-01

A review of a successful cleanup effort made in response to the Julie N spill was presented. On September 27, 1996, the tanker Julie N spilled a total of 679,914 litres of oil into the Portland, Maine harbour. The spill oiled 22 kilometers of shoreline and led to a seven week cleanup effort involving more than 700 people from 60 oil spill removal organizations. The two networks of responders which were involved included the Home Team and the Away Team. The Home Team made sure that a high level of preparedness and aggressive response capability existed. It provided the response equipment and personnel resources used during the first 24 hours of the spill. It also opened a temporary command center and set up a field communication network with command. The Away Team was responsible for taking the spill from the first response emergency phase to a multi-faceted, long-term and controlled project phase. It was responsible for engaging additional contractor and equipment resources and provided logistical support of all response activities. It also developed waste disposal and equipment decontamination plans and conducted the environmental assessment. 16 refs., 1 tab

Improving recovery time following heart transplantation: the role of the multidisciplinary health care team

Directory of Open Access Journals (Sweden)

Roussel MG

2013-08-01

Full Text Available Maureen G Roussel,1 Noreen Gorham,2 Lynn Wilson,2 Abeel A Mangi2 1Heart and Vascular Center, Yale-New Haven Hospital, New Haven, CT, USA; 2Center for Advanced Heart Failure, Mechanical Circulatory Support and Cardiac Transplantation, Yale New Haven Heart and Vascular Institute, Yale-New Haven Hospital, New Haven, CT, USA Background: The care of cardiac transplant patients is complex requiring a finely orchestrated endeavor to save a patient’s life. Given the chronic and complex nature of these patients, multiple disciplines are involved in their care. Recognizing difficulties with communication among team members and striving for improved efficiencies in our pretransplant listing process and in our inpatient care, our team was prompted to change the existing approach to patient care related to heart transplantation. Methods: Daily multidisciplinary rounds were instituted and the format of the weekly Multidisciplinary Review Committee (MDRC meetings was modified with the list of attendees broadened to include a larger interdisciplinary team. Additionally, the approach to patient care was analyzed for process improvement. Results: The quality improvements are improved communication and throughput, quantified in an 85% decrease in time to complete transplant evaluation, a 37% decrease in median length of stay posttransplantation, and a 33% reduction in the 30 day readmission rate. In addition, pre- and posttransplant caregivers now participate in MDRC in person or via an electronic meeting platform to support the continuum of care. Quality metrics were chosen and tracked via a transparent electronic platform allowing all involved to assess progress toward agreed upon goals. These were achieved in an 18 month time period following the recruitment of new leadership and invested team members working together as a multidisciplinary team to improve the quality of cardiac transplant care. Discussion: Implementation of daily multidisciplinary rounds and

Home-based nursing interventions improve knowledge of disease and management in patients with heart failure 1

Science.gov (United States)

Azzolin, Karina de Oliveira; Lemos, Dayanna Machado; Lucena, Amália de Fátima; Rabelo-Silva, Eneida Rejane

2015-01-01

OBJECTIVE: to assess patient knowledge of heart failure by home-based measurement of two NOC Nursing Outcomes over a six-month period and correlate mean outcome indicator scores with mean scores of a heart failure Knowledge Questionnaire. METHODS: in this before-and-after study, patients with heart failure received four home visits over a six-month period after hospital discharge. At each home visit, nursing interventions were implemented, NOC outcomes were assessed, and the Knowledge Questionnaire was administered. RESULTS: overall, 23 patients received home visits. Mean indicator scores for the outcome Knowledge: Medication were 2.27±0.14 at home visit 1 and 3.55±0.16 at home visit 4 (P<0.001); and, for the outcome Knowledge: Treatment Regimen, 2.33±0.13 at home visit 1 and 3.59±0.14 at home visit 4 (P<0.001). The correlation between the Knowledge Questionnaire and the Nursing Outcomes Classification scores was strong at home visit 1 (r=0.7, P<0.01), but weak and non significant at visit 4. CONCLUSION: the results show improved patient knowledge of heart failure and a strong correlation between Nursing Outcomes Classification indicator scores and Knowledge Questionnaire scores. The NOC Nursing Outcomes proved effective as knowledge assessment measures when compared with the validated instrument. PMID:25806630

The effectiveness of crisis resolution/home treatment teams for older people with mental health problems: a systematic review and scoping exercise.

Science.gov (United States)

Toot, Sandeep; Devine, Mike; Orrell, Martin

2011-12-01

To assess the effectiveness of crisis resolution/home treatment services for older people with mental health problems. A systematic review was conducted to report on the effectiveness of crisis resolution/home treatment teams (CRHTTs) for older people with mental health problems. As part of the review, we also carried out a scoping exercise to assess the typologies of older people's CRHTTs in practice, and to review these in the context of policy and research findings. The literature contains Grade C evidence, according to the Oxford Centre of Evidence Based Medicine (CEBM) guidelines, that CRHTTs are effective in reducing numbers of admissions to hospitals. Outcomes such as length of hospital stay and maintenance of community residence were reviewed but evidence was inadequate for drawing conclusions. The scoping exercise defined three types of home treatment service model: generic home treatment teams; specialist older adults home treatment teams; and intermediate care services. These home treatment teams seemed to be effectively managing crises and reducing admissions. This review has shown a lack of evidence for the efficacy of crisis resolution/home treatment teams in supporting older people with mental health problems to remain at home. There is clearly a need for a randomised controlled trial to establish the efficacy of crisis resolution/home treatment services for older people with mental health problems, as well as a more focussed assessment of the different home treatment service models which have developed in the UK. Copyright © 2011 John Wiley & Sons, Ltd.

Home-based cardiac rehabilitation for people with heart failure

DEFF Research Database (Denmark)

Zwisler, Ann Dorthe Olsen; Norten, RJ; Dean, SG

2016-01-01

AIMS: To assess the effectiveness of home-based cardiac rehabilitation (CR) for heart failure compared to either usual medical care (i.e. no CR) or centre-based CR on mortality, morbidity, exercise capacity, health-related quality of life, drop out, adherence rates, and costs. METHODS: Randomised...

Expanding Horizons with Chameleon: Team Missouri’s Innovative Home Automation System

Directory of Open Access Journals (Sweden)

Bryan Glass

2010-06-01

Full Text Available Team Missouri’s 2009 Solar Decathlon entry featured a revolutionary home automation system, Chameleon, promoting both convenience and energy savings. This was accomplished using the typical controls of a convenience based automation system, while maintaining user set points, such as a home’s ambient temperature, in the most energy efficient manner. Environmental features of the system include controls for home heating, ventilation and air conditioning, lighting, windows, shades, appliances, indoor air quality, as well as indoor and outdoor irrigation. Further analysis and refinement to the prototype system displayed at the competition is also presented in this paper.

Status of the Japanese ITER Home Team: January 1993

International Nuclear Information System (INIS)

Matsuda, Shinzaburo

1994-01-01

In June, 1992, Atomic Energy Commission of Japan determined the Third Phase Basic Program of Fusion Research and Development. It directs national policy for the experimental reactor phase of fusion research and development. As a government committee, the promotion and the planning of the entire fusion program will be continually carried out by the Fusion Council of Atomic Energy Commission. The Fusion Council has recently established an ITER Technical Committee which will give advice on technical matters of the ITER program to the Fusion Council. Thus, the government is ready to be fully supportive of ITER for the execution of this unprecedented international collaboration. There will be some other units to be organized in the fear future, in pace with the evolution of ITER activities. The involvement of other research institutes is open as a future possibility. The number of persons nominated as Home Team members is about 100 at present and will be increased depending upon the tasks assigned to the Japanese Home Team. The participation of industries in the EDA is of significant importance for the success of ITER. Firstly, innovative concepts or proposals owing to the technical expertise in other fields can be expected. Secondly, experience in production, fabrication or assembly is valuable in the integral review of the design. Thirdly, development and integration of production technologies are essential to realize future construction

Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: a retrospective cohort study.

Science.gov (United States)

Riolfi, Mirko; Buja, Alessandra; Zanardo, Chiara; Marangon, Chiara Francesca; Manno, Pietro; Baldo, Vincenzo

2014-05-01

It has been demonstrated that most patients in the terminal stages of cancer would benefit from palliative home-care services. The aim of this study was to assess the effectiveness of appropriate palliative home-care services in reducing hospital admissions, and to identify factors predicting the likelihood of patients treated at home being hospitalized. Retrospective cohort study. We enrolled all 402 patients listed by the Local Health Authority No. 5, Veneto Region (North-East Italy), as dying of cancer in 2011. Of the cohort considered, 39.9% patients had been taken into care by a palliative home-care team. Irrespective of age, gender, and type of tumor, patients taken into care by the palliative home-care team were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life. Among the patients taken into care by the palliative home-care team, those with hematological cancers and hepatocellular carcinoma were more likely to be hospitalized, and certain symptoms (such as dyspnea and delirium) were predictive of hospitalization. Our study confirms the effectiveness of palliative home care in enabling patients to spend the final period of their lives at home. The services of a palliative home-care team reduced the consumption of hospital resources. This study also provided evidence of some types of cancer (e.g. hematological cancers and hepatocellular carcinoma) being more likely to require hospitalization, suggesting the need to reconsider the pathways of care for these diseases.

Interdisciplinary Team Education Promotes Innovations in the Home Care of Older People

Science.gov (United States)

Pitkälä, Kaisu H.; Finne-Soveri, Harriet; Immonen, Susanna; Lehti, Tuuli; Tiilikainen, Ida; Vesterinen, Teppo; Saarinen, Esa

2018-01-01

This article describes a new type of team training that involves undergraduate students of medicine, students from the Aalto University (industrial engineering and management, architecture, information networks, collaborative and industrial design and bioinformation technology) and specialized home care nurses. During the course, the students…

What the cardiothoracic surgeon wants to know from the radiologist: from X-ray reporting to imaging consultancy and Heart Team membership

Energy Technology Data Exchange (ETDEWEB)

Bogers, Ad J.J.C. [Erasmus MC, Department of Cardiothoracic Surgery, Thoraxcentre, Bd 557, P.O. Box 2040, Rotterdam (Netherlands); Head, Stuart J.; Kappetein, A.P. [Erasmus MC, Department of Cardiothoracic Surgery, Rotterdam (Netherlands)

2015-01-01

In the early days of cardiac surgery, the pretreatment multidisciplinary discussion involved a presentation of the case history and diagnostic imaging by the clinical cardiologist. At this time, most, if not all, cardiac imaging techniques were in the hands of the cardiologist. If the radiologist made a report, this was done relatively late in the clinical process and only concerned the perioperative radiographs. In recent years, multidisciplinary decision-making in the context of a Heart Team has gained an increasingly important role in the process of decision-making with regard to the available therapy options in individual patients. Nevertheless, the concept of the Heart Team is still evolving. The minimal requirements for the Heart Team include the presence of the attending cardiologist, an interventional cardiologist and a cardiac surgeon. Those members of the Heart Team should be aware of the local possibilities, should correctly make conclusions about the available data and should put this information into the clinical context and preference of the patient. In addition, in areas where expertise in cardiac imaging such as CT and MRI is relevant, this would explicitly require expertise of the Heart Team in these specific areas, most often by involving a radiologist, to provide the optimal joint treatment strategy recommendation. (orig.)

Exploring partners' perspectives on participation in heart failure home care: a mixed-method design.

Science.gov (United States)

Näsström, Lena; Luttik, Marie Louise; Idvall, Ewa; Strömberg, Anna

2017-05-01

To describe the partners' perspectives on participation in the care for patients with heart failure receiving home care. Partners are often involved in care of patients with heart failure and have an important role in improving patients' well-being and self-care. Partners have described both negative and positive experiences of involvement, but knowledge of how partners of patients with heart failure view participation in care when the patient receives home care is lacking. A convergent parallel mixed-method design was used, including data from interviews and questionnaires. A purposeful sample of 15 partners was used. Data collection lasted between February 2010 - December 2011. Interviews were analysed with content analysis and data from questionnaires (participation, caregiving, health-related quality of life, depressive symptoms) were analysed statistically. Finally, results were merged, interpreted and labelled as comparable and convergent or as being inconsistent. Partners were satisfied with most aspects of participation, information and contact. Qualitative findings revealed four different aspects of participation: adapting to the caring needs and illness trajectory, coping with caregiving demands, interacting with healthcare providers and need for knowledge to comprehend the health situation. Results showed confirmatory results that were convergent and expanded knowledge that gave a broader understanding of partner participation in this context. The results revealed different levels of partner participation. Heart failure home care included good opportunities for both participation and contact during home visits, necessary to meet partners' ongoing need for information to comprehend the situation. © 2016 John Wiley & Sons Ltd.

Expanding horizons with Chameleon: team Missouri's innovative home automation system

Energy Technology Data Exchange (ETDEWEB)

Glass, B. [Department of Computer Engineering, Missouri University of Science and Technology, 1401 Pine Street, Rolla, MO 65409 (United States); Brannon, B. [Department of Electrical Engineering, Missouri University of Science and Technology, 1401 Pine Street, Rolla, MO 65409 (United States); Grantham, K. [Department of Engineering Management, Missouri University of Science and Technology, 1401 Pine Street, Rolla, MO 65409 (United States); Baur, S. [Department of Civil, Architectural and Environmental Engineering, Missouri University of Science and Technology, 1401 Pine Street, Rolla, MO 65409 (United States)

2010-06-15

Team Missouri's 2009 Solar Decathlon entry featured a revolutionary home automation system, Chameleon, promoting both convenience and energy savings. This was accomplished using the typical controls of a convenience based automation system, while maintaining user set points, such as a home's ambient temperature, in the most energy efficient manner. Environmental features of the system include controls for space heating, ventilation and air conditioning, lighting, windows, shades, appliances, indoor air quality, as well as indoor and outdoor irrigation. Further analysis and refinement to the prototype system displayed at the competition is also presented in this paper. (authors)

An evaluation of a multidisciplinary team for intermediate care at home

Directory of Open Access Journals (Sweden)

Roger Beech

2004-10-01

Full Text Available Background: The implementation of the National Health Service Plan for the UK will see an expansion of services for intermediate care. Such services are usually targeted at older people and aim to: prevent ‘avoidable’ admissions to acute inpatient care; facilitate the timely discharge of patients from acute inpatient care; promote patient rehabilitation. A range of services might fall under the banner of intermediate care. They are usually delivered in patients' homes or in non-acute institutions. This paper describes an evaluation of a multidisciplinary Rapid Response Team (RRT. This service aimed to provide a home based alternative to care previously provided in an acute hospital bed which was acceptable to patients and carers and which maintained clinical care standards. The service was provided for the population of Hereford, a rural town in the middle of England. Methods: A mixed-method descriptive design using quantitative and qualitative techniques was used to monitor: the characteristics of service users, the types and amounts of care received, any ‘adverse’ events arising from that care, and the acceptability of the service to patients and carers. A collaborative approach involving key stakeholders allowed appropriate data to be gathered from patient case notes, RRT staff, local health and social care providers, and patients and their carers. A suite of self-completed questionnaires was, therefore, designed to capture study data on patients and activities of care, and workshops and semi-structured interview schedules used to obtain feedback from users and stakeholders. Results: Service users (231 were elderly (mean age 75.9, from three main diagnostic categories (respiratory conditions 19.0%, heart/stroke 16.2%, falls 13.4%, with the majority (57.0% having both medical and social care needs. All patients received care at home (mean duration 5.6 days with only 5.7% of patients having to be re-admitted to acute care. Overall

Is home delivery safe for all involved? A new arrival breaks grandma's heart. Literally.

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Doolub, Gemina; Daniels, Matthew J; Ormerod, Oliver

2011-12-01

Home birth is becoming increasingly popular. Labour in the privacy and comfort of a familiar environment has clear appeal. Home birth is usually as safe for low-risk women with appropriate prenatal care. Yet events during delivery can be unpredictable and may be stressful for unprepared family members. Here we report a case of Tako-tsubo cardiomyopathy, also known as broken-heart syndrome, in a relative attending an impromptu home delivery. Thus, while home delivery is generally safe for the mother we ask: is it safe for everyone involved?

Team functioning as a predictor of patient outcomes in early medical home implementation.

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Wu, Frances M; Rubenstein, Lisa V; Yoon, Jean

2018-03-12

New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality. Retrospective longitudinal cohort analysis of patient outcomes measured at two time points (2012 and 2013) after PCMH implementation began in Veterans Health Administration practices. Multilevel models examined practice-level measures of team functioning in relationship to patient outcomes (all-cause and ambulatory care-sensitive condition-related hospitalizations, emergency department visits, and mortality). We controlled for practice-level factors likely to affect team functioning, including leadership support, provider and staff burnout, and staffing sufficiency, as well as for individual patient characteristics. We also tested the model among a subgroup of vulnerable patients (homeless, mentally ill, or with dementia). In adjusted analyses, higher team functioning was associated with lower mortality (OR = 0.92, p = .04) among all patients and with fewer all-cause admissions (incidence rate ratio [IRR] = 0.90, p team functioning within PCMH models for achieving improved patient outcomes. A focus on team functioning is important especially in the early implementation of team-based primary care models.

Implementation and consistency of Heart Team decision-making in complex coronary revascularisation.

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Pavlidis, Antonis N; Perera, Divaka; Karamasis, Grigoris V; Bapat, Vinayak; Young, Chris; Clapp, Brian R; Blauth, Chris; Roxburgh, James; Thomas, Martyn R; Redwood, Simon R

2016-03-01

A multidisciplinary team (MDT) approach for decision-making in patients with complex coronary artery disease (CAD) is now a class IC recommendation in the European and American guidelines for myocardial revascularisation. The aim of this study was to evaluate the implementation and consistency of Heart Team HT decision-making in complex coronary revascularisation. We prospectively evaluated the data of 399 patients derived from 51 consecutive MDT meetings held in a tertiary cardiac centre. A subset of cases was randomly selected and re-presented with the same clinical data to a panel blinded to the initial outcome, at least 6 months after the initial discussion, in order to evaluate the reproducibility of decision-making. The most common decisions included continued medical management (30%), coronary artery bypass grafting (CABG) (26%) and percutaneous coronary intervention (PCI) (17%). Other decisions, such as further assessment of symptoms or evaluation with further invasive or non-invasive tests were made in 25% of the cases. Decisions were implemented in 93% of the cases. On re-discussion of the same data (n=40) within a median period of 9 months 80% of the initial HT recommendations were successfully reproduced. The Heart Team is a robust process in the management of patient with complex CAD and decisions are largely reproducible. Although outcomes are successfully implemented in the majority of the cases, it is important that all clinical information is available during discussion and patient preference is taken into account. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

[Team Collaboration in Home Medical Care to Support Patients at the End-of-Life - Review of Service Personnel Meeting on Discharge Day].

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Ogiwara, Miyoko; Irino, Hiromi; Yamaoka, Keita; Fujimaki, Yoko; Watanabe, Mutsuko; Yamamoto, Takeshi; Hirohara, Masayoshi; Kushida, Kazuki

2018-03-01

Due to the rising number of patients at the terminal stage or with high dependence on medical care, the cooperation of 2 teams, the hospital discharge support team and the home support team, has become very important. The recent spread of the Internet has enabled both patients and their families who have chosen home care to obtain a wide range of information about home services, as well as diseases, and form a picture of what will happen. However, there are actually many cases in which patients and families find that things are not as they imagined, and they are uneasy and unsure of what to do. Here, we report a case in which the mismatch between the patient's and family's expectations created an unsatisfactory care situation.

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

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

2017-04-01

Those who are seriously ill and facing death are often living with physical, emotional, social, and spiritual suffering. Teamwork is considered to be necessary to holistically meet the diverse needs of patients in palliative care. Reviews of studies regarding palliative care team outcomes have concluded that teams provide benefits, especially regarding pain and symptom management. Much of the research concerning palliative care teams has been performed from the perspective of the service providers and has less often focused on patients' and families' experiences of care. Our aim was to investigate how the team's work is manifested in care episodes narrated by patients and families in specialized palliative home care (SPHC). A total of 13 interviews were conducted with patients and families receiving specialized home care. Six patients and seven family members were recruited through SPHC team leaders. Interviews were transcribed verbatim and the transcripts qualitatively analyzed into themes. Two themes were constructed through thematic analysis: (1) security ("They are always available," "I get the help I need quickly"); and (2) continuity of care ("They know me/us, our whole situation and they really care"). Of the 74 care episodes, 50 were descriptions of regularly scheduled visits, while 24 related to acute care visits and/or interventions. Patients' and family members' descriptions of the work of SPHC teams are conceptualized through experiences of security and continuity of care. Experiences of security are fostered through the 24/7 availability of the team, sensitivity and flexibility in meeting patients' and families' needs, and practical adjustments to enable care at home. Experiences of continuity of care are fostered through the team's collective approach, where the individual team member knows the patients and family members, including their whole situation, and cares about the little things in life as well as caring for the family unit.

Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States.

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Pandolfi, Michelle M; Wang, Yun; Spenard, Ann; Johnson, Florence; Bonner, Alice; Ho, Shih-Yieh; Elwell, Timothy; Bakullari, Anila; Galusha, Deron; Leifheit-Limson, Erica; Lichtman, Judith H; Krumholz, Harlan M

2017-12-01

readmission rates for Medicare fee-for-service patients for acute myocardial infarction, heart failure or pneumonia. Coordinated care between hospitals and nursing homes is essential to reduce readmissions. Nursing homes can improve performance and reduce readmissions by increasing registered nursing homes. Further, communities can work together to create cross-continuum care teams comprised of hospitals, nursing homes, patients and their families, and other community-based service providers to reduce unplanned readmissions. © 2017 John Wiley & Sons Ltd.

Working with 'hands-off' support: a qualitative study of multidisciplinary teams' experiences of home rehabilitation for older people.

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Randström, Kerstin Björkman; Wengler, Yvonne; Asplund, Kenneth; Svedlund, Marianne

2014-03-01

There is a move towards the provision of rehabilitation for older people in their homes. It is essential to ensure that rehabilitation services promote independence of older people. The aim of the study was to explore multidisciplinary teams' experiences of home rehabilitation for older people. Five focus groups were conducted with multidisciplinary teams based in a municipality in Sweden, covering seven different professions. In total, 28 participants volunteered to participate in these interviews. Interviews were transcribed verbatim and analysed according to content analysis. Two main categories, as well as four subcategories, emerged. The first main category, having a rehabilitative approach in everyday life, consisted of the subcategories: 'giving 'hands-off' support' and 'being in a home environment'. The second main category, working across professional boundaries, consisted of the subcategories: 'coordinating resources' and 'learning from each other'. Common goals, communication skills and role understanding contributed to facilitating the teams' performances of rehabilitation. A potential benefit of home rehabilitation, because the older person is in a familiar environment, is to work a rehabilitative approach into each individual's activity in their everyday life in order to meet their specific needs. At an organisational level, there is a need for developing services to further support older people's psychosocial needs during rehabilitation. Team performance towards an individual's rehabilitation should come from an emerged whole and not only from the performance of a specific professional approach depending on the traditional role of each profession. A rehabilitative approach is based on 'hands-off' support in order to incorporate an individual's everyday activities as a part of their rehabilitation. © 2012 Blackwell Publishing Ltd.

Home inotropic therapy in advanced heart failure: cost analysis and clinical outcomes.

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Harjai, K J; Mehra, M R; Ventura, H O; Lapeyre, Y M; Murgo, J P; Stapleton, D D; Smart, F W

1997-11-05

This study was conducted to assess cost savings and clinical outcomes associated with the use of home i.v. inotropic therapy in patients with advanced (New York Heart Association [NYHA] class IV) heart failure. Retrospective analysis. Tertiary care referral center. Twenty-four patients (13 men, 11 women; age, 61+/-12 years) with left ventricular ejection fraction home i.v. inotropic therapy for at least 4 consecutive weeks between May 1994 and April 1996. Inotropic agents used included dobutamine (n=20; dose, 5.0+/-2.2 microg/kg/min) or milrinone (n=7; dose, 0.53+/-0.05 microg/kg/min). Cost of care and clinical outcomes (hospital admissions, length of hospital stay, NYHA functional class) were compared during the period of inotropic therapy (study period) and the immediate preceding period of equal duration (control period). In comparison to the control period, the study period (3.9+/-2.7 months) was associated with a 16% reduction in cost, amounting to a calculated savings of $5,700 per patient or $1,465 per patient per month. Concomitantly, a decrease in the number of hospital admissions from 2.7+/-2.6 to 1.3+/-1.3 (p=0.056) and length of hospital stay from 20.9+/-12.7 to 5.5+/-5.4 days (p=0.0004) was observed with improvement in NYHA functional class from 4.0+/-0.0 to 2.7+/-0.9 (phome i.v. inotropic therapy. Home i.v. inotropic therapy reduces hospital admissions, length of stay, and cost of care and improves functional class in patients with advanced (NYHA class IV) heart failure.

Human care system for heart-rate and human-movement trajectory in home and its application to detect mental disease

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Hata, Yutaka; Kanazawa, Seigo; Endo, Maki; Tsuchiya, Naoki; Nakajima, Hiroshi

2012-06-01

This paper proposes a heart rate monitoring system for detecting autonomic nervous system by the heart rate variability using an air pressure sensor to diagnose mental disease. Moreover, we propose a human behavior monitoring system for detecting the human trajectory in home by an infrared camera. In day and night times, the human behavior monitoring system detects the human movement in home. The heart rate monitoring system detects the heart rate in bed in night time. The air pressure sensor consists of a rubber tube, cushion cover and pressure sensor, and it detects the heart rate by setting it to bed. It unconstraintly detects the RR-intervals; thereby the autonomic nervous system can be assessed. The autonomic nervous system analysis can examine the mental disease. While, the human behavior monitoring system obtains distance distribution image by an infrared camera. It classifies adult, child and the other object from distance distribution obtained by the camera, and records their trajectories. This behavior, i.e., trajectory in home, strongly corresponds to cognitive disorders. Thus, the total system can detect mental disease and cognitive disorders by uncontacted sensors to human body.

Heart Health - Brave Heart

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... Bar Home Current Issue Past Issues Cover Story Heart Health Brave Heart Past Issues / Winter 2009 Table of Contents For ... you can have a good life after a heart attack." Lifestyle Changes Surviving—and thriving—after such ...

The Community Intervention Team as a means of Improving the transition from hospital to home for patients

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Kearns, Michelle; Curran, Margaret; Collier, Dorcas; Burke, Mary; Lawler, Michelle

2017-01-01

Introduction: Too frequently patients are discharged from hospital to their home without local support from healthcare professionals. Without this support patients are often readmitted to hospital unnecessarily.Short description of practice change implemented: Networked Community intervention team (CIT) services make a unique contribution in facilitating the transition between hospital and home.Aim and theory of change: The aim is to facilitate early discharge from an acute setting, providing...

Developing High-Functioning Teams: Factors Associated With Operating as a "Real Team" and Implications for Patient-Centered Medical Home Development.

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Stout, Somava; Zallman, Leah; Arsenault, Lisa; Sayah, Assaad; Hacker, Karen

2017-01-01

Team-based care is a foundation of health care redesign models like the patient-centered medical home (PCMH). Yet few practices rigorously examine how the implementation of PCMH relates to teamwork. We identified factors associated with the perception of a practice operating as a real team. An online workforce survey was conducted with all staff of 12 primary care sites of Cambridge Health Alliance at different stages of PCMH transformation. Bivariate and multivariate analyses of factors associated with teamwork perceptions were conducted. In multivariate models, having effective leadership was the main factor associated with practice teamwork perceptions (odds ratio [OR], 10.49; 95% confidence interval [CI], 5.39-20.43); in addition, practicing at a site in an intermediate stage of PCMH transformation was also associated with enhanced team perceptions (OR, 2.44; 95% CI, 1.28-4.64). In a model excluding effective leadership, respondents at sites in an intermediate stage of PCMH transformation (OR, 1.95; 95% CI, 1.1-3.4) and who had higher care team behaviors (such as huddles and weekly meetings; OR, 3.41; 95% CI, 1.30-8.92), higher care team perceptions (OR, 2.65; 95% CI, 1.15-6.11), and higher job satisfaction (OR, 2.00; 95% CI, 1.02-3.92) had higher practice teamwork perceptions. This study highlights the strong association between effective leadership, care team behaviors and perceptions, and job satisfaction with perceptions that practices operate as real teams. Although we cannot infer causality with these cross-sectional data, this study raises the possibility that providing attention to these factors may be important in augmenting practice teamwork perceptions.

In-reach specialist nursing teams for residential care homes: uptake of services, impact on care provision and cost-effectiveness

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Nelson Sara

2008-12-01

Full Text Available Abstract Background A joint NHS-Local Authority initiative in England designed to provide a dedicated nursing and physiotherapy in-reach team (IRT to four residential care homes has been evaluated. The IRT supported 131 residents and maintained 15 'virtual' beds for specialist nursing in these care homes. Methods Data captured prospectively (July 2005 to June 2007 included: numbers of referrals; reason for referral; outcome (e.g. admission to IRT bed, short-term IRT support; length of stay in IRT; prevented hospital admissions; early hospital discharges; avoided nursing home transfers; and detection of unrecognised illnesses. An economic analysis was undertaken. Results 733 referrals were made during the 2 years (range 0.5 to 13.0 per resident per annum resulting in a total of 6,528 visits. Two thirds of referrals aimed at maintaining the resident's independence in the care home. According to expert panel assessment, 197 hospital admissions were averted over the period; 20 early discharges facilitated; and 28 resident transfers to a nursing home prevented. Detection of previously unrecognised illnesses accounted for a high number of visits. Investment in IRT equalled £44.38 per resident per week. Savings through reduced hospital admissions, early discharges, delayed transfers to nursing homes, and identification of previously unrecognised illnesses are conservatively estimated to produce a final reduction in care cost of £6.33 per resident per week. A sensitivity analysis indicates this figure might range from a weekly overall saving of £36.90 per resident to a 'worst case' estimate of £2.70 extra expenditure per resident per week. Evaluation early in implementation may underestimate some cost-saving activities and greater savings may emerge over a longer time period. Similarly, IRT costs may reduce over time due to the potential for refinement of team without major loss in effectiveness. Conclusion Introduction of a specialist nursing in

Understanding palliative care on the heart failure care team: an innovative research methodology.

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Lingard, Lorelei A; McDougall, Allan; Schulz, Valerie; Shadd, Joshua; Marshall, Denise; Strachan, Patricia H; Tait, Glendon R; Arnold, J Malcolm; Kimel, Gil

2013-05-01

There is a growing call to integrate palliative care for patients with advanced heart failure (HF). However, the knowledge to inform integration efforts comes largely from interview and survey research with individual patients and providers. This work has been critically important in raising awareness of the need for integration, but it is insufficient to inform solutions that must be enacted not by isolated individuals but by complex care teams. Research methods are urgently required to support systematic exploration of the experiences of patients with HF, family caregivers, and health care providers as they interact as a care team. To design a research methodology that can support systematic exploration of the experiences of patients with HF, caregivers, and health care providers as they interact as a care team. This article describes in detail a methodology that we have piloted and are currently using in a multisite study of HF care teams. We describe three aspects of the methodology: the theoretical framework, an innovative sampling strategy, and an iterative system of data collection and analysis that incorporates four data sources and four analytical steps. We anticipate that this innovative methodology will support groundbreaking research in both HF care and other team settings in which palliative integration efforts are emerging for patients with advanced nonmalignant disease. Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

The challenge of home discharge with a total artificial heart: the La Pitie Salpetriere experience.

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Demondion, Pierre; Fournel, Ludovic; Niculescu, Michaela; Pavie, Alain; Leprince, Pascal

2013-11-01

The total artificial heart (TAH) helps to counteract the current decrease in heart donors and is likely to bridge patients to transplant under favourable conditions. Today's mobile consoles facilitate home discharge. The aim of this study was to report on the La Pitie Hospital experience with CardioWest TAH recipients, and more particularly, on generally successful outpatient' management. A retrospective analysis was performed on clinical and biological data from patients implanted with a TAH between December 2006 and July 2010 in a single institution. Morbi-mortality during hospital stay, number and causes of rehospitalizations, quality of life during home discharge, bridge to transplant results and survival have all been analysed. Twenty-seven patients were implanted with the CardioWest. Fifteen patients (55.5%) died during support. Prior to home discharge, the most frequent cause of death was multi-organ failure (46.6%). Twelve patients were discharged home from hospital within a median of 88 days [range 35-152, interquartile range 57] postimplantation. Mean rehospitalization rate was 1.2 by patient, on account of device infection (n = 7), technical problems with the console (n = 3) and other causes (n = 4). Between discharge and transplant, patients spent 87% of their support time out of hospital. All patients who returned home with the TAH were subsequently transplanted, and 1 died in post-transplant. Despite the morbidity and mortality occurring during the postimplantation period, home discharge with a TAH is possible. Portables drivers allow for a safe return home. Aside from some remaining weak points such as infectious complications or noise, CardioWest TAH allows for successful rehabilitation of graft candidates, and assures highly satisfactory transplant results.

Surveying multiple health professional team members within institutional settings: an example from the nursing home industry.

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Clark, Melissa A; Roman, Anthony; Rogers, Michelle L; Tyler, Denise A; Mor, Vincent

2014-09-01

Quality improvement and cost containment initiatives in health care increasingly involve interdisciplinary teams of providers. To understand organizational functioning, information is often needed from multiple members of a leadership team since no one person may have sufficient knowledge of all aspects of the organization. To minimize survey burden, it is ideal to ask unique questions of each member of the leadership team in areas of their expertise. However, this risks substantial missing data if all eligible members of the organization do not respond to the survey. Nursing home administrators (NHA) and directors of nursing (DoN) play important roles in the leadership of long-term care facilities. Surveys were administered to NHAs and DoNs from a random, nationally representative sample of U.S. nursing homes about the impact of state policies, market forces, and organizational factors that impact provider performance and residents' outcomes. Responses were obtained from a total of 2,686 facilities (response rate [RR] = 66.6%) in which at least one individual completed the questionnaire and 1,693 facilities (RR = 42.0%) in which both providers participated. No evidence of nonresponse bias was detected. A high-quality representative sample of two providers in a long-term care facility can be obtained. It is possible to optimize data collection by obtaining unique information about the organization from each provider while minimizing the number of items asked of each individual. However, sufficient resources must be available for follow-up to nonresponders with particular attention paid to lower resourced, lower quality facilities caring for higher acuity residents in highly competitive nursing home markets. © The Author(s) 2014.

Renal telemedicine through video-as-a-service delivered to patients on home dialysis: A qualitative study on the renal care team members' experience.

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Ditchburn, Jae-Llane; Marshall, Alison

2017-09-01

The Lancashire Teaching Hospitals NHS Trust in the UK has been providing renal care through video-as-a-service (VAAS) to patients since 2013, with support from the North West NHS Shared Infrastructure Service, a collaborative team that supports information and communication technology use in the UK National Health Service. Renal telemedicine offered remotely to patients on home dialysis supports renal care through the provision of a live high-quality video link directly to unsupported patients undergoing haemodialysis at home. Home haemodialysis is known to provide benefits to patients, particularly in making them more independent. The use of a telemedicine video-link in Lancashire and South Cumbria, UK, further reduces patient dependence on the professional team. The purpose of this paper is to present the perspectives of the renal care team members using the renal telemedicine service to understand the perceived benefits and issues with the service. Ten semi-structured interviews with members of the renal care team (two renal specialists, one matron, two renal nurses, one business manager, one renal technical services manager, two IT technicians and one hardware maintenance technician) were conducted. Thematic analysis was undertaken to analyse the qualitative data. A range of incremental benefits to the renal team members were reported, including more efficient use of staff time, reduced travel, peace of mind and a strong sense of job satisfaction. Healthcare staff believed that remote renal care through video was useful, encouraged concordance and could nurture confidence in patients. Key technological issues and adjustments which would improve the renal telemedicine service were also identified. The impact of renal telemedicine was positive on the renal team members. The use of telemedicine has been demonstrated to make home dialysis delivery more efficient and safe. The learning from staff feedback could inform development of services elsewhere. © 2017

Home-care nursing staff in self-directed teams are more satisfied with their job and feel they have more autonomy over patient care: a nationwide survey.

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Maurits, Erica E M; de Veer, Anke J E; Groenewegen, Peter P; Francke, Anneke L

2017-10-01

The aims of this study were: (1) To examine whether working in a self-directed team is related to home-care nursing staff's job satisfaction; (2) To assess the mediating effect of self-perceived autonomy over patient care; (3) To investigate the moderating effect of educational level on the association between autonomy over patient care and job satisfaction. Self-directed teams are being introduced in home care in several countries. It is unknown whether working in a self-directed team is related to nursing staff's job satisfaction. It is important to gain insight into this association since self-directed teams may help in retaining nursing staff. A cross-sectional study based on two questionnaire surveys in 2014 and 2015. The study involved 191 certified nursing assistants and registered nurses employed in Dutch home-care organizations (mean age of 50). These were members of the Dutch Nursing Staff Panel, a nationwide panel of nursing staff working in various healthcare settings. Self-direction is positively related to nursing staff's job satisfaction. This relationship is partly mediated by autonomy over patient care. For certified nursing assistants and registered nurses with a bachelor's degree, a greater sense of autonomy over patient care in self-directed teams is positively related to job satisfaction. No significant association was found between autonomy over patient care and job satisfaction for registered nurses with an associate degree. This study suggests that home-care organizations should consider the use of self-directed teams as this increases nursing staff's job satisfaction and may therefore help to retain nursing staff in home care. © 2017 John Wiley & Sons Ltd.

Exploration and Resource Assessment at Mountain Home Air Force Base, Idaho Using an Integrated Team Approach

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Joseph C. Armstrong; Robert P. Breckenridge; Dennis L. Nielson; John W. Shervais; Thomas R. Wood

2012-10-01

The U.S. Air Force is facing a number of challenges as it moves into the future, one of the biggest being how to provide safe and secure energy to support base operations. A team of scientists and engineers met at Mountain Home Air Force Base near Boise, Idaho, to discuss the possibility of exploring for geothermal resources under the base. The team identified that there was a reasonable potential for geothermal resources based on data from an existing well. In addition, a regional gravity map helped identify several possible locations for drilling a new well. The team identified several possible sources of funding for this well—the most logical being to use U.S. Department of Energy funds to drill the upper half of the well and U.S. Air Force funds to drill the bottom half of the well. The well was designed as a slimhole well in accordance with State of Idaho Department of Water Resources rules and regulations. Drilling operations commenced at the Mountain Home site in July of 2011 and were completed in January of 2012. Temperatures increased gradually, especially below a depth of 2000 ft. Temperatures increased more rapidly below a depth of 5500 ft. The bottom of the well is at 5976 ft, where a temperature of about 140°C was recorded. The well flowed artesian from a depth below 5600 ft, until it was plugged off with drilling mud. Core samples were collected from the well and are being analyzed to help understand permeability at depth. Additional tests using a televiewer system will be run to evaluate orientation and directions at fractures, especially in the production zone. A final report on the well exploitation will be forthcoming later this year. The Air Force will use it to evaluate the geothermal resource potential for future private development options at Mountain Home AFB.

The implementation of crisis resolution home treatment teams in wales: results of the national survey 2007-2008.

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Jones, Richard; Jordan, Sue

2010-02-18

In mental health nursing, Crisis Resolution and Home Treatment (CRHT) services are key components of the shift from in-patient to community care. CRHT has been developed mainly in urban settings, and deployment in more rural areas has not been examined. We aimed to evaluate CRHT services' progress towards policy targets. All 18 CRHT teams in Wales were surveyed. A service profile questionnaire was distributed to team leaders. Fourteen of 18 teams responded in full. All but one were led by nurses, who formed the main professional group. All teams reported providing an alternative to hospital admission and assisting early discharge. With one exception, teams were 'gatekeeping' hospital beds. There was some divergence in clients seen, perceived impact of the service, operational hours, distances travelled, team structure, input of consultant psychiatrists and caseloads. We found some differences between the 8 urban teams and the 6 teams serving rural or mixed areas: rural teams travelled more, had fewer inpatient beds, and less medical input (0.067 compared to 0.688 whole time equivalents).. Most respondents felt that resource constraints were limiting further developments. Teams met standards for CHRT services in Wales; however, these are less onerous than those in England, particularly in relation to operational hours and staffing complement. As services develop, it will be important to ensure that rural and mixed areas receive the same level of input as urban areas.

Heart Health - Heart Disease: Symptoms, Diagnosis, Treatment

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... Bar Home Current Issue Past Issues Cover Story Heart Health Heart Disease: Symptoms, Diagnosis, Treatment Past Issues / Winter 2009 ... of this page please turn Javascript on. Most heart attacks happen when a clot in the coronary ...

Organisation, regulations, preparation and logistics of parenteral nutrition in hospitals and homes; the role of the nutrition support team – Guidelines on Parenteral Nutrition, Chapter 8

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Kester, L.

2009-11-01

Full Text Available PN (parenteral nutrition should be standardised to ensure quality and to reduce complications, and it should be carried out in consultation with a specialised nutrition support team whenever possible. Interdisciplinary nutrition support teams should be established in all hospitals because effectiveness and efficiency in the implementation of PN are increased. The tasks of the team include improvements of quality of care as well as enhancing the benefit to cost ratio. Therapeutic decisions must be taken by attending physicians, who should collaborate with the nutrition support team. “All-in-One” bags are generally preferred for PN in hospitals and may be industrially manufactured, industrially manufactured with the necessity to add micronutrients, or be prepared “on-demand” within or outside the hospital according to a standardised or individual composition and under consideration of sterile and aseptic conditions. A standardised procedure should be established for introduction and advancement of enteral or oral nutrition. Home PN may be indicated if the expected duration of when PN exceeds 4 weeks. Home PN is a well established method for providing long-term PN, which should be indicated by the attending physician and be reviewed by the nutrition support team. The care of home PN patients should be standardised whenever possible. The indication for home PN should be regularly reviewed during the course of PN.

Heart Health: The Heart Truth Campaign 2009

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... Bar Home Current Issue Past Issues Cover Story Heart Health The Heart Truth Campaign 2009 Past Issues / Winter 2009 Table ... one of the celebrities supporting this year's The Heart Truth campaign. Both R&B singer Ashanti (center) ...

Elements of team-based care in a patient-centered medical home are associated with lower burnout among VA primary care employees.

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Helfrich, Christian D; Dolan, Emily D; Simonetti, Joseph; Reid, Robert J; Joos, Sandra; Wakefield, Bonnie J; Schectman, Gordon; Stark, Richard; Fihn, Stephan D; Harvey, Henry B; Nelson, Karin

2014-07-01

A high proportion of the US primary care workforce reports burnout, which is associated with negative consequences for clinicians and patients. Many protective factors from burnout are characteristics of patient-centered medical home (PCMH) models, though even positive organizational transformation is often stressful. The existing literature on the effects of PCMH on burnout is limited, with most findings based on small-scale demonstration projects with data collected only among physicians, and the results are mixed. To determine if components of PCMH related to team-based care were associated with lower burnout among primary care team members participating in a national medical home transformation, the VA Patient Aligned Care Team (PACT). Web-based, cross-sectional survey and administrative data from May 2012. A total of 4,539 VA primary care personnel from 588 VA primary care clinics. The dependent variable was burnout, and the independent variables were measures of team-based care: team functioning, time spent in huddles, team staffing, delegation of clinical responsibilities, working to top of competency, and collective self-efficacy. We also included administrative measures of workload and patient comorbidity. Overall, 39 % of respondents reported burnout. Participatory decision making (OR 0.65, 95 % CI 0.57, 0.74) and having a fully staffed PACT (OR 0.79, 95 % CI 0.68, 0.93) were associated with lower burnout, while being assigned to a PACT (OR 1.46, 95 % CI 1.11, 1.93), spending time on work someone with less training could do (OR 1.29, 95 % CI 1.07, 1.57) and a stressful, fast-moving work environment (OR 4.33, 95 % CI 3.78, 4.96) were associated with higher burnout. Longer tenure and occupation were also correlated with burnout. Lower burnout may be achieved by medical home models that are appropriately staffed, emphasize participatory decision making, and increase the proportion of time team members spend working to the top of their competency level.

Parents' perceptions during the transition to home for their child with a congenital heart defect: How can we support families of children with hypoplastic left heart syndrome?

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March, Sarita

2017-07-01

The aim of the study was to explore the literature related to transitions in healthcare between the hospital and home that caregivers experience with a child who has a congenital heart defect (CHD), specifically related to hypoplastic left heart syndrome (HLHS). A systematic literature review was conducted searching OVID Medline, CINAHL, and PubMed to discover the caregivers' perceptions on their transitions between hospital care and home care of their child with a CHD. Articles included those with focus on the transitions of caregivers between hospital and home care for children with CHD. Excluded articles were studies focused on adolescents, transition to adult healthcare, mortality results, other diseases associated with CHDs, comparison of CHD treatments, feasibility studies, differences in care between hospitals, home monitoring, and comparison of videoconference and telephone home communication. Ten articles were selected. Many parents voiced their concerns with feeding their child, learning medical skills and knowledge, reported a disrupted relationship between parents and their child, and identified stress and anxiety associated with taking care of a child with a CHD. There were limited studies on caregivers' transitions with a child with HLHS, but there also was limited focus on the caregivers' experiences with transitions between hospital and home care for their child with any CHD. Research on the transition experience between hospital care and home care for caregivers of children born with a CHD, and a specific focus on HLHS from the caregivers' viewpoint, would provide insight into the perspective of caregivers during the numerous transitions. © 2017 Wiley Periodicals, Inc.

Climate Action Team

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Science Partnerships Contact Us Climate Action Team & Climate Action Initiative The Climate Action programs and the state's Climate Adaptation Strategy. The CAT members are state agency secretaries and the . See CAT reports Climate Action Team Pages CAT Home Members Working Groups Reports Back to Top

Effects of intravenous home dobutamine in palliative end-stage heart failure on quality of life, heart failure hospitalization, and cost expenditure.

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Martens, Pieter; Vercammen, Jan; Ceyssens, Wendy; Jacobs, Linda; Luwel, Evert; Van Aerde, Herwig; Potargent, Peter; Renaers, Monique; Dupont, Matthias; Mullens, Wilfried

2018-01-17

In patients with palliative end-stage heart failure, interventions that could provide symptomatic relief and prevent hospital admissions are important. Ambulatory continuous intravenous inotropes have been advocated by guidelines for such a purpose. We sought to determine the effect of intravenous dobutamine on symptomatic status, hospital stay, mortality, and cost expenditure. All consecutive end-stage heart failure patients not amenable for advanced therapies and discharged with continuous intravenous home dobutamine from a single tertiary centre between April 2011 and January 2017 were retrospectively analysed. Dobutamine (fixed dose) was infused through a single-lumen central venous catheter with a small pump that was refilled by a nurse on a daily basis. Symptomatic status was longitudinally assessed as the change in New York Heart Association class and patient global assessment scale. Antecedent and incident heart failure hospitalizations were determined in a paired fashion, and cost impact was assessed. A total of 21 patients (age 77 ± 9 years) were followed up for 869 ± 647 days. At first follow-up (6 ± 1 weeks) after the initiation of dobutamine, patients had a significant improvement in New York Heart Association class (-1.29 ± 0.64; P heart failure hospitalizations assessed at 3, 6, and 12 months were significantly reduced (P heart failure hospitalizations over the same time period. Cost expenditure was significantly lower at 3 (P heart failure is feasible and associated with improved symptomatic status, heart failure hospitalizations, and health-care-related costs. Nevertheless, results should be interpreted in the context of the small and retrospective design. Larger studies are necessary to evaluate the effect of dobutamine in palliative end-stage heart failure. © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Back home after an acquired brain injury: building a "low-cost" team to provide theory-driven cognitive rehabilitation after routine interventions.

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Pierini, Davide; Hoerold, Doreen

2014-01-01

Individuals with Acquired Brain Injury (ABI) could benefit from further cognitive rehabilitation, after they have returned home. However, a lack of specialist services to provide such rehabilitation often prevents this. This leads to reduced reintegration of patients, increased social disadvantages and ultimately, higher economic costs. 10 months post-stroke, a 69 year-old woman was discharged from an inpatient rehabilitation program and returned home with severe cognitive impairments. We describe a pilot project which provided an individualised, low cost rehabilitation program, supervised and trained by a neuropsychologist. Progress was monitored every 3 months in order to decide on continuation of the program, based on the achieved results and predicted costs. Post intervention, despite severe initial impairment, cognitive and most notably daily functioning had improved. Although the financial investment was moderately high for the family, the intervention was still considered cost-effective when compared with the required costs of care in a local non-specialist care home. Moreover, the pilot experience was used to build a "local expert team" available for other individuals requiring rehabilitation. These results encourage the development of similar local "low cost" teams in the community, to provide scientifically-grounded cognitive rehabilitation for ABI patients returning home.

Interprofessional care collaboration for patients with heart failure.

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Boykin, Amanda; Wright, Danielle; Stevens, Lydia; Gardner, Lauren

2018-01-01

An innovative collaborative care model to improve transitions of care (TOC) for patients with heart failure (HF) is described. As part of a broad effort by New Hanover Regional Medical Center (NHRMC) to reduce avoidable 30-day hospital readmissions and decrease associated healthcare costs through a team-centered, value-based approach to patient care, an interprofessional team was formed to help reduce hospital readmissions among discharged patients with HF. The team consists of 5 TOC pharmacists, 4 community paramedics, and 4 advanced care practitioners (ACPs) who collaborate to coordinate care and prevent 30-day readmissions among patients with HF transitioning from the hospital to the community setting. Each team member plays an integral role in providing high-quality postdischarge care. The TOC pharmacist ensures that patients have access to all needed medications, provides in-home medication reconciliation services, makes medication recommendations, and alerts the team of potential medication-related issues. Community paramedics conduct home visits consisting of physical and mental health assessments, diet and disease state education, reviews of medication bottles and education on proper medication use, and administration of i.v. diuretics to correct volume status under provider orders. The ACPs offer close clinic follow-up (typically initiated within 7 days of discharge) as well as long-term HF management and education. At NHRMC, collaboration among healthcare professionals, including a TOC pharmacist, community paramedics, and ACPs, has assisted in the growth and expansion of services provided to patients with HF. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Introduction of an interdisciplinary heart team-based transcatheter aortic valve implantation programme: short and mid-term outcomes.

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Martínez, G J; Seco, M; Jaijee, S K; Adams, M R; Cartwright, B L; Forrest, P; Celermajer, D S; Vallely, M P; Wilson, M K; Ng, M K C

2014-09-01

Transcatheter aortic valve implantation (TAVI) has been developed to treat symptomatic aortic stenosis in patients deemed too high risk for open-heart surgery. To address this complex population, an interdisciplinary heart team approach was proposed. Present the short- and mid-term outcomes of the first 100 patients in the Royal Prince Alfred Hospital multidisciplinary TAVI programme. Single-centre registry. Baseline and procedural data were prospectively recorded. Outcomes were recorded according to Valve Academic Research Consortium - version 2 guidelines. All patients underwent a comprehensive interdisciplinary pre-procedural evaluation. Sixty-eight transfemoral and 32 transapical implantations were performed. Mean age was 82 (±8.9) years old with an average logistic EuroSCORE of 33. Although 13 procedures had major complications, there was no intraprocedural mortality. During the first month, 9% of patients were re-admitted due to heart failure and 13% had a permanent pacemaker implanted. A 3% 30-day and 8% follow-up (mean 17 months) mortalities were recorded. While no significant differences in the rate of complications were found between the first and second half of the experience, all cases of mortality within 30 days (n = 3) occurred in the initial half. Sustained haemodynamic results were obtained with TAVI (immediate mean aortic valve gradient reduction from 47 to 9 mmHg; 1-year echocardiographic gradient 9.9 mmHg, with no moderate or severe aortic regurgitation). Excellent results can be achieved with TAVI in very high-risk patients at an Australian institution. A comprehensive evaluation based on a heart team can overcome most of the difficulties imposed by this challenging population. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Heart Health: Learn the Truth About Your Heart

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... Bar Home Current Issue Past Issues Cover Story Heart Health Learn the Truth About Your Heart Past Issues / Winter 2009 Table of Contents For ... turn Javascript on. Photo: iStock February is American Heart Month. Now is the time to make sure ...

Advanced Heart Failure

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... Artery Disease Venous Thromboembolism Aortic Aneurysm More Advanced Heart Failure Updated:May 9,2017 When heart failure (HF) ... Making This content was last reviewed May 2017. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

Adult congenital heart disease nurse coordination: Essential skills and role in optimizing team-based care a position statement from the International Society for Adult Congenital Heart Disease (ISACHD).

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Sillman, Christina; Morin, Joanne; Thomet, Corina; Barber, Deena; Mizuno, Yoshiko; Yang, Hsiao-Ling; Malpas, Theresa; Flocco, Serena Francesca; Finlay, Clare; Chen, Chi-Wen; Balon, Yvonne; Fernandes, Susan M

2017-02-15

Founded in 1992, the International Society for Adult Congenital Heart Disease (ISACHD) is the leading global organization of professionals dedicated to pursuing excellence in the care of adults with congenital heart disease (CHD) worldwide. Among ISACHD's objectives is to "promote a holistic team-based approach to the care of the adult with CHD that is comprehensive, patient-centered, and interdisciplinary" (http://www.isachd.org). This emphasis on team-based care reflects the fact that adults with CHD constitute a heterogeneous population with a wide spectrum of disease complexity, frequent association with other organ involvement, and varied co-morbidities and psychosocial issues. Recognizing the vital role of the adult CHD (ACHD) nurse coordinator (ACHD-NC) in optimizing team-based care, ISACHD established a task force to elucidate and provide guidance on the roles and responsibilities of the ACHD-NC. Acknowledging that nursing roles can vary widely from region to region based on factors such as credentials, scopes of practice, regulations, and local culture and tradition, an international panel was assembled with experts from North America, Europe, East Asia, and Oceania. The writing committee was tasked with reviewing key aspects of the ACHD-NC's role in team-based ACHD care. The resulting ISACHD position statement addresses the ACHD-NC's role and skills required in organizing, coordinating, and facilitating the care of adults with CHD, holistic assessment of the ACHD patient, patient education and counseling, and support for self-care management and self-advocacy. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

Association of medical home team-based care functions and perceived improvements in patient-centered care at VHA primary care clinics.

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Helfrich, Christian D; Dolan, Emily D; Fihn, Stephan D; Rodriguez, Hector P; Meredith, Lisa S; Rosland, Ann-Marie; Lempa, Michele; Wakefield, Bonnie J; Joos, Sandra; Lawler, Lauren H; Harvey, Henry B; Stark, Richard; Schectman, Gordon; Nelson, Karin M

2014-12-01

Team-based care is central to the patient-centered medical home (PCMH), but most PCMH evaluations measure team structure exclusively. We assessed team-based care in terms of team structure, process and effectiveness, and the association with improvements in teams׳ abilities to deliver patient-centered care. We fielded a cross-sectional survey among 913 VA primary care clinics implementing a PCMH model in 2012. The dependent variable was clinic-level respondent-reported improvements in delivery of patient-centered care. Independent variables included three sets of measures: (1) team structure, (2) team process, and (3) team effectiveness. We adjusted for clinic workload and patient comorbidity. 4819 surveys were returned (25% estimated response rate). The highest ratings were for team structure (median of 89% of respondents being assigned to a teamlet, i.e., a PCP working with the same clinical associate, nurse care manager and clerk) and lowest for team process (median of 10% of respondents reporting the lowest level of stress/chaos). In multivariable regression, perceived improvements in patient-centered care were most strongly associated with participatory decision making (β=32, Pteam processes). A stressful/chaotic clinic environment was associated with higher barriers to patient centered care (β=0.16-0.34, P=Team process and effectiveness measures, often omitted from PCMH evaluations, had stronger associations with perceived improvements in patient-centered care than team structure measures. Team process and effectiveness measures may facilitate synthesis of evaluation findings and help identify positive outlier clinics. Published by Elsevier Inc.

Home care utilization and outcomes among Asian and other Canadian patients with heart failure

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King Kathryn M

2010-03-01

Full Text Available Abstract Background Heart failure (HF is a major cause of hospitalization and death in the aging population around the world. Home care utilization is associated with improved survival for the patients with HF, and varies by ethno-culture. The purpose of this study was to investigate the difference in hospital readmission rate and mortality between Asian and other Canadian HF patients. Methods HF patients were identified using hospital discharge abstracts from March 31, 2000 to April 1, 2006 in Calgary Health Region. Readmission and one-year mortality for HF were determined by linking hospital discharge and vital statistics data. Stratified by home care services use, readmission and mortality rates were compared between the Asians and other Canadians while controlling for age, sex, comorbidities, and household income. Results Of 26,171 HF patients discharged from hospital, 56.6% of Asians and 58.0% of other Canadians used home care services [adjusted odds ratio (OR for Asian: 0.84, 95% confidence interval (CI: 0.74-0.89]. The hospital readmission rate was similar between Asians and other Canadians regardless of home care services use. Mortality was similar between those who used home care services (adjusted OR for Asian: 0.96, 95% CI: 0.81-1.13. For patients who did not use home care services, Asians had significantly lower mortality than other Canadians (adjusted OR for Asian: 0.76, 95% CI: 0.60-0.86. Conclusion Mortality was similar between Asian and other Canadian patients when home care services were utilized. However, among those without home care, Asian patients had a significantly lower mortality than other Canadian patients.

Ontario pharmacists practicing in family health teams and the patient-centered medical home.

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Dolovich, Lisa

2012-04-01

The patient-centered medical home (PCMH) approach continues to gather momentum in the United States and Canada as a broad approach to reform the delivery of the complete primary care system. The family health team (FHT) model implemented in Ontario, Canada, best mirrors the PCMH approach of the United States. The integration of pharmacists as key members of the health care team providing on-site, in-office coordinated care to FHT patients was included from the start of planning the FHT model and represents a substantial opportunity for pharmacists to realize their professional vision. Several research projects in Canada and elsewhere have contributed to providing evidence to support the integration of pharmacists into primary care practice sites. Two major research programs, the Seniors Medication Assessment Research Trial (SMART) cluster randomized controlled trial and the Integrating Family Medicine and Pharmacy to Advance Primary Care Therapeutics (IMPACT) multipronged demonstration project made substantial contributions to evidence-informed policy decisions supporting the integration of pharmacists into FHTs. These projects can provide useful information to support the integration of pharmacists into the PCMH and to encourage further research to better measure the effect of the pharmacist from the holistic patient-centered perspective.

Improved Cost-effectiveness for Management of Chronic Heart Failure by Combined Home-based Intervention with Clinical Nursing Specialists

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Yi-Lwun Ho

2007-01-01

Conclusion: The home- and clinic-based caring system is capable of decreasing adverse outcomes, most notably hospitalization and length of stay, and could trigger significant cost savings in the management of heart failure. [J Formos Med Assoc 2007;106(4:313-319

Heart Team therapeutic decision-making and treatment in severe aortic valve stenosis

DEFF Research Database (Denmark)

Thyregod, Hans Gustav Hørsted; Holmberg, Fredrik; Gerds, Thomas Alexander

2016-01-01

Objectives: After transcatheter aortic valve implantation (TAVI) has been available for high-risk patients with severe aortic valve stenosis (AVS), the decision-making of the Heart Team (HT) has not been examined. Design: All adult patients with severe AVS referred to a large tertiary medical......%), and surgical aortic valve replacement (SAVR) in 392 (81%) of patients. In patients referred to intervention, TAVI compared with SAVR patients were older (OR = 1.17 per year, 95% CI 1.09-1.26; p obesity (OR = 4.69, 1.......51-13.77; p disease (COPD) (OR = 3.66, 1.21-10.75; p = 0.02). MT patients compared with patients referred to any intervention were older, had a higher prevalence of COPD, peripheral arterial disease, previous myocardial infarction, and cerebrovascular disease...

HOME ADVANTAGE ANALYSIS IN ACB LEAGUE IN SEASON 2007-2008

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Javier Garc\\u00EDa

2009-01-01

Full Text Available Home advantage was defined as the fact that home teams win more than the 50% of their matches (Courneya & Carron, 1992. The aim of this work was to investigate the home advantage in the ACB league and identify the game-related statistics which best discriminate home and away teams. The data were obtained from the Spanish Basketball Association for the period 2007-2008 ACB league (n= 306. Game related statistics were normalized to 100 ball possessions. In order to compare game related statistics in home and away teams, a discriminative analysis was employed. This analysis identifies the game related statistics that best discriminate between home and away teams. The function obtained was interpreted with the structural canonical coefficients (SC, with values higher than |.30|. In the 2007-2008 ACB league, the home teams won the 55.22% (n=169 of the games. The analysis identifying the two-point field goals made, blocks made, dunks, the defensive rebounds and the assists as common to the mean vectors that discriminate home teams in all games. Blocks received contribute to discriminate away teams in ACB league. These results could be used by the psychologist who works with the team. They must design specific programs to decrease anxiety levels, and to improve motivation and concentration levels in basketball players before a competition.

Cost-Effectiveness of a Home Based Intervention for Secondary Prevention of Readmission with Chronic Heart Disease.

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Joshua Byrnes

Full Text Available The aim of this study is to consider the cost-effectiveness of a nurse-led, home-based intervention (HBI in cardiac patients with private health insurance compared to usual post-discharge care. A within trial analysis of the Young @ Heart multicentre, randomized controlled trial along with a micro-simulation decision analytical model was conducted to estimate the incremental costs and quality adjusted life years associated with the home based intervention compared to usual care. For the micro-simulation model, future costs, from the perspective of the funder, and effects are estimated over a twenty-year time horizon. An Incremental Cost-Effectiveness Ratio, along with Incremental Net Monetary Benefit, is evaluated using a willingness to pay threshold of $50,000 per quality adjusted life year. Sub-group analyses are conducted for men and women across three age groups separately. Costs and benefits that arise in the future are discounted at five percent per annum. Overall, home based intervention for secondary prevention in patients with chronic heart disease identified in the Australian private health care sector is not cost-effective. The estimated within trial incremental net monetary benefit is -$3,116 [95% CI: -11,145, $4,914]; indicating that the costs outweigh the benefits. However, for males and in particular males aged 75 years and above, home based intervention indicated a potential to reduce health care costs when compared to usual care (within trial: -$10,416 [95% CI: -$26,745, $5,913]; modelled analysis: -$1,980 [95% CI: -$22,843, $14,863]. This work provides a crucial impetus for future research to understand for whom disease management programs are likely to benefit most.

Structure and functioning of a multidisciplinary 'Heart Team' for patients with coronary artery disease: rationale and recommendations from a joint BCS/BCIS/SCTS working group.

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Luckraz, Heyman; Norell, Michael; Buch, Mamta; James, Rachael; Cooper, Graham

2015-10-01

The decision-making process in the management of patients with ischaemic heart disease has historically been the responsibility of the cardiologist and encompasses medical management, percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Currently, there is significant geographical variability in the PCI:CABG ratio. There are now emerging recommendations that this decision-making process should be carried out through a multidisciplinary approach, namely the Heart Team. This work was carried out on behalf of The British Cardiovascular Society (BCS), Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) and British Cardiovascular Intervention Society (BCIS). This manuscript sets out the principles for the functioning of the Heart Team. This work has been approved by the Executive Committees of BCS/BCIS/SCTS. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Heart transplant centers with multidisciplinary team show a higher level of chronic illness management - Findings from the International BRIGHT Study.

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Cajita, Maan Isabella; Baumgartner, Eva; Berben, Lut; Denhaerynck, Kris; Helmy, Remon; Schönfeld, Sandra; Berger, Gabriele; Vetter, Christine; Dobbels, Fabienne; Russell, Cynthia L; De Geest, Sabina

The objectives of this study were to: (1) explore the proportion of HTx centers that have a multidisciplinary team and (2) assess the relationship between multidisciplinarity and the level of chronic illness management (CIM). The International Society for Heart and Lung Transplantation (ISHLT) recommends a multidisciplinary approach in heart transplant (HTx) follow-up care but little is known regarding the proportion of HTx centers that meet this recommendation and the impact on patient care. HTx centers with a multidisciplinary team may offer higher levels of CIM, a care model that has the potential to improve outcomes after HTx. We conducted a secondary analysis of the BRIGHT study, a cross-sectional study in 11 countries. Multidisciplinarity in the 36 HTx centers was assessed through HTx director reports and was defined as having a team that was composed of physician(s), nurse(s), and another healthcare professional (either a social worker, psychiatrist, psychologist, pharmacist, dietician, physical therapist, or occupational therapist). CIM was assessed with the Patient Assessment of Chronic Illness Care (PACIC). Multiple linear regression assessed the relationship between multidisciplinarity and the level of CIM. Twenty-nine (80.6%) of the HTx centers had a multidisciplinary team. Furthermore, multidisciplinarity was significantly associated with higher levels of CIM (β = 5.2, P = 0.042). Majority of the HTx centers follows the ISHLT recommendation for a multidisciplinary approach. Multidisciplinarity was associated with CIM and point toward a structural factor that needs to be in place for moving toward CIM. Copyright © 2017 Elsevier Inc. All rights reserved.

Heart Disease Risk Factors

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... About CDC.gov . Home About Heart Disease Coronary Artery Disease Heart Attack Heart Attack Signs and Symptoms ... Privacy FOIA No Fear Act OIG 1600 Clifton Road Atlanta , GA 30329-4027 USA 800-CDC-INFO ( ...

The Team Approach to Pain Relief

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... Navigation Bar Home Current Issue Past Issues The Team Approach to Pain Relief Past Issues / Fall 2007 ... Roberts is seen here with some of the team members, (left to right) Dr. Berger, Jacques Bolle, ...

Heart valve surgery - discharge

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... ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College ... Editorial team. Related MedlinePlus Health Topics Heart Surgery Heart Valve Diseases Browse the Encyclopedia A.D.A.M., Inc. ...

Nuclear Heart Scan

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... Home / Nuclear Heart Scan Nuclear Heart Scan Also known as Nuclear Stress Test , ... Learn More Connect With Us Contact Us Directly Policies Privacy Policy Freedom of Information Act (FOIA) Accessibility ...

Parenting a child at home with hypoplastic left heart syndrome: experiences of commitment, of stress, and of love.

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Cantwell-Bartl, Annie M; Tibballs, James

2017-09-01

To evaluate the experiences of parenting a child with hypoplastic left heart syndrome after the child has been discharged home from hospital. A study of the parents' experiences using face-to-face interviews and psychometric measures with parents whose child had survived stage surgery. Parents were interviewed within the home environment or within the hospital if that was their choice. A total of 29 parents (16 mothers and 13 fathers) of surviving children. Intervention A semi-structured face-to-face interview plus psychometric tests (parent demographics, Maslach Burnout Inventory, Impact on Family Scale, and the Psychological Check List - Civilian). Measurements and main results The parents' experience in supporting a child with hypoplastic left heart syndrome is one of stress, of commitment, and of love. Although parents experienced joy in their child, they were also subjected to anxiety with four parents test positive to post-traumatic stress disorder and hypervigilance while monitoring their child's condition. Parents lived with many difficulties, and demands.

Implementation of the concept of home hospitalisation for heart patients by means of telehomecare technology: integration of clinical tasks

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Birthe Dinesen

2007-05-01

Full Text Available Purpose: To explore how the implementation of the concept ‘Home hospitalisation of heart patients’ by means of telehomecare technology influences the integration of clinical tasks across healthcare sectors. Theory: Inter-organisational theory. Methods: The case study approach was applied. Triangulations of data collection techniques were used: documentary materials, participant observation, qualitative and focus group interviews. Results: The clinical decision-making and task solving became multidisciplinary and integrated with the implementation of telehomecare and, therefore, complex in terms of the prescription and adjustment of patient medicine. Workflows between healthcare professionals across sectors changed from sequential to collective client flows. Pre-existing procedures for patient care, treatment, and responsibility were challenged. In addition, the number of tasks for the district nurses increased. Integration in the clinical task-solving area increases fragmentation in the knowledge technologies in a network perspective. Conclusions: Implementing the concept of ‘Home hospitalisation of heart patients’ by means of telehomecare technology will result in a more integrated clinical task-solving process that involves healthcare professionals from various sectors. Overall, the integration of clinical tasks between hospital and district nursing will result in a direct benefit for the heart patients.

GAME LOCATION AND TEAM QUALITY EFFECTS ON PERFORMANCE PROFILES IN PROFESSIONAL SOCCER

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Carlos Lago-Peñas

2011-09-01

Full Text Available Home advantage in team sports has an important role in determining the outcome of a game. The aim of the present study was to identify the soccer game- related statistics that best discriminate home and visiting teams according to the team quality. The sample included all 380 games of the Spanish professional men's league. The independent variables were game location (home or away and the team quality. Teams were classified into four groups according to their final ranking at the end of the league. The game-related statistics registered were divided into three groups: (i variables related to goals scored; (ii variables related to offense and (iii variables related to defense. A univariate (t-test and Mann-Whitney U and multivariate (discriminant analysis analysis of data was done. Results showed that home teams have significantly higher means for goal scored, total shots, shots on goal, attacking moves, box moves, crosses, offsides committed, assists, passes made, successful passes, dribbles made, successful dribbles, ball possession, and gains of possession, while visiting teams presented higher means for losses of possession and yellow cards. In addition, the findings of the current study confirm that game location and team quality are important in determining technical and tactical performances in matches. Teams described as superior and those described as inferior did not experience the same home advantage. Future research should consider the influence of other confounding variables such as weather conditions, game status and team form

Description of a Heart Team approach to coronary revascularization and its beneficial long-term effect on clinical events after PCI.

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Bonzel, Tassilo; Schächinger, Volker; Dörge, Hilmar

2016-05-01

We present a first description of a Heart Team (HT)-guided approach to coronary revascularization and its long-term effect on clinical events after percutaneous coronary intervention (PCI). The HT approach is a structured process to decide for coronary bypass grafting (CABG), PCI or conservative therapy in ad hoc situations as well as in HT conferences. As a hypothesis, during the long-term course after a PCI performed according to HT rules, a low number of late revascularizations, especially CABGs, are expected (F-PCI study). In this monocentric study, the HT approach to an all-comer population was first analyzed and described in general with the help of a database. Next the use of a HT approach was described for a more homogeneous subgroup with newly detected CAD (1.CAD). Those patients in whom the HT decision was PCI (which was a 1.PCI) were then studied with the help of questionnaires for clinical events during a very long-term follow-up. Events were CABG, PCI, diagnostic catheterization (DCath) and death. A significant number of patients were presented to HT conferences: 22 % out of all 11,174 catheterizations, 24 % out of all 7867 CAD cases and 35 % out of 3408 1.CAD cases. Most of these patients had multi-vessel disease (MVD). Conference decisions were isolated CABG in 46-66 %, PCI in 10-14 %, valvular surgery in 9-16 %, HTx in 10-21 % (Endstage heart failure candidates for surgery) and conservative therapy (Medical or no therapy, additional diagnostic procedures or no adherence to recommended therapy) in 2-3 %. However, most PCIs, ad hoc and elective, were performed under Heart Team rules, but without conference. During follow-up of 1.PCI patients (Kaplan-Meier analysis), CABG occurred in only 15 % of patients, PCI in 37 % and DCath in 65 %; mortality of any course was 51 %. Mortalities were similar in one-vessel disease and in a population of the same year, matched for age and sex (p PCI patients with MVD (p PCI) rates after a 1.PCI, without

SETI@home

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Project Help Donate Porting Graphics Add-ons Science About SETI@home About Astropulse Science Community Message boards Questions and Answers Teams Profiles User search Web sites Pictures and music User University of California SETI@home and Astropulse are funded by grants from the National Science Foundation

The second leg home advantage: evidence from European football cup competitions.

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Page, Lionel; Page, Katie

2007-12-01

The home advantage is a widely acknowledged sporting phenomenon, especially in association football. Here, we examine the second leg home advantage, an effect that is discussed in the public domain but which has received very little scientific attention. The second leg home advantage effect occurs when on average teams are more likely to win a two-stage knock-out competition when they play at home in the second leg. That is, both teams have a home advantage but this advantage is significantly greater for the team that plays at home second. Examining data from three different European Cup football competitions spanning 51 years, we show that the second leg home advantage is a real phenomenon. The second leg home team has more than a 50% probability to qualify for the next round in the competition even after controlling for extra time and team ability as possible alternative explanations. The second leg home advantage appears, however, to have decreased significantly over the past decade. Possible reasons for its existence and subsequent decline are presented.

Home Discharge and Out-of-Hospital Follow-Up of Total Artificial Heart Patients Supported by a Portable Driver System

Science.gov (United States)

2014-01-01

To enhance ambulation and facilitate hospital discharge of total artificial heart (TAH)–supported patients, we adapted a mobile ventricular assistance device (VAD) driver (Excor) for TAH use and report on the performance of Excor-driven TAH patients discharged home. Ten patients stabilized on a TAH, driven by the CSS (“Circulatory Support System”), were progressively switched over to the Excor in hospital over 14 days as a pilot, with daily hemodynamics and laboratory parameters measured. Twenty-two stable TAH patients were subsequently placed on the Excor, trained, and discharged home. Clinical and hemodynamic parameters were followed. All pilot study patients were clinically stable on the Excor, with no decrease in TAH output noted (6.3 + 0.3 L/min [day 1] vs. 5.8 + 0.2 L/min [day 14], p = 0.174), with a trend suggesting improvement of both hepatic and renal function. Twenty-two TAH patients were subsequently successfully discharged home on the portable driver and were supported out of hospital for up to 598 days (range, 2–598; mean = 179 ± 140 days), remaining ambulatory, New York Heart Association (NYHA) class I or II, and free of readmission for 88.5% of the time of support. TAH patients may be effectively and safely supported by a mobile drive system. As such, the utility of the TAH may be extended to support patients beyond the hospital, at home, with overall ambulatory freedom. PMID:24577369

Predictors of Better Self-Care in Patients with Heart Failure after Six Months of Follow-Up Home Visits

Science.gov (United States)

Trojahn, Melina Maria; Ruschel, Karen Brasil; Nogueira de Souza, Emiliane; Mussi, Cláudia Motta; Naomi Hirakata, Vânia; Nogueira Mello Lopes, Alexandra; Rabelo-Silva, Eneida Rejane

2013-01-01

This study aimed to examine the predictors of better self-care behavior in patients with heart failure (HF) in a home visiting program. This is a longitudinal study nested in a randomized controlled trial (ISRCTN01213862) in which the home-based educational intervention consisted of a six-month followup that included four home visits by a nurse, interspersed with four telephone calls. The self-care score was measured at baseline and at six months using the Brazilian version of the European Heart Failure Self-Care Behaviour Scale. The associations included eight variables: age, sex, schooling, having received the intervention, social support, income, comorbidities, and symptom severity. A simple linear regression model was developed using significant variables (P ≤ 0.20), followed by a multivariate model to determine the predictors of better self-care. One hundred eighty-eight patients completed the study. A better self-care behavior was associated with patients who received intervention (P < 0.001), had more years of schooling (P = 0.016), and had more comorbidities (P = 0.008). Having received the intervention (P < 0.001) and having a greater number of comorbidities (P = 0.038) were predictors of better self-care. In the multivariate regression model, being in the intervention group and having more comorbidities were a predictor of better self-care. PMID:24083023

A crisis resolution and home treatment team in Norway: a longitudinal survey study Part 2. Provision of professional services

Directory of Open Access Journals (Sweden)

Karlsson Bengt

2012-09-01

Full Text Available Abstract Background Crisis resolution and home treatment (CRHT is an emerging mode of delivering acute mental health care in the community. There is a paucity of knowledge regarding the workings of CRHT in the literature. This is the second paper in a series of three from the longitudinal survey of patients of a CRHT team in Norway, which was aimed at describing the characteristics of patients served, professional services provided, and clinical outcomes. This report focuses on the provision of professional services by the team. Methods The project was a descriptive, quantitative study based on the patient data from a longitudinal survey of one CRHT team in Norway. The participants of the survey, a total of 363 patients, constituted the complete registration of patients of this team in the period from February 2008 to July 2009. Results The average length of service by the team was about 15 days, and those with depression as the major symptom had the longest mean length of stay on the team. The team was engaged in providing a variety of services including individual treatments involving multiple professionals, group treatment meetings, and coordination activities involving external service sectors. While the type of professionals providing individual treatment was not associated with the severity level of clinical problems, those receiving various group treatment meetings had more serious level of clinical symptoms than those not receiving group treatment meetings. In addition coordination activities involving healthcare professionals and social services in the community were in line with the patients' clinical and social needs. The results of the study show that the team functioned effectively in addressing the general guidelines for the functioning of CRHT teams.

New American Home(regsign): Atlanta, Georgia - 2001; Building America--The New American Home

International Nuclear Information System (INIS)

IBACOS; Anderson, R.

2001-01-01

The New American Home(reg s ign) is an annual showcase project designed by committee and co-sponsored by the National Association of Home Builders' National Council of the Housing Industry, BUILDERS Magazine, and Ladies Home Journal. Hedgewood Properties teamed with Building America's IBACOS Consortium and Southface Energy Institute to build a house with a Home Energy Rating Systems (HERS) level of 90

Heart failure - fluids and diuretics

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000112.htm Heart failure - fluids and diuretics To use the sharing features ... to Expect at Home When you have heart failure, your heart does not pump out enough blood. This causes ...

A Study of the Association Between Multidisciplinary Home Care and Home Death Among Thai Palliative Care Patients.

Science.gov (United States)

Nagaviroj, Kittiphon; Anothaisintawee, Thunyarat

2017-06-01

Many terminally ill patients would prefer to stay and die in their own homes, but unfortunately, some may not be able to do so. Although there are many factors associated with successful home deaths, receiving palliative home visits from the multidisciplinary care teams is one of the key factors that enable patients to die at home. Our study was aimed to find whether there was any association between our palliative home care program and home death. A retrospective study was conducted in the Department of Family Medicine at Ramathibodi Hospital between January 2012 and May 2014. All of the patients who were referred to multidisciplinary palliative care teams were included. The data set comprised of patient's profile, disease status, functional status, patient's symptoms, preferred place of death, frequency of home visits, types of team interventions, and patient's actual place of death. Multiple logistic regression was applied in order to determine the association between the variables and the probability of dying at home. A total of 142 patients were included into the study. At the end of the study, 50 (35.2%) patients died at home and 92 (64.8%) patients died in the hospital. The multivariate logistic regression analysis demonstrated a strong association between multidisciplinary home care and home death (odds ratio 6.57, 95% confidence interval [CI] 2.48-17.38). Palliative home care was a significant factor enabling patients who want to die at home. We encourage health policy makers to promote the development of community-based palliative care programs in Thailand.

Quality Assurance Strategy for Existing Homes: Final Quality Management Primer for High Performing Homes

Energy Technology Data Exchange (ETDEWEB)

Del Bianco, M.; Taggart, J.; Sikora, J.; Wood, A.

2012-12-01

This guide is designed to help Building America (BA) Teams understand quality management and its role in transitioning from conventional to high performance home building and remodeling. It explains what quality means, the value of quality management systems, the unique need for QMS when building high performing homes, and the first steps to a implementing a comprehensive QMS. This document provides a framework and context for BA teams when they encounter builders and remodelers.

Quality Assurance Strategy for Existing Homes. Final Quality Management Primer for High Performing Homes

Energy Technology Data Exchange (ETDEWEB)

Del Bianco, M. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Taggart, J. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Sikora, J. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States); Wood, A. [NAHB Research Center Industry Partnership, Upper Marlboro, MD (United States)

2012-12-01

This guide is designed to help Building America (BA) teams understand quality management and its role in transitioning from conventional to high performance home building and remodeling. It explains what quality means, the value of quality management systems, the unique need for QMS when building high performing homes, and the first steps to a implementing a comprehensive QMS. This document provides a framework and context for BA teams when they encounter builders and remodelers.

Valvular Heart Disease in Heart Failure

Directory of Open Access Journals (Sweden)

Giuseppe MC Rosano

2017-01-01

Full Text Available Structural valvular heart disease may be the cause of heart failure or may worsen the clinical status of patients with heart failure. Heart failure may also develop in patients treated with valve surgery. Patients with heart failure with valvular heart disease are at increased risk of events including sudden cardiac death. Before considering intervention (surgical or percutaneous all patients should receive appropriate medical and device therapy taking into account that vasodilators must be used with caution in patients with severe aortic stenosis. Numerous percutaneous and/or hybrid procedures have been introduced in the past few years and they are changing the management of valvular heart disease. In patients with heart failure and valvular heart disease, either primary or functional, the whole process of decision-making should be staged through a comprehensive evaluation of the risk– benefit ratio of different treatment strategies and should be made by a multidisciplinary ‘heart team’ with a particular expertise in valvular heart disease. The heart team should include heart failure cardiologists, cardiac surgeons/structural valve interventionists, imaging specialists, anaesthetists, geriatricians and intensive care specialists. This article will review recent developments and distill practical guidance in the management of this important heart failure co-morbidity.

Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial

DEFF Research Database (Denmark)

Oerkild, Bodil; Frederiksen, Marianne; Hansen, Jorgen Fischer

2011-01-01

BACKGROUND: participation in centre-based cardiac rehabilitation (CR) is known to reduce morbidity and mortality but participation rates among the elderly are low. Establishing alternative programmes is important, and home-based CR is the predominant alternative. However, no studies have...... investigated the effect of home-based CR among a group of elderly patients with coronary heart disease with a long-term follow-up. METHODS: randomised clinical trial comparing home-based CR with comprehensive centre-based CR among patients = 65 years with coronary heart disease. RESULTS: seventy-five patients...... in the secondary outcomes of systolic blood pressure (-0.6 mmHg, 95% CI -11.3, 10.0), LDL cholesterol (0.3 mmol/l, 95% CI -0.04, 0.7), HDL cholesterol (0.2 mmol/l, 95% CI -0.01, 0.3), body composition, proportion of smokers and health-related quality of life. A group of patients who did not have an effect...

Planning Ahead: Advanced Heart Failure

Science.gov (United States)

... Venous Thromboembolism Aortic Aneurysm More Planning Ahead: Advanced Heart Failure Updated:May 9,2017 An important part of ... Care This content was last reviewed May 2017. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

Red shirt colour is associated with long-term team success in English football.

Science.gov (United States)

Attrill, Martin J; Gresty, Karen A; Hill, Russell A; Barton, Robert A

2008-04-01

The colour of sportswear has been shown to influence the outcome of bouts for several different combat sports. The generality of these effects, and whether they extend to collaborative forms of contests (team sports), is uncertain. Since 1947, English football teams wearing red shirts have been champions more often than expected on the basis of the proportion of clubs playing in red. To investigate whether this indicates an enhancement of long-term performance in red-wearing teams, we analysed the relative league positions of teams wearing different hues. Across all league divisions, red teams had the best home record, with significant differences in both percentage of maximum points achieved and mean position in the home league table. The effects were not due simply to a difference between teams playing in a colour and those playing in a predominantly white uniform, as the latter performed better than teams in yellow hues. No significant differences were found for performance in matches away from home, when teams commonly do not wear their "home" colours. A matched-pairs analysis of red and non-red wearing teams in eight English cities shows significantly better performance of red teams over a 55-year period. These effects on long-term success have consequences for colour selection in team sports, confirm that wearing red enhances performance in a variety of competitive contexts, and provide further impetus for studies of the mechanisms underlying these effects.

Home advantage in professional tennis

NARCIS (Netherlands)

Koning, Ruud H.

2011-01-01

Home advantage is a pervasive phenomenon in sport. It has been established in team sports such as basketball, baseball, American football, and European soccer. Attention to home advantage in individual sports has so far been limited. The aim of this study was to examine home advantage in

Outcome of patients undergoing open heart surgery at the Uganda ...

African Journals Online (AJOL)

An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI). Objectives: We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative ...

Congenital Heart Defects and CCHD

Science.gov (United States)

... and more. Stony Point, NY 10980 Close X Home > Complications & Loss > Birth defects & other health conditions > Congenital heart defects and ... in congenital heart defects. You have a family history of congenital heart ... syndrome or VCF. After birth Your baby may be tested for CCHD as ...

Heart Disease Affects Women of All Ages

Science.gov (United States)

Skip Navigation Bar Home Current Issue Past Issues Heart Disease Affects Women of All Ages Past Issues / Winter ... weeks of a heart attack. For Women with Heart Disease: About 6 million American women have coronary heart ...

Creating Teams Increases Extension Educator Productivity

Science.gov (United States)

Chalker-Scott, Linda; Daniels, Catherine H.; Martini, Nicole

2016-01-01

The Garden Team at Washington State University is a transdisciplinary group of faculty, staff, and students with expertise in applied plant and soil sciences and an interest in Extension education. The team's primary mission is to create current, relevant, and peer-reviewed materials as Extension publications for home gardeners. The average yearly…

An ecological dynamics rationale to explain home advantage in professional football

Science.gov (United States)

Gama, José; Dias, Gonçalo; Couceiro, Micael; Passos, Pedro; Davids, Keith; Ribeiro, João

2016-03-01

Despite clear findings, research on home advantage in team sports lacks a comprehensive theoretical rationale for understanding why this phenomenon is so compelling. The aim of this study was to provide an explanatory theoretical rationale in ecological dynamics for the influence of home advantage observed in research on professional football. We recorded 30 competitive matches and analyzed 13958 passes, from one highly successful team in the Portuguese Premier League, during season 2010/2011. Performance data were analyzed using the Match Analysis Software—Amisco® (version 3.3.7.25), allowing us to characterize team activity profiles. Results were interpreted from an ecological dynamics perspective, explaining how task and environmental constraints of a competitive football setting required performers to continuously co-adapt to teammate behaviors. Despite slight differences in percentage of ball possession when playing home or away, the number of passes achieved by the team, while in possession of the ball, was quite different between home or away venues. When playing at home, the number of passes performed by the team was considerably higher than when playing away. The explanation proposed in this study for a home advantage effect can be understood from studying interpersonal coordination tendencies of team sports players as agents in a complex adaptive system.

Smart homes and home health monitoring technologies for older adults: A systematic review.

Science.gov (United States)

Liu, Lili; Stroulia, Eleni; Nikolaidis, Ioanis; Miguel-Cruz, Antonio; Rios Rincon, Adriana

2016-07-01

Around the world, populations are aging and there is a growing concern about ways that older adults can maintain their health and well-being while living in their homes. The aim of this paper was to conduct a systematic literature review to determine: (1) the levels of technology readiness among older adults and, (2) evidence for smart homes and home-based health-monitoring technologies that support aging in place for older adults who have complex needs. We identified and analyzed 48 of 1863 relevant papers. Our analyses found that: (1) technology-readiness level for smart homes and home health monitoring technologies is low; (2) the highest level of evidence is 1b (i.e., one randomized controlled trial with a PEDro score ≥6); smart homes and home health monitoring technologies are used to monitor activities of daily living, cognitive decline and mental health, and heart conditions in older adults with complex needs; (3) there is no evidence that smart homes and home health monitoring technologies help address disability prediction and health-related quality of life, or fall prevention; and (4) there is conflicting evidence that smart homes and home health monitoring technologies help address chronic obstructive pulmonary disease. The level of technology readiness for smart homes and home health monitoring technologies is still low. The highest level of evidence found was in a study that supported home health technologies for use in monitoring activities of daily living, cognitive decline, mental health, and heart conditions in older adults with complex needs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Adaptive practices in heart failure care teams: implications for patient-centered care in the context of complexity

Directory of Open Access Journals (Sweden)

Tait GR

2015-08-01

Full Text Available Glendon R Tait,1 Joanna Bates,2 Kori A LaDonna,3 Valerie N Schulz,4 Patricia H Strachan,5 Allan McDougall,3 Lorelei Lingard3 1Department of Psychiatry and Division of Medical Education, Dalhousie University, Halifax, NS, 2Centre for Health Education Scholarship, Vancouver General Hospital, Vancouver, BC, 3Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, 4Palliative Care, London Health Sciences Centre, University Hospital, London; 5School of Nursing, McMaster University, Hamilton, ON, Canada Background: Heart failure (HF, one of the three leading causes of death, is a chronic, progressive, incurable disease. There is growing support for integration of palliative care’s holistic approach to suffering, but insufficient understanding of how this would happen in the complex team context of HF care. This study examined how HF care teams, as defined by patients, work together to provide care to patients with advanced disease. Methods: Team members were identified by each participating patient, generating team sampling units (TSUs for each patient. Drawn from five study sites in three Canadian provinces, our dataset consists of 209 interviews from 50 TSUs. Drawing on a theoretical framing of HF teams as complex adaptive systems (CAS, interviews were analyzed using the constant comparative method associated with constructivist grounded theory. Results: This paper centers on the dominant theme of system practices, how HF care delivery is reported to work organizationally, socially, and practically, and describes two subthemes: “the way things work around here”, which were commonplace, routine ways of doing things, and “the way we make things work around here”, which were more conscious, effortful adaptations to usual practice in response to emergent needs. An adaptive practice, often a small alteration to routine, could have amplified effects beyond those intended by the innovating team

Effects of home telemonitoring interventions on patients with chronic heart failure: an overview of systematic reviews.

Science.gov (United States)

Kitsiou, Spyros; Paré, Guy; Jaana, Mirou

2015-03-12

Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions

Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews

Science.gov (United States)

Paré, Guy; Jaana, Mirou

2015-01-01

Background Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. Objective This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. Methods A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. Results A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively

Constipation prophylaxis reduces length of stay in elderly hospitalized heart failure patients with home laxative use.

Science.gov (United States)

Staller, Kyle; Khalili, Hamed; Kuo, Braden

2015-11-01

Elderly, hospitalized patients suffer disproportionately from constipation; however, little data suggest that constipation prophylaxis reduces length of stay (LOS). We performed a retrospective analysis of elderly patients admitted to our hospital with congestive heart failure (CHF) to determine the effects of constipation prophylaxis on LOS. Patients ≥ 65 years old admitted with the diagnosis of CHF in 2012 were evaluated for home and hospital laxative use on admission. Our primary outcome was LOS. We used linear regression modeling to independently evaluate the impact of constipation prophylaxis on LOS. Among 618 patients who were eligible for our study, 201 (32.5%) were using laxatives at home, whereas 254 (41.1%) were started on a prophylactic laxative on admission. There was no significant difference in LOS between patients receiving prophylaxis versus those who did not (P = 0.32). Patients with home laxative use had a 1 day longer LOS compared to those without laxative use (6 vs 5, P = 0.03). Among patients with home laxative use, there were 2 days longer LOS in those who were not given constipation prophylaxis on admission (8 vs 6, P = 0.002). After multivariate adjustment, failure to use constipation prophylaxis in patients with home laxative use was the only independent predictor of increased LOS (P = 0.03). Among elderly patients admitted for CHF exacerbations, failure to use constipation prophylaxis in patients with home laxative use is associated with a significantly longer LOS. Our data suggest that routine use of bowel prophylaxis for elderly CHF patients with preexisting constipation may reduce LOS. © 2015 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex.

Science.gov (United States)

Aliku, Twalib O; Lubega, Sulaiman; Lwabi, Peter; Oketcho, Michael; Omagino, John O; Mwambu, Tom

2014-12-01

Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI). We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative outcomes and challenges faced in conducting open heart surgery in a developing country. Medical records of patients undergoing open heart surgery at the UHI from October 2007 to June 2012 were reviewed. A total of 124 patients underwent open heart surgery during the study period. The commonest conditions were: venticular septal defects (VSDs) 34.7% (43/124), Atrial septal defects (ASDs) 34.7% (43/124) and tetralogy of fallot (TOF) in 10.5% (13/124). Non governmental organizations (NGOs) funded 96.8% (120/124) of the operations, and in only 4 patients (3.2%) families paid for the surgeries. There was increasing complexity in cases operated upon from predominantly ASDs and VSDs at the beginning to more complex cases like TOFs and TAPVR. The local team independently operated 19 patients (15.3%). Postoperative morbidity was low with arrhythmias, left ventricular dysfunction and re-operations being the commonest seen. Post operative sepsis occurred in only 2 cases (1.6%). The overall mortality rate was 3.2. Open heart surgery though expensive is feasible in a developing country. With increased direct funding from governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally.

Estimation of the players maximum heart rate in real game situations in team sports: a practical propose

Directory of Open Access Journals (Sweden)

Jorge Cuadrado Reyes

2011-05-01

Full Text Available Abstract   This  research developed a logarithms  for calculating the maximum heart rate (max. HR for players in team sports in  game situations. The sample was made of  thirteen players (aged 24 ± 3   to a  Division Two Handball team. HR was initially measured by Course Navette test.  Later, twenty one training sessions were conducted  in which HR and Rate of Perceived Exertion (RPE, were  continuously monitored, in each task. A lineal regression analysis was done  to help find a max. HR prediction equation from the max. HR of the three highest intensity sessions. Results from  this equation correlate significantly with data obtained in the Course Navette test and with those obtained by other indirect methods. The conclusion of this research is that this equation provides a very useful and easy way to measure the max. HR in real game situations, avoiding non-specific analytical tests and, therefore laboratory testing..   Key words: workout control, functional evaluation, prediction equation.

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30- and 60-Day Hospitalization: The Depression Care for Patients at Home Cluster-Randomized Trial.

Science.gov (United States)

Bruce, Martha L; Lohman, Matthew C; Greenberg, Rebecca L; Bao, Yuhua; Raue, Patrick J

2016-11-01

To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization. Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams). Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone. Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306). The Depression CARE for PATients at Home (CAREPATH) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted telephone conferences with team supervisors every 2 weeks. Hospitalization while receiving home health services was assessed using data from the home health record. Hospitalization within 30 days of starting home health, regardless of how long recipients received home health services, was assessed using data from the home care record and research assessments. The relative hazard of being admitted to the hospital directly from home health was 35% lower within 30 days of starting home health care (hazard ratio (HR) = 0.65, P = .01) and 28% lower within 60 days (HR = 0.72, P = .03) for CAREPATH participants than for participants receiving EUC. In participants referred to home health directly from the hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, P = .001) for CAREPATH participants. Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Ownership type and team climate in elderly care facilities: the moderating effect of stress factors.

Science.gov (United States)

Heponiemi, Tarja; Elovainio, Marko; Kouvonen, Anne; Noro, Anja; Finne-Soveri, Harriet; Sinervo, Timo

2012-03-01

This paper is a report of a study examining the association between ownership type and perceived team climate among older people care staff. In addition, we examined whether work stress factors (time pressure, resident-related stress, role conflicts and role ambiguity) mediated or moderated the above mentioned association. There has been a trend towards contracting out in older people care facilities in Finland and the number of private for-profit firms has increased. Studies suggest that there may be differences in employee well-being and quality of care according to the ownership type of older people care. Cross-sectional survey data was collected during the autumn of 2007 from 1084 Finnish female older people care staff aged 18-69 years were used. Team Climate Inventory was used to measure team climate. Ownership type was divided into four categories: for-profit sheltered homes, not-for-profit sheltered homes, public sheltered homes and not-for-profit nursing homes. Analyses of covariance were used to examine the associations. Team climate dimensions participative safety, vision and support for innovation were higher in not-for-profit organizations (both sheltered homes and nursing homes) compared to for-profit sheltered homes and public sheltered homes. Stress factors did not account for these associations but acted as moderators in a way that in terms of task orientation and participative safety employees working in for-profit organizations seemed to be slightly more sensitive to work-related stress than others. Our results suggest that for-profit organizations and public organizations may have difficulties in maintaining their team climate. In consequence, these organizations should focus more effort on improving their team climate. © 2011 Blackwell Publishing Ltd.

SPQR Team Description Paper

OpenAIRE

Cherubini , Andrea; Leonetti , M; Marchetti , L; De Luca , A; Iocchi , L; Nardi , D; Oriolo , G; Vendittelli , M

2008-01-01

International audience; SPQR is the group of the Faculty of Engineering at Sapienza University of Rome in Italy, that is involved in RoboCup competitions since 1998 in different leagues (Middle-size 1998-2002, Four-legged since 2000, Real-rescue-robots 2003-2006, Virtual-rescue since 2006 and @Home in 2006). In RoboCup 2008, SPQR team will participate in the Standard Platform League with Nao humanoid robots and in the Virtual Rescue League.The team for 2008 is composed by two groups from the C...

Home Healthcare Medical Devices: A Checklist

Science.gov (United States)

... not using it. Contact your doctor and home healthcare team often to review your health condition. * Check ... assurance of their safety and effectiveness. A home healthcare medical device is any product or equipment used ...

Heart Failure Questions to Ask Your Doctor

Science.gov (United States)

... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Heart Failure Questions to Ask Your Doctor Updated:May 9, ... you? This content was last reviewed May 2017. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

Association of comorbidities with home care service utilization of patients with heart failure while receiving telehealth.

Science.gov (United States)

Radhakrishnan, Kavita; Jacelon, Cynthia S; Bigelow, Carol; Roche, Joan P; Marquard, Jenna L; Bowles, Kathryn H

2013-01-01

Comorbidities adversely impact heart failure (HF) outcomes. Telehealth can assist healthcare providers, especially nurses, in guiding their patients to follow the HF regimen. However, factors, including comorbidity patterns, that act in combination with telehealth to reduce home care nursing utilization are still unclear. The purpose of this article was to examine the association of the comorbidity characteristics of HF patients with nursing utilization along with withdrawal from telehealth service during an episode of tele-home care. A descriptive, correlational study design using retrospective chart review was used. The sample comprised Medicare patients admitted to a New England home care agency who had HF as a diagnosis and had used telehealth from 2008 to 2010. The electronic documentation at the home care agency served as the data source, which included Outcome and Assessment Information Set data of patients with HF. Logistic and multiple regression analyses were used to analyze data. The sample consisted of 403 participants, of whom 70% were older than 75 years, 55% were female, and 94% were white. Comorbidities averaged 5.19 (SD, 1.92), ranging from 1 to 11, and nearly 40% of the participants had 5 or more comorbidities. The mean (SD) nursing contacts in the sample was 9.9 (4.7), ranging from 1 to 26, and 52 (12.7%) patients withdrew from telehealth service. For patients with HF on telehealth, comorbidity characteristics of anemia, anxiety, musculoskeletal, and depression were significantly associated with nursing utilization patterns, and renal failure, cancer, and depression comorbidities were significantly associated with withdrawal from telehealth service. Knowledge of the association of comorbidity characteristics with the home care service utilization patterns of patients with HF on telehealth can assist the home health nurse to develop a tailored care plan that attains optimal patient outcomes. Knowledge of such associations would also focus home

Perceptions of seniors with heart failure regarding autonomous zero-effort monitoring of physiological parameters in the smart-home environment.

Science.gov (United States)

Grace, Sherry L; Taherzadeh, Golnoush; Jae Chang, Isaac Sung; Boger, Jennifer; Arcelus, Amaya; Mak, Susanna; Chessex, Caroline; Mihailidis, Alex

Technological advances are leading to the ability to autonomously monitor patient's health status in their own homes, to enable aging-in-place. To understand the perceptions of seniors with heart failure (HF) regarding smart-home systems to monitor their physiological parameters. In this qualitative study, HF outpatients were invited to a smart-home lab, where they completed a sequence of activities, during which the capacity of 5 autonomous sensing modalities was compared to gold standard measures. Afterwards, a semi-structured interview was undertaken. These were transcribed and analyzed using an interpretive-descriptive approach. Five themes emerged from the 26 interviews: (1) perceptions of technology, (2) perceived benefits of autonomous health monitoring, (3) disadvantages of autonomous monitoring, (4) lack of perceived need for continuous health monitoring, and (5) preferences for autonomous monitoring. Patient perception towards autonomous monitoring devices was positive, lending credence to zero-effort technology as a viable and promising approach. Copyright © 2017 Elsevier Inc. All rights reserved.

Case management: a randomized controlled study comparing a neighborhood team and a centralized individual model.

Science.gov (United States)

Eggert, G M; Zimmer, J G; Hall, W J; Friedman, B

1991-10-01

This randomized controlled study compared two types of case management for skilled nursing level patients living at home: the centralized individual model and the neighborhood team model. The team model differed from the individual model in that team case managers performed client assessments, care planning, some direct services, and reassessments; they also had much smaller caseloads and were assigned a specific catchment area. While patients in both groups incurred very high estimated health services costs, the average annual cost during 1983-85 for team cases was 13.6 percent less than that of individual model cases. While the team cases were 18.3 percent less expensive among "old" patients (patients who entered the study from the existing ACCESS caseload), they were only 2.7 percent less costly among "new" cases. The lower costs were due to reductions in hospital days and home care. Team cases averaged 26 percent fewer hospital days per year and 17 percent fewer home health aide hours. Nursing home use was 48 percent higher for the team group than for the individual model group. Mortality was almost exactly the same for both groups during the first year (about 30 percent), but was lower for team patients during the second year (11 percent as compared to 16 percent). Probable mechanisms for the observed results are discussed.

NLM MedlinePlus Magazine Team | NIH MedlinePlus the Magazine

Science.gov (United States)

... Home Current issue contents Magazine Team Follow us Magazine Team National Library of Medicine at the National ... MLS, MA TREASURER Dennis Cryer, MD NIH MedlinePlus magazine is published by Friends of the NLM in ...

42 CFR 494.100 - Condition: Care at home.

Science.gov (United States)

2010-10-01

... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide services to home patients must ensure through its interdisciplinary team, that home dialysis services are at... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Care at home. 494.100 Section 494.100...

Pan-Britain, mixed-methods study of multidisciplinary teams teaching parents to manage children's long-term kidney conditions at home: Study protocol

Science.gov (United States)

2012-01-01

Background Care of children and young people (children) with long-term kidney conditions is usually managed by multidisciplinary teams. Published guidance recommends that whenever possible children with long-term conditions remain at home, meaning parents may be responsible for performing the majority of clinical care-giving. Multidisciplinary team members, therefore, spend considerable time promoting parents' learning about care-delivery and monitoring care-giving. However, this parent-educative aspect of clinicians' role is rarely articulated in the literature so little evidence exists to inform professionals' parent-teaching interventions. Methods/Design This ongoing study addresses this issue using a combination of quantitative and qualitative methods involving the twelve children's kidney units in England, Scotland and Wales. Phase I involves a survey of multidisciplinary team members' parent-teaching interventions using: i) A telephone-administered questionnaire to determine: the numbers of professionals from different disciplines in each team, the information/skills individual professionals relay to parents and the teaching strategies/interventions they use. Data will be managed using SPSS to produce descriptive statistics ii) Digitally-recorded, qualitative group or individual interviews with multidisciplinary team members to explore their accounts of the parent-teaching component of their role. Interviews will be transcribed anonymously and analysed using Framework Technique. Sampling criteria will be derived from analysis to identify one/two unit(s) for subsequent in-depth study Phase II involves six prospective, ethnographic case-studies of professional-parent interactions during parent-teaching encounters. Parents of six children with a long-term kidney condition will be purposively sampled according to their child's age, diagnosis, ethnicity and the clinical care-giving required; snowball sampling will identify the professionals involved in each case

Assessment of potential heart donors: A statement from the French heart transplant community.

Science.gov (United States)

Dorent, Richard; Gandjbakhch, Estelle; Goéminne, Céline; Ivanes, Fabrice; Sebbag, Laurent; Bauer, Fabrice; Epailly, Eric; Boissonnat, Pascale; Nubret, Karine; Amour, Julien; Vermes, Emmanuelle; Ou, Phalla; Guendouz, Soulef; Chevalier, Philippe; Lebreton, Guillaume; Flecher, Erwan; Obadia, Jean-François; Logeart, Damien; de Groote, Pascal

2018-02-01

Assessment of potential donors is an essential part of heart transplantation. Despite the shortage of donor hearts, donor heart procurement from brain-dead organ donors remains low in France, which may be explained by the increasing proportion of high-risk donors, as well as the mismatch between donor assessment and the transplant team's expectations. Improving donor and donor heart assessment is essential to improve the low utilization rate of available donor hearts without increasing post-transplant recipient mortality. This document provides information to practitioners involved in brain-dead donor management, evaluation and selection, concerning the place of medical history, electrocardiography, cardiac imaging, biomarkers and haemodynamic and arrhythmia assessment in the characterization of potential heart donors. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Valvular Heart Disease.

Science.gov (United States)

Mrsic, Zorana; Hopkins, Scott P; Antevil, Jared L; Mullenix, Philip S

2018-03-01

This article outlines the diagnosis and management of commonly occurring valvular heart diseases for the primary care provider. Basic understanding of pathologic murmurs is important for appropriate referral. Echocardiography is the gold standard for diagnosis and severity grading. Patients with progressive valvular heart disease should be followed annually by cardiology and imaging should be performed based on the severity of valvular dysfunction. Surgery or intervention is recommended only when symptoms dictate or when changes in left ventricular function occur. Surgery or intervention should be performed after discussion by a heart team, including cardiologists and cardiac surgeons. Published by Elsevier Inc.

Home Field Advantage Calculation for Physical Education and Sport Students

Science.gov (United States)

Inan, Tugbay

2018-01-01

It is a well-established fact that playing at home field is an advantageous condition for professional sport teams. For this reason, the home field advantage in team sports is an important issue to be explored. It is also one of the different topics that physical education and sports students can use when they want to perform performance analysis…

An in-depth, longitudinal examination of the daily physical activity of a patient with heart failure using a Nintendo Wii at home: a case report.

Science.gov (United States)

Klompstra, Leonie Verheijden; Jaarsma, Tiny; Strömberg, Anna

2013-06-01

To explore the influence of the Nintendo Wii on the daily physical activity of a patient with chronic heart failure at home. A 74-year-old Swedish patient with heart failure had access to a Nintendo Wii at home for 12 weeks. Exercise motivation, exercise self-efficacy and exercise capacity were assessed before and after the intervention. Data on perceived physical effort, global well-being and expended energy were collected every day during the intervention. During the 12 weeks of access to the Nintendo Wii, daily physical activity increased by 200% on weekdays and 57% on weekends, compared with baseline. The patient's exercise motivation and exercise self-efficacy increased during the study, whereas perceived physical effort and global well-being did not change. The patient had no difficulties in using the system and did not suffer any major harm. The results of this case study suggest that providing patients with heart failure access to a Nintendo Wii is a promising and safe intervention. The energy expended by the patient per day increased, as did exercise capacity. Playing the Nintendo Wii did not increase the perceived physical effort, but increased motivation to exercise and decreased barriers to exercising.

Team West Virginia/Rome Final Report

Energy Technology Data Exchange (ETDEWEB)

Korakakis, Dimitris [West Virginia Univ., Morgantown, WV (United States)

2017-04-10

Overall, the team, West Virginia University (WVU) and University of Rome Tor Vergata (UTV), has a goal of building an attractive, low-cost, energy-efficient solar-powered home that represents both the West Virginian and Italian cultures.

DOE Zero Energy Ready Home Case Study: Amaris Custom Homes, St. Paul, Minnesota

Energy Technology Data Exchange (ETDEWEB)

None

2015-06-01

For this project, Amaris worked with U.S. Department of Energy (DOE) team, NorthernSTAR Building America Partnership, to develop the first Zero Energy Ready Home (ZERH) in Minnesota's cold climate using reasonable, cost-effective, and replicable construction materials and practices. The result is a passive solar, super-efficient 3542-ft2 walkout ranch-style home with all the creature comforts. Along with meeting ZERH standards, Amaris also achieved certifications for Leadership in Energy & Environmental Design for Homes v4, MN Green Path Emerald, and a Builders Association of the Twin Cities Reggie Award of Excellence. The home achieves a HERS score of 41 without photovoltaics; with PV, the home achieves a HERS score of 5.

Provision and perceived quality of mental health services for older care home residents in England: a national survey.

Science.gov (United States)

Stewart, Karen; Hargreaves, Claire; Jasper, Rowan; Challis, David; Tucker, Sue; Wilberforce, Mark

2018-02-01

This study examined the nature, extent and perceived quality of the support provided by community mental health teams for older people (CMHTsOP) to care home residents. A postal survey was sent to all CMHTsOP in England. Information was collected about teams' staffing and their involvement in case finding, assessment, medication reviews, care planning and training as well as team managers' rating of the perceived quality of the service they provided for care home residents. Data were analysed using chi-squared tests of association and ordinal regression. Responses were received from 225 (54%) CMHTsOP. Only 18 per cent of these teams contained staff with allocated time for care home work. Services for care home residents varied considerably between teams. Two-fifths of teams provided formal training to care home staff. Team managers were more likely to perceive the quality of their service to care homes as good if they had a systematic process in place for reviewing antipsychotic drugs or routine mental health reviews, including contact with a GP. The findings suggested that more evidence is needed on the best approach for supporting care home residents with mental health needs. Areas to consider are the potential benefits of training to care home staff and regular mental health reviews, utilising links between GPs and CMHTsOP. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Heart failure overview

Science.gov (United States)

... bicycle. Your provider can provide a safe and effective exercise plan for you. DO NOT exercise on days ... changing your lifestyle . Get enough rest, including after exercise, ... as your health care team directed. These medicines: Help the heart ...

Guiding Principles for Team-Based Pediatric Care.

Science.gov (United States)

Katkin, Julie P; Kressly, Susan J; Edwards, Anne R; Perrin, James M; Kraft, Colleen A; Richerson, Julia E; Tieder, Joel S; Wall, Liz

2017-07-24

The American Academy of Pediatrics (AAP) recognizes that children's unique and ever-changing needs depend on a variety of support systems. Key components of effective support systems address the needs of the child and family in the context of their home and community and are dynamic so that they reflect, monitor, and respond to changes as the needs of the child and family change. The AAP believes that team-based care involving medical providers and community partners (eg, teachers and state agencies) is a crucial and necessary component of providing high-quality care to children and their families. Team-based care builds on the foundation of the medical home by reaching out to a potentially broad array of participants in the life of a child and incorporating them into the care provided. Importantly, the AAP believes that a high-functioning team includes children and their families as essential partners. The overall goal of team-based care is to enhance communication and cooperation among the varied medical, social, and educational partners in a child's life to better meet the global needs of children and their families, helping them to achieve their best potential. In support of the team-based approach, the AAP urges stakeholders to invest in infrastructure, education, and privacy-secured technology to meet the needs of children. This statement includes limited specific examples of potential team members, including health care providers and community partners, that are meant to be illustrative and in no way represent a complete or comprehensive listing of all team members who may be of importance for a specific child and family. Copyright © 2017 by the American Academy of Pediatrics.

Improving care transitions from hospital to home: standardized orders for home health nursing with remote telemonitoring.

Science.gov (United States)

Heeke, Sheila; Wood, Felecia; Schuck, Jennifer

2014-01-01

A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template.

Team-Based Models for End-of-Life Care: An Evidence-Based Analysis

Science.gov (United States)

2014-01-01

Background End of life refers to the period when people are living with advanced illness that will not stabilize and from which they will not recover and will eventually die. It is not limited to the period immediately before death. Multiple services are required to support people and their families during this time period. The model of care used to deliver these services can affect the quality of the care they receive. Objectives Our objective was to determine whether an optimal team-based model of care exists for service delivery at end of life. In systematically reviewing such models, we considered their core components: team membership, services offered, modes of patient contact, and setting. Data Sources A literature search was performed on October 14, 2013, using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), and EBM Reviews, for studies published from January 1, 2000, to October 14, 2013. Review Methods Abstracts were reviewed by a single reviewer and full-text articles were obtained that met the inclusion criteria. Studies were included if they evaluated a team model of care compared with usual care in an end-of-life adult population. A team was defined as having at least 2 health care disciplines represented. Studies were limited to English publications. A meta-analysis was completed to obtain pooled effect estimates where data permitted. The GRADE quality of the evidence was evaluated. Results Our literature search located 10 randomized controlled trials which, among them, evaluated the following 6 team-based models of care: hospital, direct contact home, direct contact home, indirect contact comprehensive, indirect contact comprehensive, direct contact comprehensive, direct, and early contact Direct contact is when team members see the patient; indirect contact is when they advise another health care practitioner (e.g., a family doctor) who sees

Spirit Hits a Home Run

Science.gov (United States)

2006-01-01

This week, NASA's Mars Exploration Rover Spirit arrived at 'Home Plate,' a feature that, when seen from orbit, looks like the home plate of a baseball diamond. Home Plate is a roughly circular feature about 80 meters (260 feet) in diameter that might be an old impact crater or volcanic feature. The Spirit team has been eager to get to Home Plate and has been enjoying distant views of the feature and a curious 'bathtub ring' of light-colored materials along its edges. The team has pushed the rover hard to get here before the deep Martian winter sets in. After scientists had identified Home Plate from orbit, they had many theories about what it could be and what they might see. But when Spirit's panoramic camera (Pancam) took this and other images, the science team was stunned. This Pancam image is of an outcrop nicknamed 'Barnhill' and surrounding rocks on the north side of Home Plate, showing the most spectacular layering that Spirit has seen. Pancam and microscopic imager views of the layers in the rocks reveal a range of grain sizes and textures that change from the lower to the upper part of the outcrop. This may help scientists figure out how the material was emplaced. Spirit is also conducting work with its arm instruments to figure out the chemistry and mineralogy of the rocks. Scientists have several hypotheses about what Home Plate could be, including features made by volcanoes and impact craters, and ways that water could have played a role. They are busy trying to figure out what the data from Spirit is really telling us. As Spirit works at Home Plate during February, the science team is choosing informal names for rocks from the great players and managers of the Negro Leagues of baseball. This outcrop, 'Barnhill,' is informally named for David Barnhill, the ace of the New York Cubans' pitching staff during the early 1940s. He compiled an 18-3 record in 1941 and defeated Satchel Paige in the 1942 East-West all-star game. Other rocks in the area are

Home and Office Blood Pressure Control among Treated Hypertensive Patients in Japan: Findings from the Japan Home versus Office Blood Pressure Measurement Evaluation (J-HOME Study

Directory of Open Access Journals (Sweden)

Nariyasu Mano

2010-02-01

Full Text Available Appropriate control of blood pressure (BP is essential for prevention of future cardiovascular events. However, BP control among treated hypertensive patients has been insufficient. Recently, the usefulness of self-measured BP at home (home BP measurement for the management of hypertension has been reported in many studies. We evaluated BP control both at home and in the office among treated hypertensive patients in primary care settings in Japan (the J-HOME study. We found poor control of home and office BPs and clarified some factors affecting control. We also examined factors associated with the magnitude of the white-coat effect, the morning–evening BP difference, and home heart rate in this J-HOME study.

Missouri Agricultural Energy Saving Team-A Revolutionary Opportunity (MAESTRO)

Energy Technology Data Exchange (ETDEWEB)

McIntosh, Jane [MDA; Schumacher, Leon [University of Missouri

2014-10-23

The Missouri Agricultural Energy Saving Team-A Revolutionary Opportunity (MAESTRO) program brought together a team of representatives from government, academia, and private industry to enhance the availability of energy efficiency services for small livestock producers in the State of Missouri. The Missouri Department of Agriculture (MDA) managed the project via a subcontract with the University of Missouri (MU), College of Agriculture Food and Natural Resources, MU Extension, the MU College of Human Environmental Sciences, the MU College of Engineering, and the Missouri Agricultural and Small Business Development Authority (MASBDA). MU teamed with EnSave, Inc, a nationally-recognized expert in agricultural energy efficiency to assist with marketing, outreach, provision of farm energy audits and customer service. MU also teamed with independent home contractors to facilitate energy audits of the farm buildings and homes of these livestock producers. The goals of the project were to: (1) improve the environment by reducing fossil fuel emissions and reducing the total energy used on small animal farms; (2) stimulate the economy of local and regional communities by creating or retaining jobs; and (3) improve the profitability of Missouri livestock producers by reducing their energy expenditures. Historically, Missouri scientists/engineers conducted programs on energy use in agriculture, such as in equipment, grain handling and tillage practices. The MAESTRO program was the first to focus strictly on energy efficiency associated with livestock production systems in Missouri and to investigate the applicability and potential of addressing energy efficiency in animal production from a building efficiency perspective. A. Project Objectives The goal of the MAESTRO program was to strengthen the financial viability and environmental soundness of Missouri's small animal farms by helping them implement energy efficient technologies for the production facility, farm

Home advantage in speed skating : Evidence from individual data

NARCIS (Netherlands)

Koning, RH

Home advantage is a well-documented phenomenon in many sports. Home advantage has been shown to exist for team sports (soccer, hockey, football, baseball, basketball) and for countries organizing sports tournaments like the Olympics and World Cup Soccer. There is also some evidence for home

Home advantage in speed skating : evidence from individual data

NARCIS (Netherlands)

Koning, Ruud H.

2003-01-01

Home advantage is a well documented phenomena in many types of sports. Home advantage has been shown to exist for team sports (soccer, hockey, football, baseball, basketball) and for countries organizing sports tournaments like the Olympics and World Cup Soccer. There is also some evidence for home

Home advantage in high-level volleyball varies according to set number.

Science.gov (United States)

Marcelino, Rui; Mesquita, Isabel; Palao Andrés, José Manuel; Sampaio, Jaime

2009-01-01

The aim of the present study was to identify the probability of winning each Volleyball set according to game location (home, away). Archival data was obtained from 275 sets in the 2005 Men's Senior World League and 65,949 actions were analysed. Set result (win, loss), game location (home, away), set number (first, second, third, fourth and fifth) and performance indicators (serve, reception, set, attack, dig and block) were the variables considered in this study. In a first moment, performance indicators were used in a logistic model of set result, by binary logistic regression analysis. After finding the adjusted logistic model, the log-odds of winning the set were analysed according to game location and set number. The results showed that winning a set is significantly related to performance indicators (Chisquare(18)=660.97, padvantage at the beginning of the game (first set) and in the two last sets of the game (fourth and fifth sets), probably due to facilities familiarity and crowd effects. Different game actions explain these advantages and showed that to win the first set is more important to take risk, through a better performance in the attack and block, and to win the final set is important to manage the risk through a better performance on the reception. These results may suggest intra-game variation in home advantage and can be most useful to better prepare and direct the competition. Key pointsHome teams always have more probability of winning the game than away teams.Home teams have higher performance in reception, set and attack in the total of the sets.The advantage of home teams is more pronounced at the beginning of the game (first set) and in two last sets of the game (fourth and fifth sets) suggesting intra-game variation in home advantage.Analysis by sets showed that home teams have a better performance in the attack and block in the first set and in the reception in the third and fifth sets.

Strategy Guideline. Partnering for High Performance Homes

Energy Technology Data Exchange (ETDEWEB)

Prahl, Duncan [IBACOS, Inc., Pittsburgh, PA (United States)

2013-01-01

High performance houses require a high degree of coordination and have significant interdependencies between various systems in order to perform properly, meet customer expectations, and minimize risks for the builder. Responsibility for the key performance attributes is shared across the project team and can be well coordinated through advanced partnering strategies. For high performance homes, traditional partnerships need to be matured to the next level and be expanded to all members of the project team including trades, suppliers, manufacturers, HERS raters, designers, architects, and building officials as appropriate. This guide is intended for use by all parties associated in the design and construction of high performance homes. It serves as a starting point and features initial tools and resources for teams to collaborate to continually improve the energy efficiency and durability of new houses.

Accounting for Complexity in Home Telemonitoring: A Need for Context-Centred Evidence.

Science.gov (United States)

Ware, Patrick; Seto, Emily; Ross, Heather J

2018-01-31

Heart failure represents a significant burden for patients and the Canadian health care system. Home telemonitoring is proposed as an intervention that can improve heart failure outcomes by identifying opportunities for earlier clinical intervention and by providing patients with self-management support between scheduled clinic visits. The objective of this review is to provide clarity with respect to the most recent evidence of the effect of home telemonitoring on heart failure outcomes. Despite some strong evidence that telemonitoring can reduce the risk of mortality and heart failure-related hospitalizations, important inconsistencies exist in the evidence. This article proposes that much of the inconsistency results from differences in the patient population being studied, the type of home telemonitoring intervention, and the implementation setting. Also important is the degree to which intervention fidelity is maintained throughout the course of a study; this is emphasized through a review of the factors that influence the degree to which patients and health care providers use home telemonitoring interventions as intended. In this article we propose that for researchers to produce definitive answers regarding the effect of home telemonitoring on heart failure outcomes, interventions and studies need to be designed and tailored according to the characteristics of the target patient population and the implementation context. Copyright © 2018 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Psychometric test of the Team Climate Inventory-short version investigated in Dutch quality improvement teams

Directory of Open Access Journals (Sweden)

Nieboer Anna P

2009-07-01

Full Text Available Abstract Background Although some studies have used the Team Climate Inventory within teams working in health care settings, none of these included quality improvement teams. The aim of our study is to investigate the psychometric properties of the 14-item version of the Team Climate Inventory in healthcare quality improvement teams participating in a Dutch quality collaborative. Methods This study included quality improvement teams participating in the Care for Better improvement program for home care, care for the handicapped and the elderly in the Netherlands between 2006 and 2008. As part of a larger evaluation study 270 written questionnaires from team members were collected at baseline and 139 questionnaires at end measurement. Confirmatory factor analyses, reliability, Pearson correlations and paired samples t-tests were conducted to investigate construct validity, reliability, predictive validity and temporal stability. Results Confirmatory factor analyses revealed the expected four-factor structure and good fit indices. For the four subscales – vision, participative safety, task orientation and support for innovation – acceptable Cronbach's alpha coefficients and high inter-item correlations were found. The four subscales all proved significant predictors of perceived team effectiveness, with participatory safety being the best predictor. As expected the four subscales were found to be stable over time; i.e. without significant changes between baseline and end measurement. Conclusion The psychometric properties of the Dutch version of the TCI-14 are satisfactory. Together these results show that the TCI-14 is a useful instrument to assess to what extent aspects of team climate influence perceived team effectiveness of quality improvement teams.

Psychometric test of the Team Climate Inventory-short version investigated in Dutch quality improvement teams.

Science.gov (United States)

Strating, Mathilde M H; Nieboer, Anna P

2009-07-24

Although some studies have used the Team Climate Inventory within teams working in health care settings, none of these included quality improvement teams. The aim of our study is to investigate the psychometric properties of the 14-item version of the Team Climate Inventory in healthcare quality improvement teams participating in a Dutch quality collaborative. This study included quality improvement teams participating in the Care for Better improvement program for home care, care for the handicapped and the elderly in the Netherlands between 2006 and 2008. As part of a larger evaluation study 270 written questionnaires from team members were collected at baseline and 139 questionnaires at end measurement. Confirmatory factor analyses, reliability, Pearson correlations and paired samples t-tests were conducted to investigate construct validity, reliability, predictive validity and temporal stability. Confirmatory factor analyses revealed the expected four-factor structure and good fit indices. For the four subscales--vision, participative safety, task orientation and support for innovation--acceptable Cronbach's alpha coefficients and high inter-item correlations were found. The four subscales all proved significant predictors of perceived team effectiveness, with participatory safety being the best predictor. As expected the four subscales were found to be stable over time; i.e. without significant changes between baseline and end measurement. The psychometric properties of the Dutch version of the TCI-14 are satisfactory. Together these results show that the TCI-14 is a useful instrument to assess to what extent aspects of team climate influence perceived team effectiveness of quality improvement teams.

Factors influencing home care nurse intention to remain employed.

Science.gov (United States)

Tourangeau, Ann; Patterson, Erin; Rowe, Alissa; Saari, Margaret; Thomson, Heather; MacDonald, Geraldine; Cranley, Lisa; Squires, Mae

2014-11-01

To identify factors affecting Canadian home care nurse intention to remain employed (ITR). In developed nations, healthcare continues to shift into community settings. Although considerable research exists on examining nurse ITR in hospitals, similar research related to nurses employed in home care is limited. In the face of a global nursing shortage, it is important to understand the factors influencing nurse ITR across healthcare sectors. A qualitative exploratory descriptive design was used. Focus groups were conducted with home care nurses. Data were analysed using qualitative content analysis. Six categories of influencing factors were identified by home care nurses as affecting ITR: job characteristics; work structures; relationships/communication; work environment; nurse responses to work; and employment conditions. Findings suggest the following factors influence home care nurse ITR: having autonomy; flexible scheduling; reasonable and varied workloads; supportive work relationships; and receiving adequate pay and benefits. Home care nurses did not identify job satisfaction as a single concept influencing ITR. Home care nursing management should support nurse autonomy, allow flexible scheduling, promote reasonable workloads and create opportunities for team building that strengthen supportive relationships among home care nurses and other health team members. © 2013 John Wiley & Sons Ltd.

Overcoming the ten most common barriers to effective team communication.

Science.gov (United States)

Hills, Laura

2013-01-01

Communication is at the heart of medical practice management. Yet there are many barriers to effective communication that can interfere with the smooth running of the practice. This article describes the 10 most common barriers to effective medical practice team communication and offers six steps the practice manager can take to break them down. This article also suggests that the practice develop a team communication strategy. It suggests 10 communication principles readers can share directly with their teams and describes three hallmarks of effective team communication. Finally, this article provides a list of 25 practical questions practice managers can use to improve their team's communication.

Heart team discussion in managing patients with coronary artery disease: outcome and reproducibility.

Science.gov (United States)

Long, Jenny; Luckraz, Heyman; Thekkudan, Joyce; Maher, Abdul; Norell, Michael

2012-05-01

Recent ESC/EACTS revascularization guidelines advocate a 'Heart Team' (HT) approach in the decision-making process when managing patients with coronary disease. We prospectively assessed HT decision-making in 150 patients analysing personnel attendance, data presented, the 'actioning' of the HT decision and, if not completed, then the reasons why. Additionally, 50 patients were specifically re-discussed after 1 year in order to assess consistency in decision-making. We have two HT meetings each week. At least one surgeon, interventional cardiologist and non-interventional cardiologist were present at all meetings. Data presented included patient demographics, symptoms, co-morbidities, coronary angiography, left ventricular function and other relevant investigations, e.g. echocardiograms. HT decisions included continued medical treatment (22%), percutaneous coronary intervention (PCI; 22%), coronary-artery bypass grafting (CABG; 34%) or further investigations such as pressure wire studies, dobutamine stress echo or cardiac magnetic resonance imaging (22%). These decisions were fully undertaken in 86% of patients. Reasons for aberration in the remaining 21 patients included patient refusal (CABG 29%, PCI 10%) and further co-morbidities (28%). On re-discussion of the same patient data (n = 50) a year later, 24% of decisions differed from the original HT recommendations reflecting the fact that, for certain coronary artery disease pattern, either CABG or PCI could be appropriate.

[Precarity, vulnerability, anticipating end-of-life care at home].

Science.gov (United States)

Bonneval, Camille

2016-02-01

Many patients want to end their life at home. Care teams adapt to these wishes and organise a form of treatment which blends safety of care and the respect of the expectations of the patients and family members. When factors of precarity increase the vulnerability inherent to the end of life, caregivers anticipate and support as best as they can the difficulties encountered as testified by a hospital at home team in Dax. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Multisystemic engagement & nephrology based educational intervention: a randomized controlled trial protocol on the kidney team at home-study

Directory of Open Access Journals (Sweden)

Ismail Sohal Y

2012-07-01

Full Text Available Abstract Background Living donor kidney transplantation (LDKT is the most successful form of renal replacement therapy in terms of wait time and survival rates. However, we observed a significant inequality in the number of LDKT performed between the Dutch and the non-Dutch patients. The objective of this study is to adapt, implement and test an educational home-based intervention to contribute to the reduction of this inequality. Our aim is to establish this through guided communication together with the social network of the patients in an attempt that well-informed decisions regarding renal replacement therapy can be made: Multisystemic Engagement & Nephrology. This manuscript is a detailed description of the Kidney Team At Home-study protocol. Methods and design All patients (>18 yrs that are referred to the pre-transplantation outpatient clinic are eligible to participate in the study. Patients will be randomly assigned to either an experimental or a control group. The control group will continue to receive standard care. The experimental group will receive standard care plus a home-based educational intervention. The intervention consists of two sessions at the patient’s home, an initial session with the patient and a second session for which individuals from their social network are invited to take part. Based on the literature and behavioural change theories we hypothesize that reducing hurdles in knowledge, risk perception, subjective norm, self-efficacy, and communication contribute to well-informed decision making and reducing inequality in accessing LDKT programs. A change in these factors is consequently our primary outcome-measure. Based on power calculations, we aim to include 160 patients over a period of two years. Discussion If we are able to show that this home-based group educational intervention contributes to 1 achieving well-informed decision regarding treatment and 2 reducing the inequality in LDKT, the quality of life

Stress and Heart Health

Science.gov (United States)

... It Works Healthy Workplace Food and Beverage Toolkit Stress and Heart Health Updated:Jan 8,2018 When ... therapist in your community. Last reviewed 6/2014 Stress Management • Home • How Does Stress Affect You? Introduction ...

Organizational leadership for building effective health care teams.

Science.gov (United States)

Taplin, Stephen H; Foster, Mary K; Shortell, Stephen M

2013-01-01

The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they all need support from leadership to succeed. Teams have been invoked as a necessary tool to address the needs of patients with multiple chronic conditions and to address medical workforce shortages. Invoking teams, however, is much easier than making them function effectively, so we need to consider the implications of the growing emphasis on teams. Although the ACA will spur team development, organizational leadership must use what we know now to train, support, and incentivize team function. Meanwhile, we must also advance research regarding teams in health care to give those leaders more evidence to guide their work.

Non-invasive Heart Team assessment of multivessel coronary disease with coronary computed tomography angiography based on SYNTAX score II treatment recommendations: design and rationale of the randomised SYNTAX III Revolution trial

NARCIS (Netherlands)

Cavalcante, Rafael; Onuma, Yoshinobu; Sotomi, Yohei; Collet, Carlos; Thomsen, Brian; Rogers, Campbell; Zeng, Yaping; Tenekecioglu, Erhan; Asano, Taku; Miyasaki, Yosuke; Abdelghani, Mohammad; Morel, Marie-Angèle; Serruys, Patrick W.

2017-01-01

The aim of this study was to investigate whether a Heart Team decision-making process regarding the choice of revascularisation strategy based on non-invasive coronary multislice computed tomography angiography (MSCT) assessment of coronary artery disease (CAD) is equivalent to the standard-of-care

The effect of homecare team visits in terminal cancer patients: Role of health teams reaching patients homes

Directory of Open Access Journals (Sweden)

Pratik Banerjee

2009-01-01

Conclusion: The eagerness of patients wanting the teams to reach their residence may be judged by the given figures. The total number of patients visited by the homecare teams of Cansupport in the year 2008-2009 was 1025. Out of them, there were about 104 patients who were discharged. The term discharge means that the patients were not interested in our visit or were not available in our subsequent visit. It has to be mentioned here that the service is a definite demand by society provided that the cost may be catered too.

Ostomy Home Skills Program

Medline Plus

Full Text Available ... Workforce Trauma and EMS Cancer and Research Health Information Technology Scope of Practice Pediatric Issues Other Federal Legislative ... supports the entire surgical team with quality, comprehensive education. The ... A booklet with information on the operation, home skills such as emptying ...

Ostomy Home Skills Program

Medline Plus

Full Text Available ... The Ostomy Home Skills Kit supports patients with educational and simulation materials to learn and practice the skills needed for optimal postoperative recovery. The kit supports the entire surgical team with quality, comprehensive education. The standardized interactive program has been ...

Technology Solutions for Existing Homes Case Study: Accelerating the Delivery of Home-Performance Upgrades Using a Synergistic Business Model

Energy Technology Data Exchange (ETDEWEB)

None

2016-04-14

The Building America team NorthernSTAR investigated opportunities to use the massive customer networks of the home service industry as a means to connect homeowners to home-performance solutions. Home service companies could provide a pathway to advance building-science-guided upgrades by being in close proximity to homeowners when a decision-making moment is at hand. Established trust provides an opportunity for the company to deliver sound information and influence during a remodeling decision.

Delivering Chronic Heart Failure Telemanagement via Multiple Interactive Platforms

Directory of Open Access Journals (Sweden)

Joseph Finkelstein

2013-06-01

Full Text Available Existing telemonitoring systems provide limited support in implementing personalized treatment plans. We developed a Home Automated Telemanagement (HAT system for patients with congestive heart failure (CHF to provide support in following individualized treatment plans as well as to monitor symptoms, weight changes, and quality of life, while educating the patient on their disease. The system was developed for both a laptop computer and a Nintendo Wii. The system is designed to be placed in the patient's home and to communicate all patient data to a central server implementing real-time clinical decision support. The system questions the patient daily on their condition, monitors their weight, and provides the patient with instant feedback on their condition in the form of a 3-zone CHF action plan. Their medication regimen and suggested actions are determined by their care management team and integrated into the system, keeping a personalized approach to disease management while taking advantage of the technology available. The systems are designed to be as simple as possible, making it usable by patients with no prior computer or videogame experience. A feasibility assessment in African American patients with CHF and without prior computer or videogame experience demonstrated high level of acceptance of the CHF HAT laptop and Wii systems. Keywords: telem

Hospital to Home: Plan for a Smooth Transition

Science.gov (United States)

... with this task. If you are eligible for home care agency services, find out what the agency provides and what ... on the hospital team, as well as any home care agency involved with your care and a listing of community services you may need. Make sure you know what ...

Creating a successful culturally sensitive home care program.

Science.gov (United States)

Blanter, R; Page, P M

1995-12-01

Providing quality home care services to immigrants requires an integrated, holistic approach that genuinely addresses language and cultural differences. One home care agency in Massachusetts developed a team-oriented, culturally sensitive outreach program that ensures non-English-speaking patients the same level of service that the general population receives.

Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care.

Science.gov (United States)

Feld, April; Madden-Baer, Rose; McCorkle, Ruth

2016-01-01

The Centers for Medicare and Medicaid Services Innovation Center's Episode-Based Payment initiatives propose a large opportunity to reduce cost from waste and variation and stand to align hospitals, physicians, and postacute providers in the redesign of care that achieves savings and improve quality. Community-based organizations are at the forefront of this care redesign through innovative models of care aimed at bridging gaps in care coordination and reducing hospital readmissions. This article describes a community-based provider's approach to participation under the Bundled Payments for Care Improvement initiative and a 90-day model of care for congestive heart failure in home care.

Guidelines for Better Heart Health

Science.gov (United States)

Skip Navigation Bar Home Current Issue Past Issues Guidelines for Better Heart Health Past Issues / Winter 2007 ... women either had or did not have CVD. Guidelines at a Glance: Prevention should be tailored to ...

'I try to make a net around each patient': home care nursing as relational practice.

Science.gov (United States)

Bjornsdottir, Kristin

2018-03-01

As a result of restructuring, home care is increasingly defined in a narrow, task-based way, undermining the holistic nature of practice. Recent practice theories can aid us in articulating the nature of this important, yet often invisible practice. My aim in this article was to enhance our knowledge and understanding of the nature of home care nursing practice. The approach was ethnographic, involving extensive fieldwork and formal interviews with members of five home care nursing teams and 15 older persons receiving care at home in a metropolitan area of Iceland. The study was approved by the National Bioethics Committee. As a net of services, home care was enacted through relational, but often invisible care practices, relating different actors - patient, family and health-care and social-care workers - in doing the work needed for the older persons to live comfortably at home. The work was collective in that it was shared by different actors and motivated by a common understanding that had developed and was preserved in conversations in the teams. Although the findings are limited in that they only reflect home care as practiced in one neighbourhood, they can be seen as providing important insights into what is needed for home care services to work. Home care practice can be understood as relational, aimed at creating a net of needed assistance. This work is a collective accomplishment of the teams and shaped by ideals and values shared among team members. © 2017 Nordic College of Caring Science.

Retrofitting Las Vegas. Implementing Energy Efficiency in Two Las Vegas Test Homes

Energy Technology Data Exchange (ETDEWEB)

Puttagunta, S. [Consortium for Advanced Residential Buildings, Norwalk, CT (United States)

2013-04-01

In 2009, the state of Nevada received nearly $40 million in Neighborhood Stabilization Funds from the Department of Housing and Urban Development to use to stabilize communities that have suffered from foreclosures and abandonment. In order to provide guidance to local officials and maximize how effectively this NSP funding is used in retrofitting homes, the CARB team provided design specifications, energy modeling, and technical support for the BARA team and its local partners—Better Building Performance, Nevada Energy Star Partners Green Alliance, and Home Free Nevada—for two retrofit test homes. One home demonstrated a modest retrofit and the other a deep energy retrofit. This report describes the retrofit packages, which were used as an educational experience for home performance professionals, building trades, remodelers, and the general public.

Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use.

Science.gov (United States)

Ruiz, Sarah; Snyder, Lynne Page; Rotondo, Christina; Cross-Barnet, Caitlin; Colligan, Erin Murphy; Giuriceo, Katherine

2017-03-01

While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or both for beneficiaries relative to comparators. These findings present a strong case for the potential value of home visits by practice-extender teams to reduce Medicare expenditures and service use in a particularly vulnerable and costly segment of the Medicare population. Project HOPE—The People-to-People Health Foundation, Inc.

Impact of a Hurricane Shelter Viral Gastroenteritis Outbreak on a Responding Medical Team.

Science.gov (United States)

Gaither, Joshua B; Page, Rianne; Prather, Caren; Paavola, Fred; Garrett, Andrew L

2015-08-01

Introduction In late October of 2012, Hurricane Sandy struck the northeast United States and shelters were established throughout the impacted region. Numerous cases of infectious viral gastroenteritis occurred in several of these shelters. Such outbreaks are common and have been well described in the past. Early monitoring for, and recognition of, the outbreak allowed for implementation of aggressive infection control measures. However, these measures required intensive medical response team involvement. Little is known about how such outbreaks affect the medical teams responding to the incident. Hypothesis/Problem Describe the impact of an infectious viral gastroenteritis outbreak within a single shelter on a responding medical team. The number of individuals staying in the single shelter each night (as determined by shelter staff) and the number of patients treated for symptoms of viral gastroenteritis were recorded each day. On return from deployment, members of a single responding medical team were surveyed to determine how many team members became ill during, or immediately following, their deployment. The shelter population peaked on November 5, 2012 with 811 individuals sleeping in the shelter. The first patients presented to the shelter clinic with symptoms of viral gastroenteritis on November 4, 2012, and the last case was seen on November 21, 2012. A total of 64 patients were treated for nausea, vomiting, or diarrhea over the 17-day period. A post-deployment survey was sent to 66 deployed medical team members and 45 completed the survey. Twelve (26.7%) of the team members who responded to the survey experienced symptoms of probable viral gastroenteritis. Team members reported onset of symptoms during deployment as well as after returning home. Symptoms started on days 4-8, 8-14, on the trip home, and after returning home in four, four, two, and two team members, respectively. Medical teams providing shelter care during viral gastroenteritis outbreaks are

Attitudes among healthcare professionals towards ICT and home follow-up in chronic heart failure care.

Science.gov (United States)

Gund, Anna; Lindecrantz, Kaj; Schaufelberger, Maria; Patel, Harshida; Sjöqvist, Bengt Arne

2012-11-28

eHealth applications for out-of-hospital monitoring and treatment follow-up have been advocated for many years as a promising tool to improve treatment compliance, promote individualized care and obtain a person-centred care. Despite these benefits and a large number of promising projects, a major breakthrough in everyday care is generally still lacking. Inappropriate organization for eHealth technology, reluctance from users in the introduction of new working methods, and resistance to information and communication technology (ICT) in general could be reasons for this. Another reason may be attitudes towards the potential in out-of-hospital eHealth applications. It is therefore of interest to study the general opinions among healthcare professionals to ICT in healthcare, as well as the attitudes towards using ICT as a tool for patient monitoring and follow-up at home. One specific area of interest is in-home follow-up of elderly patients with chronic heart failure (CHF). The aim of this paper is to investigate the attitudes towards ICT, as well as distance monitoring and follow-up, among healthcare professionals working with this patient group. This paper covers an attitude survey study based on responses from 139 healthcare professionals working with CHF care in Swedish hospital departments, i.e. cardiology and medicine departments. Comparisons between physicians and nurses, and in some cases between genders, on attitudes towards ICT tools and follow-up at home were performed. Out of the 425 forms sent out, 139 were collected, and 17 out of 21 counties and regions were covered in the replies. Among the respondents, 66% were nurses, 30% physicians and 4% others. As for gender, 90% of nurses were female and 60% of physicians were male. Internet was used daily by 67% of the respondents. Attitudes towards healthcare ICT were found positive as 74% were positive concerning healthcare ICT today, 96% were positive regarding the future of healthcare ICT, and 54% had high

Efficient Solutions for New Homes Case Study: Savannah Gardens

Energy Technology Data Exchange (ETDEWEB)

None

2016-03-15

The Savannah Housing Department is leading sustainable and affordable housing development in Georgia. It partnered with Southface Energy Institute, a member of the U.S. Department of Energy’s Partnership for Home Innovation Building America research team, to seek cost-effective solutions for increasing the energy efficiency of the Savannah Housing Department’s standard single-family home plans in the Savannah Gardens Community. Based on engineering, cost, and constructability analyses, the combined research team chose to pilot two technologies to evaluate efficiency and comfort impacts for homeowners: a heat-pump water heater in an encapsulated attic and an insulated exterior wall sheathing.

Spirit's View Beside 'Home Plate' on Sol 1823

Science.gov (United States)

2009-01-01

NASA's Mars Exploration Rover Spirit used its navigation camera to take the images that have been combined into this 180-degree view of the rover's surroundings during the 1,823rd Martian day, or sol, of Spirit's surface mission (Feb. 17, 2009). The center of the view is toward the south-southwest. The rover had driven 7 meters (23 feet) eastward earlier on Sol 1823, part of maneuvering to get Spirit into a favorable position for climbing onto the low plateau called 'Home Plate.' However, after two driving attempts with negligible progress during the following three sols, the rover team changed its strategy for getting to destinations south of Home Plate. The team decided to drive Spirit at least partway around Home Plate, instead of ascending the northern edge and taking a shorter route across the top of the plateau. Layered rocks forming part of the northern edge of Home Plate can be seen near the center of the image. Rover wheel tracks are visible at the lower edge. This view is presented as a cylindrical projection with geometric seam correction.

Blood Pressure vs. Heart Rate

Science.gov (United States)

... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Blood Pressure vs. Heart Rate (Pulse) Updated:Nov 13,2017 ... This content was last reviewed October 2016. High Blood Pressure • Home • Get the Facts About HBP Introduction What ...

"Mobile technology to improve heart failure outcomes: A proof of concept paper".

Science.gov (United States)

Athilingam, Ponrathi; Jenkins, Bradlee A; Zumpano, Heather; Labrador, Miguel A

2018-02-01

Heart failure (HF) causes significant symptom burden and human suffering with considerable economic burden due to hospital readmissions. Targeted interventions to encourage and support self-management behavior is warranted. To test the proof of concept of a mobile application (HeartMapp) in improving self-care management of patients with heart failure. An exploratory inquiry used a field study strategy with purposeful sampling and constant comparative analysis to test the proof of concept of HeartMapp using The Business Model Canvas framework. A total of 125 individuals, who were identified as potential candidates to use the HeartMapp completed the interview over a seven-week period in 2016. Constant comparative analysis indicated themes that Skilled Nursing Facilities had increased readmissions. Participants from Skilled Nursing Facilities reported concern on lack of staffing, star rating, and malpractice claims. Two types of patients were identified as early adapters of technology and those in denial. Health care facilities reported challenges on transitional care, nurses struggle with engagement of patients on self-care management. To avoid readmission penalty, hospitals task home care agencies to keep the patients home for 30-days. While home care agencies rely on remote telemonitoring reported that current telemonitoring devices are costly to maintain, thus exploring novel technology. The Business Model Canvas provided directions for future testing of HeartMapp for its usability as an adjunct device in home health setting to improve self-management and enhance communication with providers, and ultimately reduce readmissions. Copyright © 2017 Elsevier Inc. All rights reserved.

Give your heart a workout

Science.gov (United States)

... to your health care provider before starting an exercise program. The Benefits of Exercise Exercise helps your heart in several ways. Burns ... A.M. Editorial team. Related MedlinePlus Health Topics Benefits of Exercise Exercise and Physical Fitness How to Lower Cholesterol ...

A team-level investigation of the relationship between leader-member-exchange (LMX) differentiation and commitment and performance

NARCIS (Netherlands)

Le Blanc, P.M.; González-Romá, V.

2012-01-01

Although the differential treatment of team members by their leader is at the heart of Leader–Member Exchange (LMX) theory, empirical studies exploring the role of within-team LMX differentiation in relation to team outcomes are still relatively scarce. This study among 269 Dutch secondary school

[Refractory heart failure. Models of hospital, ambulatory, and home management].

Science.gov (United States)

Oliva, Fabrizio; Alunni, Gianfranco

2002-08-01

Chronic heart failure is an enormous and growing public health problem and is reaching epidemic proportions. Its economic impact is dramatic; two thirds of expenses are for hospitalizations and relatively little is being spent for medications and outpatient visits. Most of the hospitalizations, deaths and costs are incurred by a relatively small minority of patients who may be described as having "complex", "advanced", "refractory" or "end-stage" heart failure; however, in essence they are patients who have severe symptoms and/or recurrent hospitalizations and/or emergency department visits despite maximal oral therapy. Many of the recommendations regarding the management of these patients are based more on experience than on evidence from controlled trials. This, because such patients require an individualized therapy which limits their inclusion in large trials and because support is less easily available when testing specific strategies than when testing specific agents. Improving the treatment of this group of patients by optimizing their medical regimen, aggressive monitoring and providing early intervention to avert heart failure can reduce their morbidity, mortality and costs of care. Refractory heart failure is not a single disease and it is extremely unlikely that all patients should be treated in a similar manner; before selecting the appropriate therapy, the clinician must categorize and profile the patient. The first step should be a re-evaluation of the previous treatment because many patients are treated suboptimally. It is also important to identify reversible or precipitating factors. For patients with advanced heart failure, the initial goal of therapy is to improve symptoms; the next goal is to maintain the improvement and to prevent later deterioration. The appropriate treatment plan will reflect the presence of comorbidities, the patients' history regarding previous responses to therapy, their own expectations with regard to daily life. The most

Testosterone and cortisol responses in male soccer players: The effect of home and away venues.

Science.gov (United States)

Fothergill, Melissa; Wolfson, Sandy; Neave, Nick

2017-08-01

The present studies examined the influence of playing venue on psychobiological responses in male soccer players. Many studies have demonstrated the existence of a home advantage, wherein teams perform better at home than away. A recent focus has attempted to explain this advantage from a psychobiological perspective, with studies showing hormonal differences with regard to venue, game outcome, dominance and perceived stress. Two studies investigated testosterone and cortisol responses in relation to home and away venues. In an initial study of 18 male elite Premier League academy soccer players (age, 17.47, SD, 64), salivary cortisol levels were monitored in two competitive matches, both at home and away. Higher post-game cortisol levels were observed at home (p=0.002), with the team winning all its games. In a second study involving a 12 semi-professional group of players (age, 23.17, SD, 3.8), the same post-game cortisol findings at home were replicated (p=0.001), with this team losing all its games. No effects were observed for testosterone in either study. The results extend earlier research findings on the complex relationship which surrounds the psychobiological impact on the home advantage. The findings suggest that higher levels of stress are experienced by home players in their home matches. Copyright © 2017 Elsevier Inc. All rights reserved.

Pulse Oximetry Screening Adapted to a System with Home Births: The Dutch Experience

Directory of Open Access Journals (Sweden)

Ilona C. Narayen

2018-03-01

Full Text Available Neonatal screening for critical congenital heart defects is proven to be safe, accurate, and cost-effective. The screening has been implemented in many countries across all continents in the world. However, screening for critical congenital heart defects after home births had not been studied widely yet. The Netherlands is known for its unique perinatal care system with a high rate of home births (18% and early discharge after an uncomplicated delivery in hospital. We report a feasibility, accuracy, and acceptability study performed in the Dutch perinatal care system. Screening newborns for critical congenital heart defects using pulse oximetry is feasible after home births and early discharge, and acceptable to mothers. The accuracy of the test is comparable to other early-screening settings, with a moderate sensitivity and high specificity.

Consequences of Empowered CNA Teams in Nursing Home Settings: A Longitudinal Assessment

Science.gov (United States)

Yeatts, Dale E.; Cready, Cynthia M.

2007-01-01

Purpose: Recent studies have concluded that there is a lack of "patient-centered" care in nursing homes and subsequently a need for nursing home culture change. As a result, a variety of new, promising initiatives have been introduced, with most of these incorporating the use of "empowered" employees. The purpose of this study…

Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors : A mixed-methods study

NARCIS (Netherlands)

Doekhie, K.; Buljac, M.; Strating, M.; Paauwe, J.

2017-01-01

Background: Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care professionals

Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors : A mixed-methods study

NARCIS (Netherlands)

K.D. Doekhie (Kirti); M. Buljac-Samardzic (Martina); M.M.H. Strating (Mathilde); J. Paauwe (Jaap)

2017-01-01

markdownabstract__Background:__ Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care

Diversity faultlines, shared objectives, and top management team performance

NARCIS (Netherlands)

van Knippenberg, D.; Dawson, J.F.; West, M.A.; Homan, A.C.

2011-01-01

Faultline theory suggests that negative effects of team diversity are better understood by considering the influence of different dimensions of diversity in conjunction, rather than for each dimension separately. We develop and extend the social categorization analysis that lies at the heart of

Genetics Home Reference: familial atrial fibrillation

Science.gov (United States)

... Twitter Home Health Conditions Familial atrial fibrillation Familial atrial fibrillation Printable PDF Open All Close All Enable Javascript to view the expand/collapse boxes. Description Familial atrial fibrillation is an inherited abnormality of the heart's normal ...

Supported Discharge Teams for older people in hospital acute care: a randomised controlled trial.

Science.gov (United States)

Parsons, Matthew; Parsons, John; Rouse, Paul; Pillai, Avinesh; Mathieson, Sean; Parsons, Rochelle; Smith, Christine; Kenealy, Tim

2018-03-01

Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services. To determine whether older people referred to a Supported Discharge Team have: (i) reduced length-of-stay in hospital; (ii) reduced risk of hospital readmission; and (iii) reduced healthcare costs. Randomised controlled trial with follow-up to 6 months; 103 older women and 80 men (n = 183) (mean age 79), in hospital, were randomised to receive either Supported Discharge Team or usual care. Home-based rehabilitation was delivered by trained Health Care Assistants up to four times a day, 7 days a week, under the guidance of registered nurses, allied health and geriatricians for up to 6 weeks. Participants randomised to the Supported Discharge Team spent less time in hospital during the index admission (mean 15.7 days) in comparison to usual care (mean 21.6 days) (mean difference 5.9: 95% CI 0.6, 11.3 days: P = 0.03) and spent less time in hospital in the 6 months following discharge home. Supported discharge group costs were calculated at mean NZ$10,836 (SD NZ$12,087) compared to NZ$16,943 (SD NZ$22,303) in usual care. A Supported Discharge Team can provide an effective means of discharging older people home early from hospital and can make a cost-effective contribution to managing increasing demand for hospital beds. © The Author 2017. Published by Oxford University Press on behalf of the British Geriatrics Society.All rights reserved. For permissions, please email: journals.permissions@oup.com

Efficient Solutions for Existing Homes Case Study: Rehabilitations of USDA Multifamily Homes

Energy Technology Data Exchange (ETDEWEB)

None

2016-04-01

Rea Ventures Group, LLC, partnered with Southface Energy Institute (Southface), a member of the U.S. Department of Energy's Partnership for Home Innovation Building America research team, to develop a prescriptive approach for rehabilitating a portfolio of rural multifamily rental properties in Georgia, which was funded by the U.S. Department of Agriculture (USDA).

Palliative care team visits. Qualitative study through participant observation.

Science.gov (United States)

Alfaya Góngora, Maria Del Mar; Bueno Pernias, Maria José; Hueso Montoro, César; Guardia Mancilla, Plácido; Montoya Juárez, Rafael; García Caro, Maria Paz

2016-03-30

To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants. A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room) were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed. The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources. Home visits from basic palliative care teams play an important role in patient and family well-being. The visits seem to focus on controlling symptoms and are conditioned by available resources.

The Diversity of Providers on the Family Medicine Team.

Science.gov (United States)

Bazemore, Andrew; Wingrove, Peter; Peterson, Lars; Petterson, Stephen

2016-01-01

Family physicians are increasingly incorporating other health care providers into their practice teams to better meet the needs of increasingly complex and comorbid patients. While a majority of family physicians report working with a nurse practitioner, only 21% work with a behavioral health specialist. A better understanding of optimal team composition and function in primary care is essential to realizing the promise of a patient-centered medical home and achieving the triple aim. © Copyright 2016 by the American Board of Family Medicine.

Evaluation of health centre community nurse team.

Science.gov (United States)

Dixon, P N; Trounson, E

1969-02-01

This report gives an account of the work during six months of a community nurse team attached to the doctors working from a new health centre. The team consisted of two community nurses, who had both health visiting and Queen's nursing qualifications, and a State-enrolled nurse. The community nurses, in addition to undertaking all the health visiting for the population at risk, assessed the social and nursing needs of patients at the request of the general practitioners and ensured that these needs were met. When necessary they undertook practical nursing tasks in the home and in the health centre, but most of the bedside nursing in the home was done by the State-enrolled nurse.The needs of the population at risk were such that only one State-enrolled nurse could usefully be employed, and this proved to be a considerable disadvantage. Despite this, the experimental work pattern held advantages to patients, doctors, and nurses, and is potentially capable of providing a satisfying and economic division of responsibilities, with different tasks being carried out by the individual most appropriately qualified.

Bridging the gap in heart failure prevention: rationale and design of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study

DEFF Research Database (Denmark)

Carrington, Melinda J; Stewart, Simon; de Courten, Barbora

2010-01-01

AIMS: The primary objective of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study is to develop a programme of care that cost-effectively prevents the development of chronic heart failure (CHF). Methods NIL-CHF is a randomized controlled trial of a hybrid, home- and clinic-...

Who is Responsible for Training the Civilian Members of the Provincial Reconstruction Teams (PRTs)

Science.gov (United States)

2010-05-01

Quoted from an interview conducted by AI. Hemingway , "CORDS: Winning Hearts and Minds in Vietnam," Vietnam Magazine, (February 1994). 82 Brig. Gen Dinh...Team-a model for coordination." Air University Review, July-August 1967. Hemingway , AI. "CORDS: Winning Hearts and Minds in Vietnam." Vietnam Magazine

Creating and supporting a mixed methods health services research team.

Science.gov (United States)

Bowers, Barbara; Cohen, Lauren W; Elliot, Amy E; Grabowski, David C; Fishman, Nancy W; Sharkey, Siobhan S; Zimmerman, Sheryl; Horn, Susan D; Kemper, Peter

2013-12-01

To use the experience from a health services research evaluation to provide guidance in team development for mixed methods research. The Research Initiative Valuing Eldercare (THRIVE) team was organized by the Robert Wood Johnson Foundation to evaluate The Green House nursing home culture change program. This article describes the development of the research team and provides insights into how funders might engage with mixed methods research teams to maximize the value of the team. Like many mixed methods collaborations, the THRIVE team consisted of researchers from diverse disciplines, embracing diverse methodologies, and operating under a framework of nonhierarchical, shared leadership that required new collaborations, engagement, and commitment in the context of finite resources. Strategies to overcome these potential obstacles and achieve success included implementation of a Coordinating Center, dedicated time for planning and collaborating across researchers and methodologies, funded support for in-person meetings, and creative optimization of resources. Challenges are inevitably present in the formation and operation of effective mixed methods research teams. However, funders and research teams can implement strategies to promote success. © Health Research and Educational Trust.

Team Learning Ditinjau dari Team Diversity dan Team Efficacy

OpenAIRE

Pohan, Vivi Gusrini Rahmadani; Ancok, Djamaludin

2010-01-01

This research attempted to observe team learning from the level of team diversity and team efficacy of work teams. This research used an individual level of analysis rather than the group level. The team members measured the level of team diversity, team efficacy and team learning of the teams through three scales, namely team learning scale, team diversity scale, and team efficacy scale. Respondents in this research were the active team members in a company, PT. Alkindo Mitraraya. The total ...

Team Learning Ditinjau dari Team Diversity dan Team Efficacy

OpenAIRE

Vivi Gusrini Rahmadani Pohan; Djamaludin Ancok

2015-01-01

This research attempted to observe team learning from the level of team diversity and team efficacy of work teams. This research used an individual level of analysis rather than the group level. The team members measured the level of team diversity, team efficacy and team learning of the teams through three scales, namely team learning scale, team diversity scale, and team efficacy scale. Respondents in this research were the active team members in a company, PT. Alkindo Mitraraya. The total ...

ATLAS@Home looks for CERN volunteers

CERN Multimedia

Rosaria Marraffino

2014-01-01

ATLAS@Home is a CERN volunteer computing project that runs simulated ATLAS events. As the project ramps up, the project team is looking for CERN volunteers to test the system before planning a bigger promotion for the public.   The ATLAS@home outreach website. ATLAS@Home is a large-scale research project that runs ATLAS experiment simulation software inside virtual machines hosted by volunteer computers. “People from all over the world offer up their computers’ idle time to run simulation programmes to help physicists extract information from the large amount of data collected by the detector,” explains Claire Adam Bourdarios of the ATLAS@Home project. “The ATLAS@Home project aims to extrapolate the Standard Model at a higher energy and explore what new physics may look like. Everything we’re currently running is preparation for next year's run.” ATLAS@Home became an official BOINC (Berkeley Open Infrastructure for Network ...

Palliative home care: A designer′s perspective

Directory of Open Access Journals (Sweden)

Tigmanshu Bhatnagar

2015-01-01

Full Text Available The purpose for this observational research was to understand how Can Support provides palliative care at home and analyze its strengths and weaknesses in various socioeconomic scenarios for future development. In the period of 2 weeks, patients and their caregivers were silently observed in their natural surroundings during home care visits in order to listen their problems, identify the pattern of questions for the home care team, their natural way of storytelling, organizational techniques for medicines and medical reports, care givers lives, patient journey, etc. Such observations have enabled the understanding of the phenomena of home palliative care and have led to the identification of certain influential variables of the practice.

Leadership in Nursing Homes: Directors of Nursing Aligning Practice With Regulations.

Science.gov (United States)

Siegel, Elena O; Bettega, Kristen; Bakerjian, Debra; Sikma, Suzanne

2018-06-01

Nursing homes use team nursing, with minimal RN presence, leaving the majority of direct care to licensed practical/vocational nurses (LPNs/LVNs) and unlicensed assistive personnel (UAP), including medication aides. The current article describes challenges faced by nursing home directors of nursing (DONs) leading and managing a team nursing approach, including consideration of scope of practice, delegation and supervision regulations, and related policy implications. A secondary data analysis was performed of qualitative data from a study to develop and test DON guidelines for delegation in nursing home practice. A convenience sample (N = 29) of current or previous DONs and other nursing home leaders with knowledge and expertise in the DON role participated in in-depth, guided interviews. The findings highlight a core concern to nursing licensure policy and regulation: knowledge and practice gaps related to scope of practice and delegation and supervision among DONs, RNs, and LPNs/LVNs, as well as administrators, and the role of nursing leaders in supporting appropriate delegation practices. The findings offer directions for research and practice in addressing challenges in aligning team nursing practices with regulatory standards as well as the related gaps in knowledge among DONs, administrators, and nursing staff. [Journal of Gerontological Nursing, 44(6), 10-14.]. Copyright 2018, SLACK Incorporated.

Valvular heart disease in pregnancy.

Science.gov (United States)

Windram, Jonathan D; Colman, Jack M; Wald, Rachel M; Udell, Jacob A; Siu, Samuel C; Silversides, Candice K

2014-05-01

In women with valvular heart disease, pregnancy-associated cardiovascular changes can contribute to maternal, foetal and neonatal complications. Ideally, a woman with valvular heart disease should receive preconception assessment and counselling from a cardiologist with expertise in pregnancy. For women with moderate- and high-risk valve lesions, appropriate risk stratification and management during pregnancy will optimise outcomes. Pregnancy in women with high-risk lesions, such as severe aortic stenosis, severe mitral stenosis and those with mechanical valves, requires careful planning and coordination of antenatal care by a multidisciplinary team. The purpose of this overview is to describe the expected haemodynamic changes in pregnancy, review pregnancy risks for women with valvular heart disease and discuss strategies for management. Copyright © 2014. Published by Elsevier Ltd.

Do telemonitoring projects of heart failure fit the Chronic Care Model?

Science.gov (United States)

Willemse, Evi; Adriaenssens, Jef; Dilles, Tinne; Remmen, Roy

2014-07-01

This study describes the characteristics of extramural and transmural telemonitoring projects on chronic heart failure in Belgium. It describes to what extent these telemonitoring projects coincide with the Chronic Care Model of Wagner. The Chronic Care Model describes essential components for high-quality health care. Telemonitoring can be used to optimise home care for chronic heart failure. It provides a potential prospective to change the current care organisation. This qualitative study describes seven non-invasive home-care telemonitoring projects in patients with heart failure in Belgium. A qualitative design, including interviews and literature review, was used to describe the correspondence of these home-care telemonitoring projects with the dimensions of the Chronic Care Model. The projects were situated in primary and secondary health care. Their primary goal was to reduce the number of readmissions for chronic heart failure. None of these projects succeeded in a final implementation of telemonitoring in home care after the pilot phase. Not all the projects were initiated to accomplish all of the dimensions of the Chronic Care Model. A central role for the patient was sparse. Limited financial resources hampered continuation after the pilot phase. Cooperation and coordination in telemonitoring appears to be major barriers but are, within primary care as well as between the lines of care, important links in follow-up. This discrepancy can be prohibitive for deployment of good chronic care. Chronic Care Model is recommended as basis for future.

Interprofessional stroke rehabilitation for stroke survivors using home care.

Science.gov (United States)

Markle-Reid, Maureen; Orridge, Camille; Weir, Robin; Browne, Gina; Gafni, Amiram; Lewis, Mary; Walsh, Marian; Levy, Charissa; Daub, Stacey; Brien, Heather; Roberts, Jacqueline; Thabane, Lehana

2011-03-01

To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services. Randomized controlled trial of 101 community-living stroke survivors (stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months. A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p=0.76). A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229.

Longitudinal evaluation of physician payment reform and team-based care for chronic disease management and prevention.

Science.gov (United States)

Kiran, Tara; Kopp, Alexander; Moineddin, Rahim; Glazier, Richard H

2015-11-17

We evaluated a large-scale transition of primary care physicians to blended capitation models and team-based care in Ontario, Canada, to understand the effect of each type of reform on the management and prevention of chronic disease. We used population-based administrative data to assess monitoring of diabetes mellitus and screening for cervical, breast and colorectal cancer among patients belonging to team-based capitation, non-team-based capitation or enhanced fee-for-service medical homes as of Mar. 31, 2011 (n = 10 675 480). We used Poisson regression models to examine these associations for 2011. We then used a fitted nonlinear model to compare changes in outcomes between 2001 and 2011 by type of medical home. In 2011, patients in a team-based capitation setting were more likely than those in an enhanced fee-for-service setting to receive diabetes monitoring (39.7% v. 31.6%, adjusted relative risk [RR] 1.22, 95% confidence interval [CI] 1.18 to 1.25), mammography (76.6% v. 71.5%, adjusted RR 1.06, 95% CI 1.06 to 1.07) and colorectal cancer screening (63.0% v. 60.9%, adjusted RR 1.03, 95% CI 1.02 to 1.04). Over time, patients in medical homes with team-based capitation experienced the greatest improvement in diabetes monitoring (absolute difference in improvement 10.6% [95% CI 7.9% to 13.2%] compared with enhanced fee for service; 6.4% [95% CI 3.8% to 9.1%] compared with non-team-based capitation) and cervical cancer screening (absolute difference in improvement 7.0% [95% CI 5.5% to 8.5%] compared with enhanced fee for service; 5.3% [95% CI 3.8% to 6.8%] compared with non-team-based capitation). For breast and colorectal cancer screening, there were no significant differences in change over time between different types of medical homes. The shift to capitation payment and the addition of team-based care in Ontario were associated with moderate improvements in processes related to diabetes care, but the effects on cancer screening were less clear. © 2015

Energy Smarts Team Training Manual. A Teacher's Guide to Energy Conservation Activities for Grades 3-8.

Science.gov (United States)

Oregon State Univ., Corvallis. Extension Service.

Energy Smarts Team members are energy conscious students who want to save energy at school and at home. Students in a classroom and their teacher form an Energy Smarts Team. Selected students monitor their building each day at recess, lunch, or after school for lights or other electrical equipment that has been left on. The team members keep a log…

Handbook of Home Health Standards - Fifth edition Marrelli Tina M Handbook of Home Health Standards - Fifth edition 688pp Elsevier 9780323052245 032305224X [Formula: see text].

Science.gov (United States)

2009-06-03

Home care is different from other forms of health care. Clinicians are guests in patients' homes and may be the only healthcare providers patients see on a particular day or week, so they should feel comfortable working independently, but recognise they are part of a larger healthcare team.

Long-term follow-up in optimally treated and stable heart failure patients : primary care vs. heart failure clinic. Results of the COACH-2 study

NARCIS (Netherlands)

Luttik, Marie Louise A.; Jaarsma, Tiny; van Geel, Peter Paul; Brons, Maaike; Hillege, Hans L.; Hoes, Arno W.; de Jong, Richard; Linssen, Gerard; Lok, Dirk J. A.; Berger, Marjolein; van Veldhuisen, Dirk J.

2014-01-01

AimsIt has been suggested that home-based heart failure (HF) management in primary care may be an alternative to clinic-based management in HF patients. However, little is known about adherence to HF guidelines and adherence to the medication regimen in these home-based programmes. The aim of the

Problems experienced by informal caregivers of individuals with heart failure: An integrative review.

Science.gov (United States)

Grant, Joan S; Graven, Lucinda J

2018-04-01

The purpose of this review was to examine and synthesize recent literature regarding problems experienced by informal caregivers when providing care for individuals with heart failure in the home. Integrative literature review. A review of current empirical literature was conducted utilizing PubMed, CINAHL, Embase, Sociological Abstracts, Social Sciences Full Text, PsycARTICLES, PsycINFO, Health Source: Nursing/Academic Edition, and Cochrane computerized databases. 19 qualitative, 16 quantitative, and 2 mixed methods studies met the inclusion criteria for review. Computerized databases were searched for a combination of subject terms (i.e., MeSH) and keywords related to informal caregivers, problems, and heart failure. The title and abstract of identified articles and reference lists were reviewed. Studies were included if they were published in English between January 2000 and December 2016 and examined problems experienced by informal caregivers in providing care for individuals with heart failure in the home. Studies were excluded if not written in English or if elements of caregiving in heart failure were not present in the title, abstract, or text. Unpublished and duplicate empirical literature as well as articles related to specific end-stage heart failure populations also were excluded. Methodology described by Cooper and others for integrative reviews of quantitative and qualitative research was used. Quality appraisal of the included studies was evaluated using the Joanna Briggs Institute critical appraisal tools for cross-sectional quantitative and qualitative studies. Informal caregivers experienced four key problems when providing care for individuals with heart failure in the home, including performing multifaceted activities and roles that evolve around daily heart failure demands; maintaining caregiver physical, emotional, social, spiritual, and financial well-being; having insufficient caregiver support; and performing caregiving with uncertainty

Differences in game-related statistics of basketball performance by game location for men's winning and losing teams.

Science.gov (United States)

Gómez, Miguel A; Lorenzo, Alberto; Barakat, Rubén; Ortega, Enrique; Palao, José M

2008-02-01

The aim of the present study was to identify game-related statistics that differentiate winning and losing teams according to game location. The sample included 306 games of the 2004-2005 regular season of the Spanish professional men's league (ACB League). The independent variables were game location (home or away) and game result (win or loss). The game-related statistics registered were free throws (successful and unsuccessful), 2- and 3-point field goals (successful and unsuccessful), offensive and defensive rebounds, blocks, assists, fouls, steals, and turnovers. Descriptive and inferential analyses were done (one-way analysis of variance and discriminate analysis). The multivariate analysis showed that winning teams differ from losing teams in defensive rebounds (SC = .42) and in assists (SC = .38). Similarly, winning teams differ from losing teams when they play at home in defensive rebounds (SC = .40) and in assists (SC = .41). On the other hand, winning teams differ from losing teams when they play away in defensive rebounds (SC = .44), assists (SC = .30), successful 2-point field goals (SC = .31), and unsuccessful 3-point field goals (SC = -.35). Defensive rebounds and assists were the only game-related statistics common to all three analyses.

Patterns of Transition Experience for Parents Going Home from Hospital with their Infant after First Stage Surgery for Complex Congenital Heart Disease.

Science.gov (United States)

Gaskin, Kerry L

2017-12-04

The purpose of this study was to explore parents' experiences of one specific timepoint in their infant's journey: the transition from hospital to home, following the first stage of their infant's cardiac surgery for complex congenital heart disease. A prospective longitudinal mixed methods study, underpinned with Middle Range Transition Theory (Meleis, Sawyer, Im, Hilfinger Messias, & Schumacher, 2000). Face to face and telephone interviews were conducted and self-report forms completed by parents at four-time points: before discharge (T0), 2weeks after discharge (T1), 8weeks after discharge (T2) and after stage two surgery (T3). Interviews were transcribed verbatim before inductive thematic analysis. Parents were recruited over a 15-month period from 2013 to 2015. Twelve mothers and 4 fathers took part. The infants had functionally univentricular heart (left n=10, right n=1) and a systemic shunt dependent lesion, tetralogy of Fallot (n=1). Dynamic constructivist and constructionist social processes occurred for all parents, involving physical, physiological, psychological and cognitive elements within four 'patterns of experience', two of which 'safety and security' and 'love and support' are presented in this paper. Parental support is essential; parents need to be engaged in discharge planning process and given the opportunity to express their needs to ensure that discharge care is truly patient and family centered. Transition from hospital to home was complex and multi-faceted, with unanticipated physical and emotional transitions superimposed upon those that were expected. Copyright © 2017 Elsevier Inc. All rights reserved.

[Study of blood oxygen saturation, heart rate changes and plateau reaction of the Antarctic Kunlun station investigation team in different plateau environments].

Science.gov (United States)

Zhao, Shun-yun; Wu, Xin-min; Guo, Ya-min; Zhang, Shu-shun; An, Yan-ming; Li, Bing; Wang, Hao

2013-06-11

To explore the blood oxygen saturation and heart rate changes of the Antarctic explorers. During August 2010 to April 2011, the changes in blood oxygen saturation, heart rate and plateau reaction of 16 Antarctic expedition team in different plateau environments (Tibetan plateau versus Antarctic plateau) were monitored with the noninvasive pulse oximeter MD300-C. The extent of acute mountain sickness was determined according to the Lake Louise Consensus acute mountain reaction symptom scores and judgment method. The changes of blood oxygen saturation, heart rate at different altitudes of 110, 3650, 4300 m (96.8% ± 1.2%,89.1% ± 1.2%, 86.1% ± 2.0%, (75.0 ± 5.4) times/min, (104.0 ± 4.3) times/min, (113.0 ± 5.2) times/min,F = 214.155, 240.088,both P rate at different altitudes of 2000, 2500, 3000, 3500 and 4087 m(91.9% ± 1.3%,90.5% ± 1.3%,87.6% ± 1.4%,85.0% ± 1.8%,81.5% ± 2.2%, (85.9 ± 3.2) times/min, (90.6 ± 2.8) times/min, (97.8 ± 4.1) times/min, (102.0 ± 3.4) times/min, (106.3 ± 3.9) times/min, F = 105.418, 90.174, both P rate were both correlated with the risk of altitude sickness (r = -0.446 and 0.565, both P rate of the Antarctic explorers. And with the increases of altitude, the risk of altitude sickness gradually increases.

Heart Failure Care in General Practice

NARCIS (Netherlands)

Valk, M.J.M.

2017-01-01

Heart failure (HF) is an increasing health care problem worldwide, and a multidisciplinary approach with a general practitioner (GP) in the health care team is considered optimal. HF management has improved substantially over the last two decades, mainly for patients with HF with a reduced ejection

Analysis of maternal-fetal outcomes of valvular heart surgeries in

Directory of Open Access Journals (Sweden)

Alireza Yaghoubi

2010-03-01

Full Text Available Valvular heart surgery (VHS in pregnancy has its specific complexity and problems.Between years 1983-2007 11 women who underwent VHS during pregnancy were found and analyzed. Valvular heart surgery in pregnancy is associated with the least maternal-fetal side effects. Intensive evaluations before and during pregnancy with a specialized medical team is essential

There is no place like @home!: The value of home consultations in paediatric rehabilitation.

Science.gov (United States)

van Maren-Suir, I; Ketelaar, M; Brouns, B; van der Sanden, K; Verhoef, M

2018-07-01

Family-centred services (FCS) is widely regarded as the best practice approach in early interventions. Creating a therapeutic environment, which also stimulates collaboration between parents and service professionals, is a way to conform to the principles of FCS. The present paper describes the project entitled @home, involving the implementation of home consultations by a specialized team working with children aged 0-5 years at our rehabilitation centre in the Netherlands. The objectives of this article are to (a) describe the development and implementation of home consultations as part of regular care and (b) share the experiences of parents and service providers with home consultations. The implementation process was divided into 3 steps: (1) interviewing experts, (2) adjusting current rehabilitation trajectories, and (3) service providers offering consultations to children at home. The experiences with the home consultations were immediately incorporated in the system, making the implementation an iterative process. In 82% of the 133 home conducted consultations, the service professionals reported that it was more valuable to offer home consultations than seeing the child at the rehabilitation centre. The semistructured interviews revealed that parents and service providers found that they received and provided more tailored advice, perceived a more equal partnership between service professionals and parents, and reported that the home consultations provided a good natural therapeutic environment where a child can be itself and where the child performs best. By using the @home system based on the 3 service models, home consultations are now part of the regular paediatric rehabilitation system at our rehabilitation centre. © 2018 John Wiley & Sons Ltd.

Interdisciplinary approach to the management of medical supplies in the nursing home setting

Directory of Open Access Journals (Sweden)

Juan Francisco Peris Martí

2017-07-01

Full Text Available Introduction: Given the impact of pressure ulcers in institutionalized elderly people, an interdisciplinary approach to the care of ulcers and the management of medical supplies is essential. The aim of this study is to describe and evaluate the management of medical supplies by an interdisciplinary team in order to promote their rational use in the nursing home setting. Methods: An interdisciplinary team was set up, coordinated by a Pharmacy Unit including representatives of 18 elderly nursing homes (1,599 beds. Team interventions were assessed in terms of improvements in the management of wound care supplies. In addition, a retrospective descriptive study was carried out on those patients with pressure ulcers, in order to consider future interventions. Results: The team interventions led to a selection of 15% of the 180 wound care supplies from the public tender process. The monthly savings in wound dressing material purchases was at least 17%. Furthermore, a reduction in consumption greater than 50% was found in 7 centres. The prevalence of ulcers was 5.59%. A fourth of these ulcers were originated outside nursing homes. Conclusions: The creation of an interdisciplinary team, in which the pharmacist gets closer to patient needs, and where nurses share responsibility for the selection and management of medical supplies, leads to positive results and represents an opportunity for improvement in elderly care.

Measure Guideline: Selecting Ventilation Systems for Existing Homes

Energy Technology Data Exchange (ETDEWEB)

Aldrich, R. [Consortium for Advanced Residential Buildings (CARB), Norwalk, CT (United States)

2014-02-01

This report, developed by Building America research team CARB, addresses adding or improving mechanical ventilation systems to existing homes. The goal of this report is to assist decision makers and contractors in making informed decisions when selecting ventilation systems for homes. With more air-sealed envelopes, a mechanical means of removing contaminants is critical for indoor environmental quality and building durability. The purpose of ventilation is to remove contaminants from homes, and this report discusses where, when, and how much ventilation is appropriate in a home, including examination of relevant codes and standards. Choosing the "best" system is not always straightforward; selecting a system involves balancing performance, efficiency, cost, required maintenance, and several other factors.

Case management: a randomized controlled study comparing a neighborhood team and a centralized individual model.

OpenAIRE

Eggert, G M; Zimmer, J G; Hall, W J; Friedman, B

1991-01-01

This randomized controlled study compared two types of case management for skilled nursing level patients living at home: the centralized individual model and the neighborhood team model. The team model differed from the individual model in that team case managers performed client assessments, care planning, some direct services, and reassessments; they also had much smaller caseloads and were assigned a specific catchment area. While patients in both groups incurred very high estimated healt...

Extending Home Advantage Theory and Four Factor Theory to Men's Collegiate Basketball

Science.gov (United States)

Kelly, Yvan J.

2013-01-01

In sporting events, the home team has been found to win a disproportionate amount of games. Research into this home advantage phenomenon resulted in Courneya and Carron's framework of home advantage theory. In collegiate athletics, administrators face a competitive environment and a goal of enhancing revenues. The problem is that home…

Disease trajectories in nursing home patients.

NARCIS (Netherlands)

Husebo, B.S.; Hylen Randhoff, A.; Sandvik, R.; Omland, G.; Gysels, M.; Francke, A.; Hertogh, C.; Ribbe, M.; Deliens, L.

2011-01-01

Research aims: About 17 500 patients die in Norwegian nursing homes (NH) every year, 14-27% of these patients have diagnoses of cancer, 75% heart failure, and 80% dementia. Little is known about their last months and days regarding medical treatment, needs for multi-professional care, advance

Nutritional support teams: the cooperation among physicians and pharmacists helps improve cost-effectiveness of home parenteral nutrition (HPN).

Science.gov (United States)

Pietka, Magdalena; Watrobska-Swietlikowska, Dorota; Szczepanek, Kinga; Szybinski, Piotr; Sznitowska, Małgorzata; Kłęk, Stanisław

2014-09-12

Modern home parenteral nutrition (HPN) requires the preparation of tailored admixtures. The physicians' demands for their composition are often at the variance with pharmaceutical principles, which causes the necessity of either the preparation of ex tempore admixtures or stability testing ensuring long shelf life. Both approaches are not cost-effective. The aim of the study was to use the cooperation among physicians and pharmacists to assure both: cost-effectiveness and patient-tailored HPN admixtures. The first part of the study consisted of the thorough analysis of prescriptions for the most demanding 47 HPN patients (27 females and 20 males, mean age 53.1 year) treated at one HPN center to create few as possible long-shelf life admixtures. The second part of the study consisted of stability testing and modifications. The analysis showed over 137 variations needed to cover all macro- and micronutrients requirements. Their cost as ex-tempore solutions was extremely high (over 110 000 EURO/month) due to logistics and similarly high if stability test for variation were to be performed (68 500 EURO). Therefore prescription was prepared de novo within team of physicians and pharmacists and four base models were designed. Water and electrolytes, particularly magnesium and calcium showed to be the major issues. Stability tests failed in one admixture due to high electrolytes concentration. It was corrected, and the new formula passes the test. Five basic models were then used for creation of new bags. Cost of such an activity were 3 700 EURO (pcooperation within the members of nutritional support team could improve the cost-effectiveness and quality of HPN. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Chronic heart failure: Role of the GP in management

Directory of Open Access Journals (Sweden)

Leon Piterman

2018-02-01

Full Text Available The commonest cause of chronic heat failure in China is ischemic heart disease, followed by hypertension and valvular heart disease. Echocardiography is essential in establishing a diagnosis as well as helping to identify a cause and to monitor progress. Management includes nonpharmacological as well as pharmacological treatment, and self-care with careful monitoring of salt and fluid intake as well as regular weight measurement. Care planning and team-based care are essential in managing patients with chronic heart failure, who often have concurrent multimorbidity and are receiving polypharmacy.

The validity of the BioForce Heart Rate Variability System and the use of heart rate variability and recovery to determine the fitness levels of a cohort of university-level rugby players / Christo Alfonzo Bisschoff

OpenAIRE

Bisschoff, Christo Alfonzo

2013-01-01

The potential to track changes in training status and fitness levels of especially team sport participants by making use of more time efficient and accessible methods such as heart rate variability (HRV) and heart rate recovery (HRR) cannot be overlooked and needs to be considered. However, studies that have investigated this aspect in team sport participants are scarce. It is against this background that the main objectives of this study were firstly, to determine the relation...

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30 and 60 Day Hospitalization: The Depression CAREPATH Cluster-Randomized Trial

Science.gov (United States)

Bruce, Martha L.; Lohman, Matthew C.; Greenberg, Rebecca L.; Bao, Yuhua; Raue, Patrick J.

2016-01-01

OBJECTIVES To determine whether a depression care management intervention among Medicare home health recipients decreases risks of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to Intervention (12 teams) or Enhanced Usual Care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Patients were interviewed at home and by telephone. PARTICIPANTS Patients age>65 who screened positive for depression on nurse assessments (N=755), and a subset who consented to interviews (N=306). INTERVENTION The Depression CAREPATH (CARE for PATients at Home) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted biweekly telephone conferences with team supervisors. MEASUREMENTS The study examined acute-care hospitalization and days to hospitalization. H1 used data from the home health record to examine hospitalization over 30-day and 60-day periods while a home health patient. H2 used data from both home care record and research assessments to examine 30-day hospitalization from any setting. RESULTS The adjusted hazard ratio (HR) of being admitted to hospital directly from home health within 30 days of start of home health care was 0.65 (p=.013) for CAREPATH compared to EUC patients, and 0.72 (p=.027) within 60 days. In patients referred to home health directly from hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, p=.001) among CAREPATH patients. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk among older adults receiving Medicare home health nursing services. PMID:27739067

Hospital information technology in home care.

Science.gov (United States)

Zhang, Xiao-Ying; Zhang, Pei-Ying

2016-10-01

The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.

Top management team diversity: Faultlines, clarity of objectives, and organizational performance.

NARCIS (Netherlands)

van Knippenberg, D.; Dawson, J.F.; West, M.E.; Homan, A.C.

2011-01-01

Faultline theory suggests that negative effects of team diversity are better understood by considering the influence of different dimensions of diversity in conjunction, rather than for each dimension separately. We develop and extend the social categorization analysis that lies at the heart of

Clinical pharmacy services in heart failure: an opinion paper from the Heart Failure Society of America and American College of Clinical Pharmacy Cardiology Practice and Research Network.

Science.gov (United States)

Milfred-Laforest, Sherry K; Chow, Sheryl L; Didomenico, Robert J; Dracup, Kathleen; Ensor, Christopher R; Gattis-Stough, Wendy; Heywood, J Thomas; Lindenfeld, Joann; Page, Robert L; Patterson, J Herbert; Vardeny, Orly; Massie, Barry M

2013-05-01

Heart failure (HF) care takes place in multiple settings, with a variety of providers, and generally involves patients who have multiple comorbidities. This situation is a "perfect storm" of factors that predispose patients to medication errors. The goals of this paper are to outline potential roles for clinical pharmacists in a multidisciplinary HF team, to document outcomes associated with interventions by clinical pharmacists, to recommend minimum training for clinical pharmacists engaged in HF care, and to suggest financial strategies to support clinical pharmacy services within a multidisciplinary team. As patients transition from inpatient to outpatient settings and between multiple caregivers, pharmacists can positively affect medication reconciliation and education, assure consistency in management that results in improvements in patient satisfaction and medication adherence, and reduce medication errors. For mechanical circulatory support and heart transplant teams, the Centers for Medicare and Medicaid Services considers the participation of a transplant pharmacology expert (e.g., clinical pharmacist) to be a requirement for accreditation, given the highly specialized and complex drug regimens used. Although reports of outcomes from pharmacist interventions have been mixed owing to differences in study design, benefits such as increased use of evidence-based therapies, decreases in HF hospitalizations and emergency department visits, and decreases in all-cause readmissions have been demonstrated. Clinical pharmacists participating in HF or heart transplant teams should have completed specialized postdoctoral training in the form of residencies and/or fellowships in cardiovascular and/or transplant pharmacotherapy, and board certification is recommended. Financial mechanisms to support pharmacist participation in the HF teams are variable. Positive outcomes associated with clinical pharmacist activities support the value of making this resource available

Total artificial heart in the pediatric patient with biventricular heart failure.

Science.gov (United States)

Park, S S; Sanders, D B; Smith, B P; Ryan, J; Plasencia, J; Osborn, M B; Wellnitz, C M; Southard, R N; Pierce, C N; Arabia, F A; Lane, J; Frakes, D; Velez, D A; Pophal, S G; Nigro, J J

2014-01-01

Mechanical circulatory support emerged for the pediatric population in the late 1980s as a bridge to cardiac transplantation. The Total Artificial Heart (TAH-t) (SynCardia Systems Inc., Tuscon, AZ) has been approved for compassionate use by the Food and Drug Administration for patients with end-stage biventricular heart failure as a bridge to heart transplantation since 1985 and has had FDA approval since 2004. However, of the 1,061 patients placed on the TAH-t, only 21 (2%) were under the age 18. SynCardia Systems, Inc. recommends a minimum patient body surface area (BSA) of 1.7 m(2), thus, limiting pediatric application of this device. This unique case report shares this pediatric institution's first experience with the TAH-t. A 14-year-old male was admitted with dilated cardiomyopathy and severe biventricular heart failure. The patient rapidly decompensated, requiring extracorporeal life support. An echocardiogram revealed severe biventricular dysfunction and diffuse clot formation in the left ventricle and outflow tract. The decision was made to transition to biventricular assist device. The biventricular failure and clot formation helped guide the team to the TAH-t, in spite of a BSA (1.5 m(2)) below the recommendation of 1.7 m(2). A computed tomography (CT) scan of the thorax, in conjunction with a novel three-dimensional (3D) modeling system and team, assisted in determining appropriate fit. Chest CT and 3D modeling following implantation were utilized to determine all major vascular structures were unobstructed and the bronchi were open. The virtual 3D model confirmed appropriate device fit with no evidence of compression to the left pulmonary veins. The postoperative course was complicated by a left lung opacification. The left lung anomalies proved to be atelectasis and improved with aggressive recruitment maneuvers. The patient was supported for 11 days prior to transplantation. Chest CT and 3D modeling were crucial in assessing whether the device would

Screening for Critical Congenital Heart Disease in Newborns

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Self-Care Guide for the Heart Failure Patient

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First outline and baseline data of a randomized, controlled multicenter trial to evaluate the health economic impact of home telemonitoring in chronic heart failure - CardioBBEAT.

Science.gov (United States)

Hofmann, Reiner; Völler, Heinz; Nagels, Klaus; Bindl, Dominik; Vettorazzi, Eik; Dittmar, Ronny; Wohlgemuth, Walter; Neumann, Till; Störk, Stefan; Bruder, Oliver; Wegscheider, Karl; Nagel, Eckhard; Fleck, Eckart

2015-08-11

Evidence that home telemonitoring for patients with chronic heart failure (CHF) offers clinical benefit over usual care is controversial as is evidence of a health economic advantage. Between January 2010 and June 2013, patients with a confirmed diagnosis of CHF were enrolled and randomly assigned to 2 study groups comprising usual care with and without an interactive bi-directional remote monitoring system (Motiva®). The primary endpoint in CardioBBEAT is the Incremental Cost-Effectiveness Ratio (ICER) established by the groups' difference in total cost and in the combined clinical endpoint "days alive and not in hospital nor inpatient care per potential days in study" within the follow-up of 12 months. A total of 621 predominantly male patients were enrolled, whereof 302 patients were assigned to the intervention group and 319 to the control group. Ischemic cardiomyopathy was the leading cause of heart failure. Despite randomization, subjects of the control group were more often in NYHA functional class III-IV, and exhibited peripheral edema and renal dysfunction more often. Additionally, the control and intervention groups differed in heart rhythm disorders. No differences existed regarding risk factor profile, comorbidities, echocardiographic parameters, especially left ventricular and diastolic diameter and ejection fraction, as well as functional test results, medication and quality of life. While the observed baseline differences may well be a play of chance, they are of clinical relevance. Therefore, the statistical analysis plan was extended to include adjusted analyses with respect to the baseline imbalances. CardioBBEAT provides prospective outcome data on both, clinical and health economic impact of home telemonitoring in CHF. The study differs by the use of a high evidence level randomized controlled trial (RCT) design along with actual cost data obtained from health insurance companies. Its results are conducive to informed political and economic

Solar Electricity for Homes

Science.gov (United States)

Roman, Harry T.

2012-01-01

Every day, the sun showers the Earth with millions of times more energy than its people use. The only problem is that energy is spread out over the entire Earth's surface and must be harvested. Engineers are learning to capture and use some of this energy to make electricity for homes. Solar panels make up the heart of a solar system. They can be…

MODELLING THE PROGRESSION OF COMPETITIVE PERFORMANCE OF AN ACADEMY'S SOCCER TEAMS

Directory of Open Access Journals (Sweden)

Rita M. Malcata

2012-09-01

Full Text Available Progression of a team's performance is a key issue in competitive sport, but there appears to have been no published research on team progression for periods longer than a season. In this study we report the game-score progression of three teams of a youth talent-development academy over five seasons using a novel analytic approach based on generalised mixed modelling. The teams consisted of players born in 1991, 1992 and 1993; they played totals of 115, 107 and 122 games in Asia and Europe between 2005 and 2010 against teams differing in age by up to 3 years. Game scores predicted by the mixed model were assumed to have an over-dispersed Poisson distribution. The fixed effects in the model estimated an annual linear pro-gression for Aspire and for the other teams (grouped as a single opponent with adjustment for home-ground advantage and for a linear effect of age difference between competing teams. A random effect allowed for different mean scores for Aspire and opposition teams. All effects were estimated as factors via log-transformation and presented as percent differences in scores. Inferences were based on the span of 90% confidence intervals in relation to thresholds for small factor effects of x/÷1.10 (+10%/-9%. Most effects were clear only when data for the three teams were combined. Older teams showed a small 27% increase in goals scored per year of age difference (90% confidence interval 13 to 42%. Aspire experienced a small home-ground advantage of 16% (-5 to 41%, whereas opposition teams experienced 31% (7 to 60% on their own ground. After adjustment for these effects, the Aspire teams scored on average 1.5 goals per match, with little change in the five years of their existence, whereas their opponents' scores fell from 1.4 in their first year to 1.0 in their last. The difference in progression was trivial over one year (7%, -4 to 20%, small over two years (15%, -8 to 44%, but unclear over >2 years. In conclusion, the generalized

Crisis homes for adult psychiatric patients

DEFF Research Database (Denmark)

Aagaard, Jørgen; Freiesleben, Michael; Foldager, Leslie

2008-01-01

INTRODUCTION: Inspired by the Crisis Home programme in Madison, we have adapted and evaluated the programme at the Community Mental Health (CMH) Centre in Tønder, Denmark. MATERIAL AND METHODS: Procedures and schedules from the Crisis Home programme were applied in this open trial. Questionnaire...... data concerning satisfaction with the stay and registration data concerning the admissions and bed days two years before and two years after the first stay were obtained. RESULTS: During four years, 52 different patients had a total of 187 stays in a crisis home. Twenty (38.5%) of the patients were...... attached to the ACT team. The average duration of the stays was 4.0 days. The number of readmissions and bed days after the first stay showed a significant downward tendency for the subgroup of patients with a more severe mental disorder, but not for the whole group. The patients, the crisis homes families...

Adaptive heart rate-based epileptic seizure detection using real-time user feedback

DEFF Research Database (Denmark)

De Cooman, Thomas; Kjær, Troels Wesenberg; Van Huffel, Sabine

2017-01-01

Automated seizure detection in a home environment has been of increased interest the last couple of decades. Heart rate-based seizure detection is a way to detect temporal lobe epilepsy seizures at home, but patient-independent algorithms showed to be insufficiently accurate due to the high patient...... with incorrect user feedback, making it ideal for implementation in a home environment for a seizure warning system....

Norms for creativity and implementation in healthcare teams: testing the group innovation inventory

OpenAIRE

Strating, Mathilde M.H.; Nieboer, Anna P.

2010-01-01

textabstractAbstract OBJECTIVE: To test to what extent the four-factor structure of the group innovation inventory (GII) is confirmed for improvement teams participating in a quality improvement collaborative. DESIGN: Quasi-experimental design with baseline and end-measurement after intervention. SETTING: This study included quality improvement teams participating in the Care for Better improvement programme for home care, care for the handicapped and the elderly in the Netherlands between 20...

The complex nature of informal care in home-based heart failure management.

Science.gov (United States)

Clark, Alexander M; Reid, Margaret E; Morrison, Caroline E; Capewell, Simon; Murdoch, David L; McMurray, John J

2008-02-01

This paper is a report of a study to examine the complexities of informal caregiving for people with chronic heart failure. Little is known of the activities involved and underlying informal care. Heart failure is a common and burdensome condition in which carers play an important management role. Semi-structured interviews were carried out with 30 informal carers nominated by patients with mild-to-moderate heart failure (24 spouses, four children, one sibling and one neighbour). Interviews examined knowledge of heart failure, its effects, reported management practices and concerns, decision making and support. The data were collected in 2001. The management of heart failure was a shared and ongoing responsibility between the carer and patient. Carers' clinical knowledge of the condition and management was often limited, but they developed extensive knowledge of its personal effects on the patient. Invisible care activities included monitoring signs of symptom exacerbation and energy boundaries against perceived current and future demands and priorities. Visible care activities included medication management, dressing, bathing and help-seeking. Carers responded to patients' capacities, and adopted philosophies that sought to foster independence while facilitating as normal a life for the patient as was possible and safe. Interventions for informal carers around effective chronic heart failure management should address both visible and invisible informal caring. Future research is needed to develop interventions with carers to improve quality of care, reduce costs and improve patient quality of life. More research is needed to explore the complexities of lay caregiving and to explore the invisible dimensions of informal care further.

Study on team evaluation. Team process model for team evaluation

International Nuclear Information System (INIS)

Sasou Kunihide; Ebisu, Mitsuhiro; Hirose, Ayako

2004-01-01

Several studies have been done to evaluate or improve team performance in nuclear and aviation industries. Crew resource management is the typical example. In addition, team evaluation recently gathers interests in other teams of lawyers, medical staff, accountants, psychiatrics, executive, etc. However, the most evaluation methods focus on the results of team behavior that can be observed through training or actual business situations. What is expected team is not only resolving problems but also training younger members being destined to lead the next generation. Therefore, the authors set the final goal of this study establishing a series of methods to evaluate and improve teams inclusively such as decision making, motivation, staffing, etc. As the first step, this study develops team process model describing viewpoints for the evaluation. The team process is defined as some kinds of power that activate or inactivate competency of individuals that is the components of team's competency. To find the team process, the authors discussed the merits of team behavior with the experienced training instructors and shift supervisors of nuclear/thermal power plants. The discussion finds four team merits and many components to realize those team merits. Classifying those components into eight groups of team processes such as 'Orientation', 'Decision Making', 'Power and Responsibility', 'Workload Management', 'Professional Trust', 'Motivation', 'Training' and 'staffing', the authors propose Team Process Model with two to four sub processes in each team process. In the future, the authors will develop methods to evaluate some of the team processes for nuclear/thermal power plant operation teams. (author)

Preventing Rehospitalization through effective home health nursing care.

Science.gov (United States)

Vasquez, Monica S

2009-01-01

To identify strategies to improve patient outcomes and prevent rehospitalizations in home healthcare. PRIMARY PRACTICE SETTINGS(S): Primarily for home healthcare but can also be a tool for all other fields in nursing. Through team collaboration and the proper resources, patient outcomes can improve and be cost-effective for home healthcare agencies despite the changes implemented after the Medicare change in payment for services, the prospective payment system. The main goal for home healthcare is to improve patient outcomes. Nurses experienced in case management can devise creative strategies to ensure patient outcomes are met in a cost-effective manner. With continuous changes in reimbursement and payment incentives, case managers in every level of care must know about, and be responsible for, fiscal initiatives.

Are real teams healthy teams?

NARCIS (Netherlands)

Buljac, M.; van Woerkom, M.; van Wijngaarden, P.

2013-01-01

This study examines the impact of real-team--as opposed to a team in name only--characteristics (i.e., team boundaries, stability of membership, and task interdependence) on team processes (i.e., team learning and emotional support) and team effectiveness in the long-term care sector. We employed a

Team Learning in Teacher Teams: Team Entitativity as a Bridge between Teams-in-Theory and Teams-in-Practice

Science.gov (United States)

Vangrieken, Katrien; Dochy, Filip; Raes, Elisabeth

2016-01-01

This study aimed to investigate team learning in the context of teacher teams in higher vocational education. As teacher teams often do not meet all criteria included in theoretical team definitions, the construct "team entitativity" was introduced. Defined as the degree to which a group of individuals possesses the quality of being a…

Home is where the habit of the heart is

NARCIS (Netherlands)

Wilde, Mandy De

2016-01-01

Dutch neighborhood policy is increasingly, and quite literally, addressing the habits of the heart-residents' values, emotions, and intimate relationships-To encourage what we may call "affective citizenship." Central to this governmental strategy is the creation of communities as spheres of

Team Leader Structuring for Team Effectiveness and Team Learning in Command-and-Control Teams.

Science.gov (United States)

van der Haar, Selma; Koeslag-Kreunen, Mieke; Euwe, Eline; Segers, Mien

2017-04-01

Due to their crucial and highly consequential task, it is of utmost importance to understand the levers leading to effectiveness of multidisciplinary emergency management command-and-control (EMCC) teams. We argue that the formal EMCC team leader needs to initiate structure in the team meetings to support organizing the work as well as facilitate team learning, especially the team learning process of constructive conflict. In a sample of 17 EMCC teams performing a realistic EMCC exercise, including one or two team meetings (28 in sum), we coded the team leader's verbal structuring behaviors (1,704 events), rated constructive conflict by external experts, and rated team effectiveness by field experts. Results show that leaders of effective teams use structuring behaviors more often (except asking procedural questions) but decreasingly over time. They support constructive conflict by clarifying and by making summaries that conclude in a command or decision in a decreasing frequency over time.

Team Leader Structuring for Team Effectiveness and Team Learning in Command-and-Control Teams

Science.gov (United States)

van der Haar, Selma; Koeslag-Kreunen, Mieke; Euwe, Eline; Segers, Mien

2017-01-01

Due to their crucial and highly consequential task, it is of utmost importance to understand the levers leading to effectiveness of multidisciplinary emergency management command-and-control (EMCC) teams. We argue that the formal EMCC team leader needs to initiate structure in the team meetings to support organizing the work as well as facilitate team learning, especially the team learning process of constructive conflict. In a sample of 17 EMCC teams performing a realistic EMCC exercise, including one or two team meetings (28 in sum), we coded the team leader’s verbal structuring behaviors (1,704 events), rated constructive conflict by external experts, and rated team effectiveness by field experts. Results show that leaders of effective teams use structuring behaviors more often (except asking procedural questions) but decreasingly over time. They support constructive conflict by clarifying and by making summaries that conclude in a command or decision in a decreasing frequency over time. PMID:28490856

Transfer of residents to hospital prior to cardiac death: the influence of nursing home quality and ownership type.

Science.gov (United States)

Anic, Gabriella M; Pathak, Elizabeth Barnett; Tanner, Jean Paul; Casper, Michele L; Branch, Laurence G

2014-01-01

We hypothesised that among nursing home decedents, nursing home for-profit status and poor quality-of-care ratings, as well as patient characteristics, would lower the likelihood of transfer to hospital prior to heart disease death. Using death certificates from a large metropolitan area (Tampa Florida Metropolitan Statistical Area) for 1998-2002, we geocoded residential street addresses of heart disease decedents to identify 2172 persons who resided in nursing homes (n=131) at the time of death. We analysed decedent place of death as an indicator of transfer prior to death. Multilevel logistic regression modelling was used for analysis. Cause of death and decedent characteristics were obtained from death certificates. Nursing home characteristics, including state inspector ratings for multiple time points, were obtained from Florida's Agency for Healthcare Administration. Nursing home for-profit status, level of nursing care and quality-of-care ratings were not associated with the likelihood of transfer to hospital prior to heart disease death. Nursing homes >5 miles from a hospital were more likely to transfer decedents, compared with facilities located close to a hospital. Significant predictors of no transfer for nursing home residents were being white, female, older, less educated and widowed/unmarried. In this study population, contrary to our hypotheses, sociodemographic characteristics of nursing home decedents were more important predictors of no transfer prior to cardiac death than quality rankings or for-profit status of nursing homes.

[Telepsychiatry and cooperation between professionnals in a mobile team].

Science.gov (United States)

Boutbien, Élodie; Copin, Sabrina; Veyres-Broquin, Karine; Wendel, Yann

2016-11-01

Telepsychiatry in a mobile team uses advanced technology for the benefit of healthcare. It requires a high level of cooperation between the different players. In a nursing home, ilt provides patients with access to psyhiatric care despite the distance or the difficulties involved in travelling to an appointment. Copyright © 2016. Published by Elsevier Masson SAS.

Spirit Begins Drive Around Home Plate

Science.gov (United States)

2009-01-01

The hazard avoidance camera on the front of NASA's Mars Exploration Rover Spirit took this image after a drive by Spirit on the 1,829th Martian day, or sol, of Spirit's mission on the surface of Mars (Feb. 24, 2009). On Sol 1829, Spirit drove 6.29 meters (21 feet) northwestward, away from the northern edge of the low plateau called 'Home Plate.' The track dug by the dragged right-front wheel as the rover drove backward is visible in this image, receding toward the southeast. Rock layers of the northern slope of Home Plate are visible in the upper right portion of the image. In sols prior to 1829, the rover team had been trying to maneuver Spirit to climb onto the northern edge of Home Plate, ready to drive southward across the top of the plateau toward science destinations south of Home Plate. The Sol 1829 drive was the first move of a revised strategy to circle at least partway around Home Plate on the trek toward the sites south of the plateau.

Hotspotting: Development of an Interprofessional Education and Service Learning Program for Care Management in Home Care Patients.

Science.gov (United States)

Zomorodi, Meg; Odom, Trish; Askew, Naomi C; Leonard, Christina R; Sanders, Kimberly A; Thompson, Daniel

2018-03-28

The purpose of this article is to describe a service learning opportunity where interprofessional teams of students worked together to address patients' social determinants of health through home visits. This article describes this process, known as "hotspotting," and presents the development of this project, including collaboration with a local home health agency, recruiting of students, and weekly team meetings for debriefing. Evaluation data, barriers with implementation, and next steps for sustainability are also discussed.

Home health services in primary care: What can we do?

Directory of Open Access Journals (Sweden)

Yasemin Çayır

2013-01-01

Full Text Available Home health services is to give examination, diagnosis,treatment, and rehabilitation services to the patients whobedridden, have difficulties to access health facility due toa variety of chronic or malignant disease by professionalhealth care team. Family physicians that providing healthcare in primary care is responsible for to determine whowill need home health care services, and to make homevisit on a regular basis among registered patients in theirpopulations. It is seems that the biggest shortcoming thecontent and scope of this service is not yet a standard. Inthis article, how home health services should be given willbe discussed.Key words: Primary health care, home health care, bedriddenpatient

[The mobile geriatrics team, global patient management].

Science.gov (United States)

Bach, Fréderiue; Bloch, Frédéric

2013-01-01

The mobile geriatric team of Cochin hospital in Paris is responsible for the management and orientation of fragile elderly patients over the age of 75 admitted to emergency departments. It carries out a multi-disciplinary assessment, contributes to the creation of the care project and life project of geriatric patients and is involved in organising the patient's return home. This article focuses on the role of the social assistant through two clinical cases.

Testing Game-Based Performance in Team-Handball.

Science.gov (United States)

Wagner, Herbert; Orwat, Matthias; Hinz, Matthias; Pfusterschmied, Jürgen; Bacharach, David W; von Duvillard, Serge P; Müller, Erich

2016-10-01

Wagner, H, Orwat, M, Hinz, M, Pfusterschmied, J, Bacharach, DW, von Duvillard, SP, and Müller, E. Testing game-based performance in team-handball. J Strength Cond Res 30(10): 2794-2801, 2016-Team-handball is a fast paced game of defensive and offensive action that includes specific movements of jumping, passing, throwing, checking, and screening. To date and to the best of our knowledge, a game-based performance test (GBPT) for team-handball does not exist. Therefore, the aim of this study was to develop and validate such a test. Seventeen experienced team-handball players performed 2 GBPTs separated by 7 days between each test, an incremental treadmill running test, and a team-handball test game (TG) (2 × 20 minutes). Peak oxygen uptake (V[Combining Dot Above]O2peak), blood lactate concentration (BLC), heart rate (HR), sprinting time, time of offensive and defensive actions as well as running intensities, ball velocity, and jump height were measured in the game-based test. Reliability of the tests was calculated using an intraclass correlation coefficient (ICC). Additionally, we measured V[Combining Dot Above]O2peak in the incremental treadmill running test and BLC, HR, and running intensities in the team-handball TG to determine the validity of the GBPT. For the test-retest reliability, we found an ICC >0.70 for the peak BLC and HR, mean offense and defense time, as well as ball velocity that yielded an ICC >0.90 for the V[Combining Dot Above]O2peak in the GBPT. Percent walking and standing constituted 73% of total time. Moderate (18%) and high (9%) intensity running in the GBPT was similar to the team-handball TG. Our results indicated that the GBPT is a valid and reliable test to analyze team-handball performance (physiological and biomechanical variables) under conditions similar to competition.

3D Printing is a Transformative Technology in Congenital Heart Disease

Directory of Open Access Journals (Sweden)

Shafkat Anwar, MD

2018-04-01

Full Text Available Summary: Survival in congenital heart disease has steadily improved since 1938, when Dr. Robert Gross successfully ligated for the first time a patent ductus arteriosus in a 7-year-old child. To continue the gains made over the past 80 years, transformative changes with broad impact are needed in management of congenital heart disease. Three-dimensional printing is an emerging technology that is fundamentally affecting patient care, research, trainee education, and interactions among medical teams, patients, and caregivers. This paper first reviews key clinical cases where the technology has affected patient care. It then discusses 3-dimensional printing in trainee education. Thereafter, the role of this technology in communication with multidisciplinary teams, patients, and caregivers is described. Finally, the paper reviews translational technologies on the horizon that promise to take this nascent field even further. Key Words: cardiac imaging, cardiothoracic surgery, congenital heart disease, simulation, 3D printing

Effects of work stress and home stress on autonomic nervous function in Japanese male workers.

Science.gov (United States)

Maeda, Eri; Iwata, Toyoto; Murata, Katsuyuki

2015-01-01

Autonomic imbalance is one of the important pathways through which psychological stress contributes to cardiovascular diseases/sudden death. Although previous studies have focused mainly on stress at work (work stress), the association between autonomic function and stress at home (home stress) is still poorly understood. The purpose was to clarify the effect of work/home stress on autonomic function in 1,809 Japanese male workers. We measured corrected QT (QTc) interval and QT index on the electrocardiogram along with blood pressure and heart rate. Participants provided self-reported information about the presence/absence of work/home stress and the possible confounders affecting QT indicators. Home stress was related positively to QT index (p=0.040) after adjusting for the possible confounders, though work stress did not show a significant relation to QTc interval or QT index. The odds ratio of home stress to elevated QT index (≥105) was 2.677 (95% CI, 1.050 to 6.822). Work/home stress showed no significant relation to blood pressure or heart rate. These findings suggest that autonomic imbalance, readily assessed by QT indicators, can be induced by home stress in Japanese workers. Additional research is needed to identify different types of home stress that are strongly associated with autonomic imbalance.

Building the dental dream team: behavioral styles in the practice.

Science.gov (United States)

Boswell, S

2000-08-15

There are four different behavioral styles evident in a dental team and in patients. The styles are based on observable behaviors relating to degrees of "assertiveness" and "responsiveness." The Behavioral Style model helps to clarify why some people relate positively with each other and why others may conflict. Using finely tuned observational skills and an understanding of these styles, interpersonal transactions can be more effective, dental teams become more cohesive, and patients will be more satisfied with service provided in the dental practice. Each member of the team should understand his/her own personal style and those of teammates. Once that understanding is gained by all, it may be effectively applied to understanding patients. Behavior modification is at the heart of this concept. Adjusting your own behavior to the needs of others enables a patient to achieve more comfort with the dental team, and they are more likely to hear your verbal messages.

Parental experiences with a paediatric palliative care team: A qualitative study

NARCIS (Netherlands)

Verberne, Lisa M.; Schouten-van Meeteren, Antoinette Yn; Bosman, Diederik K.; Colenbrander, Derk A.; Jagt, Charissa T.; Grootenhuis, Martha A.; van Delden, Johannes Jm; Kars, Marijke C.

2017-01-01

Background: Parents of children with a life-limiting disease have to rely on themselves at home while adequate paediatric palliative care is lacking. In several countries, paediatric palliative care teams are introduced to ensure continuity and quality of care and to support the child and the

Practices of depression care in home health care: Home health clinician perspectives

Science.gov (United States)

Bao, Yuhua; Eggman, Ashley A.; Richardson, Joshua E.; Sheeran, Thomas; Bruce, Martha L.

2015-01-01

Objective To assess any gaps between published best practices and real-world practices of treating depression in home health care (HHC), and barriers to closing any gaps. Methods A qualitative study based on semi-structured interviews with HHC nurses and administrators from five home health agencies in five states (n=20). Audio-recorded interviews were transcribed and analyzed by a multi-disciplinary team using grounded theory method to identify themes. Results Routine home health nursing care overlapped with all functional areas of depression care. However, there were reported gaps between best practices and real-world practices. Gaps were associated with perceived scope of practice by HHC nurses, knowledge gaps and low self-efficacy in depression treatment, stigma attached to depression, poor quality of antidepressant management in primary care, and poor communication between HHC and primary care. Conclusions Strategies to close gaps between typical and best practices need to enhance HHC clinician knowledge and self-efficacy with depression treatment and improve the quality of antidepressant management and communication with primary care. PMID:26423098

Home Food Preservation Training for Extension Educators

Science.gov (United States)

Goard, Linnette Mizer; Hill, Melinda; Shumaker, Katharine; Warrix, Marisa

2013-01-01

During times of economic downturn, there has been an increased interest in home food preservation. As the primary resource for current research-based recommendations, a team of Extension Family and Consumer Sciences educators with specialization in food safety and food preservation responded to this demand by developing a standardized food…

The role of the multidisciplinary health care team in the management of patients with Marfan syndrome

Directory of Open Access Journals (Sweden)

von Kodolitsch Y

2016-11-01

Full Text Available Yskert von Kodolitsch,1 Meike Rybczynski,1 Marina Vogler,2 Thomas S Mir,3 Helke Schüler,1 Kerstin Kutsche,4 Georg Rosenberger,4 Christian Detter,5 Alexander M Bernhardt,5 Axel Larena-Avellaneda,6 Tilo Kölbel,6 E Sebastian Debus,6 Malte Schroeder,7,8 Stephan J Linke,9,10 Bettina Fuisting,9 Barbara Napp,1 Anna Lena Kammal,11 Klaus Püschel,11 Peter Bannas,12 Boris A Hoffmann,13 Nele Gessler,13 Eva Vahle-Hinz,14 Bärbel Kahl-Nieke,14 Götz Thomalla,15 Christina Weiler-Normann,16 Gunda Ohm,17 Stefan Neumann,18 Dieter Benninghoven,19 Stefan Blankenberg,1 Reed E Pyeritz20 1Clinic of Cardiology, University Heart Centre, 2Marfan Hilfe Deutschland e.V., Zentrumsehstärke, 3Clinic for Pediatric Cardiology, University Heart Centre, 4Institute of Human Genetics, 5Clinic of Cardiovascular Surgery, University Heart Centre, 6Clinic of Vascular Medicine, University Heart Centre, 7Department of Trauma, Hand, and Reconstructive Surgery, 8Department of Orthopedics, 9Clinic of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; 10Smilow Center for Translational Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 11Department of Legal Medicine, 12Diagnostic and Interventional Radiology Department and Clinic, 13Clinic of Electrophysiology, University Heart Centre, 14Department of Orthodontics, Center for Dental and Oral Medicine, 15Clinic of Neurology, 16Martin Zeitz Center for Rare Diseases, 17Strategic Business Development, 18Business Unit Quality Management, University Medical Center Hamburg-Eppendorf, 19Mühlenberg-Clinic for Rehabilitation, Bad Malente-Gremsmühlen, 20Zentrumsehstärke, Hamburg, Germany Abstract: Marfan syndrome (MFS is a rare, severe, chronic, life-threatening disease with multiorgan involvement that requires optimal multidisciplinary care to normalize both prognosis and quality of life. In this article, each key team member of all the medical disciplines of a multidisciplinary

[ESC guidelines on the management of valvular heart disease. What has changed and what is new?].

Science.gov (United States)

Mangner, N; Schuler, G

2013-12-01

In 2012 the new and collaborative "Guidelines on the management of valvular heart disease (version 2012)" were published by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). These guidelines emphasize that decision-making in patients with valvular heart disease should ideally be carried out by a"heart team" with particular expertise in valvular heart disease. In aortic regurgitation pathologies of the aortic root are frequent and in patients with Marfan syndrome, surgery is indicated when the maximal ascending aortic diameter is ≥50 mm, while the threshold for intervention should be lower in patients with risk factors for progression. Regarding aortic stenosis, transcatheter aortic valve implantation (TAVI) should be performed only in hospitals with on-site cardiac surgery and with a"heart team" available to assess patient risks. The TAVI procedure is indicated in patients with severe symptomatic aortic stenosis who are judged by the"heart team" to be unsuitable for surgery but have sufficient life expectancy. It should be considered for high-risk patients with severe symptomatic aortic stenosis based on the individual risk profile assessed by the"heart team". Furthermore, low flow - low gradient aortic stenosis with normal ejection fraction and the difficult topic of asymptomatic severe aortic stenosis and the indications for aortic valve replacement are discussed. With respect to mitral regurgitation, valve repair should be the preferred technique when it is expected to be durable. The topics of asymptomatic mitral regurgitation as well as percutaneous mitral valve repair using the edge to edge technique as an alternative for high risk patients are discussed. Tricuspid disease should not be forgotten and during left-sided valve surgery, tricuspid valve surgery should be considered in the presence of mild to moderate secondary regurgitation if there is significant annular dilatation. Last but not least

Experiences of technology integration in home care nursing.

Science.gov (United States)

Johnson, K A; Valdez, R S; Casper, G R; Kossman, S P; Carayon, P; Or, C K L; Burke, L J; Brennan, P F

2008-11-06

The infusion of health care technologies into the home leads to substantial changes in the nature of work for home care nurses and their patients. Nurses and nursing practice must change to capitalize on these innovations. As part of a randomized field experiment evaluating web-based support for home care of patients with chronic heart disease, we engaged nine nurses in a dialogue about their experience integrating this modification of care delivery into their practice. They shared their perceptions of the work they needed to do and their perceptions and expectations for patients and themselves in using technologies to promote and manage self-care. We document three overarching themes that identify preexisting factors that influenced integration or represent the consequences of technology integration into home care: doing tasks differently, making accommodations in the home for devices and computers, and being mindful of existing expectations and skills of both nurses and patients.

The Team to Address Bariatric Care in Canadian Children (Team ABC3): Team Grant Research Proposal.

Science.gov (United States)

2017-10-05

Severe obesity (SO) in Canadian children remains poorly understood. However, based on international data, the prevalence of SO appears to be increasing and is associated with a number of psychosocial, bio-mechanical, and cardiometabolic health risks. The purpose of our national Team to Address Bariatric Care in Canadian Children (Team ABC3) is to develop and lead a series of inter-related studies to enhance the understanding and management of SO in Canadian children and adolescents (0-18 years). From 2015 to 2019, Team ABC3 will conduct a series of projects at the regional, provincial, and national levels using multiple methods and study designs to respond to key knowledge gaps by (i) generating evidence on the prevalence of SO and its impact on health services utilization in children using existing Canadian data sources from primary care settings, (ii) exploring contemporary definitions of SO that link with health outcomes, (iii) comparing and contrasting health risks across the continuum of SO, (iv) understanding potential barriers to and facilitators of treatment success in children with SO, and (v) examining innovative lifestyle and behavioral interventions designed to successfully manage SO in children and their families. Furthermore, to examine the impact of innovative interventions on the management SO, we will (vi) evaluate whether adding a health coach, who provides support via text, email, and/or phone, improves children's ability to adhere to a web-based weight management program and (vii) test the feasibility and impact of a community-based weight management program for pre-school children with SO and their parents that combines group-based parenting sessions with in-home visits. Our research aligns with national priorities in obesity research, brings together leading scientists, clinicians, and stakeholders from across Canada, and will inform health services delivery throughout the country to provide the best care possible for children with SO and

Research Toward Zero Energy Homes

Energy Technology Data Exchange (ETDEWEB)

Robert Hammon

2010-12-31

This final report was compiled from the detailed annual reports that were submitted for efforts in 2008 and 2009, and from individual task reports from 2010. Reports, case studies, and presentations derived from this work are available through the Building America website. The BIRA team is led by ConSol, a leading provider of energy solutions for builders since 1983. In partnership with over fifty builders, developers, architects, manufactures, researchers, utilities, and agencies, research work was performed in California, Colorado, Utah, New Mexico, Washington, Oregon, and Hawaii and five (5) climate regions (Hot-Dry, Marine, Hot-Humid, Cold, and Hot/Mixed Dry). In addition to research work, the team provided technical assistance to our partners whose interests span the entire building process. During the three year budget period, the BIRA team performed analyses of several emerging technologies, prototype homes, and high performance communities through detailed computer simulations and extensive field monitoring to meet the required climate joule milestone targets.

Modelling the Progression of Competitive Performance of an Academy's Soccer Teams.

Science.gov (United States)

Malcata, Rita M; Hopkins, Will G; Richardson, Scott

2012-01-01

Progression of a team's performance is a key issue in competitive sport, but there appears to have been no published research on team progression for periods longer than a season. In this study we report the game-score progression of three teams of a youth talent-development academy over five seasons using a novel analytic approach based on generalised mixed modelling. The teams consisted of players born in 1991, 1992 and 1993; they played totals of 115, 107 and 122 games in Asia and Europe between 2005 and 2010 against teams differing in age by up to 3 years. Game scores predicted by the mixed model were assumed to have an over-dispersed Poisson distribution. The fixed effects in the model estimated an annual linear pro-gression for Aspire and for the other teams (grouped as a single opponent) with adjustment for home-ground advantage and for a linear effect of age difference between competing teams. A random effect allowed for different mean scores for Aspire and opposition teams. All effects were estimated as factors via log-transformation and presented as percent differences in scores. Inferences were based on the span of 90% confidence intervals in relation to thresholds for small factor effects of x/÷1.10 (+10%/-9%). Most effects were clear only when data for the three teams were combined. Older teams showed a small 27% increase in goals scored per year of age difference (90% confidence interval 13 to 42%). Aspire experienced a small home-ground advantage of 16% (-5 to 41%), whereas opposition teams experienced 31% (7 to 60%) on their own ground. After adjustment for these effects, the Aspire teams scored on average 1.5 goals per match, with little change in the five years of their existence, whereas their opponents' scores fell from 1.4 in their first year to 1.0 in their last. The difference in progression was trivial over one year (7%, -4 to 20%), small over two years (15%, -8 to 44%), but unclear over >2 years. In conclusion, the generalized mixed model

Congenital Heart Disease: Guidelines of Care for Children with Special Health Care Needs.

Science.gov (United States)

Minnesota State Dept. of Health, Minneapolis. Services for Children with Handicaps.

These guidelines were written to help families coordinate the health care that may be needed by a child with congenital heart disease. The booklet begins with general information about congenital heart disease. It then discusses the goals of health care, the health care team, the importance of periodic health care, and record keeping procedures.…

Team Size and Stretching-Exercise Effects on Simulated Chest Compression Performance and Exertion

Directory of Open Access Journals (Sweden)

Jessica C. Schoen

2017-09-01

Full Text Available Introduction: Investigators conducted a prospective experimental study to evaluate the effect of team size and recovery exercises on individual providers’ compression quality and exertion. Investigators hypothesized that 1 larger teams would perform higher quality compressions with less exertion per provider when compared to smaller teams; and 2 brief stretching and breathing exercises during rest periods would sustain compressor performance and mitigate fatigue. Methods: In Phase I, a volunteer cohort of pre-clinical medical students performed four minutes of continuous compressions on a Resusci-Anne manikin to gauge the spectrum of compressor performance in the subject population. Compression rate, depth, and chest recoil were measured. In Phase II, the highest-performing Phase I subjects were placed into 2-, 3-, and/or 4-compressor teams; 2-compressor teams were assigned either to control group (no recovery exercises or intervention group (recovery exercises during rest. All Phase II teams participated in 20-minute simulations with compressor rotation every two minutes. Investigators recorded compression quality and real-time heart rate data, and calculated caloric expenditure from contact heart rate monitor measurements using validated physiologic formulas. Results: Phase I subjects delivered compressions that were 24.9% (IQR1–3: [0.5%–74.1%] correct with a median rate of 112.0 (IQR1–3: [103.5–124.9] compressions per minute and depth of 47.2 (IQR1–3: [35.7–55.2] mm. In their first rotations, all Phase II subjects delivered compressions of similar quality and correctness (p=0.09. Bivariate analyses of 2-, 3-, and 4-compressor teams’ subject compression characteristics by subsequent rotation did not identify significant differences within or across teams. On multivariate analyses, only subjects in 2-compressor teams exhibited significantly lower compression rates (control subjects; p<0.01, diminished chest release (intervention

[Aromatherapy in nursing homes].

Science.gov (United States)

Barré, Lucile

2015-01-01

Pierre Delaroche de Clisson hospital uses essential oils as part of its daily organisation for the treatment of pain and the development of palliative care. The setting up of this project, in nursing homes and long-term care units, is the fruit of a complex mission carried out by a multidisciplinary team, which had to take into account the risks involved and overcome a certain amount of reluctance. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Undermining the rules in home care services for the elderly in Norway: flexibility and cooperation.

Science.gov (United States)

Wollscheid, Sabine; Eriksen, John; Hallvik, Jørgen

2013-06-01

This study explores the provision of home care services (home nursing and domiciliary help) for the elderly in Norwegian municipalities with purchaser-provider split model. The study draws on the assumption that flexibility in adjusting services to the care receivers' needs, and cooperation between provider and purchasers are indicators of good quality of care. Data were collected through semi-structured telephone interviews with 22 team leaders of provider units in nine municipalities. Data were collected in 2008-2009. The study has been approved by the Norwegian Social Science Data Services. We identified four different ways of organising home care services under a purchaser-provider split model: Provider empowerment, New Public Management, Vague instructions and undermining the rules. High flexibility in providing care and cooperation with the purchaser unit were identified by the team leaders as characteristics for good care. Our findings suggest that the care providers use individual strategies that allow flexibility and cooperation rather than rigidly abiding to the regulations the purchaser-provider split models implies. Ironically, in provider units where the 'rules were undermined', the informants (team leaders of provider units) seemed to be most satisfied with the quality of home care that they delivered. © 2012 Nordic College of Caring Science.

Role of environmental cleanliness and decontamination in care homes.

Science.gov (United States)

Cousins, Gary

2016-01-06

While it is widely accepted that the environment has an important role in transmission of healthcare-associated infections, there has been a paucity of empirical investigation in this area to date, and the majority of published literature relates to acute settings. People living in care homes come into contact with a communally used environment and communally used equipment daily. Equipment may include hoists, hoist slings, clinical monitoring equipment, commodes and shower chairs. In care homes, primary responsibility for decontamination lies with the healthcare team, most of whom are not nurses. The challenge for nurses working in care homes is their accountability for the provision of safe and effective care.

Efficacy of Hospital at Home in Patients with Heart Failure: A Systematic Review and Meta-Analysis.

Directory of Open Access Journals (Sweden)

Amro Qaddoura

Full Text Available Heart failure (HF is the commonest cause of hospitalization in older adults. Compared to routine hospitalization (RH, hospital at home (HaH--substitutive hospital-level care in the patient's home--improves outcomes and reduces costs in patients with general medical conditions. The efficacy of HaH in HF is unknown.We searched MEDLINE, Embase, CINAHL, and CENTRAL, for publications from January 1990 to October 2014. We included prospective studies comparing substitutive models of hospitalization to RH in HF. At least 2 reviewers independently selected studies, abstracted data, and assessed quality. We meta-analyzed results from 3 RCTs (n = 203 and narratively synthesized results from 3 observational studies (n = 329. Study quality was modest. In RCTs, HaH increased time to first readmission (mean difference (MD 14.13 days [95% CI 10.36 to 17.91], and improved health-related quality of life (HrQOL at both, 6 months (standardized MD (SMD -0.31 [-0.45 to -0.18] and 12 months (SMD -0.17 [-0.31 to -0.02]. In RCTs, HaH demonstrated a trend to decreased readmissions (risk ratio (RR 0.68 [0.42 to 1.09], and had no effect on all-cause mortality (RR 0.94 [0.67 to 1.32]. HaH decreased costs of index hospitalization in all RCTs. HaH reduced readmissions and emergency department visits per patient in all 3 observational studies.In the context of a limited number of modest-quality studies, HaH appears to increase time to readmission, reduce index costs, and improve HrQOL among patients requiring hospital-level care for HF. Larger RCTs are necessary to assess the effect of HaH on readmissions, mortality, and long-term costs.

[Emotional distress in elderly people with heart disease].

Science.gov (United States)

Martínez Santamaría, Emilia; Lameiras Fernández, María; González Lorenzo, Manuel; Rodríguez Castro, Yolanda

2006-06-30

To analyse the emotional distress associated with ageing, and its prevalence among elderly people who suffer from heart disease. Personal interviews with elderly people with and without heart problems. Interviews were conducted in public hospitals and old people's homes in the south of Galicia, Spain. The sample was made up of 130 elderly people (65 with heart problems and 65 without). The Inventory of Coping Strategies, of Halroyd and Reynolk (1984); Scheir, Caver, and Bridges Test (1984); the Life Satisfaction Scale of Diener, Emmuns, Larsen, and Griffen (1985); Rosenberg's Self-Esteem Scale (1965); and an instrument to measure Associated Symptoms (SCL-90; Derogatis, 1975). Elderly people with heart problems experienced greater anxiety and had lower self-esteem than those without such problems. Heart patients also tended to suffer more phobic anxiety and to retreat from social interaction more. With the passing of time, heart patients over 60 showed more anxiety, irritability and psychosomatic disorders. This study clearly shows the existence of emotional distress in elderly heart patients. This makes it particularly important to conduct risk-prevention programmes, since a lot of heart disease is brought on by unhealthy conduct.

Quality assessment of palliative home care in Italy.

Science.gov (United States)

Scaccabarozzi, Gianlorenzo; Lovaglio, Pietro Giorgio; Limonta, Fabrizio; Floriani, Maddalena; Pellegrini, Giacomo

2017-08-01

The complexity of end-of-life care, represented by a large number of units caring for dying patients, of different types of organizations motivates the importance of measure the quality of provided care. Despite the law 38/2010 promulgated to remove the barriers and provide affordable access to palliative care, measurement, and monitoring of processes of home care providers in Italy has not been attempted. Using data drawn by an institutional voluntary observatory established in Italy in 2013, collecting home palliative care units caring for people between January and December 2013, we assess the degree to which Italian home palliative care teams endorse a set of standards required by the 38/2010 law and best practices as emerged from the literature. The evaluation strategy is based on Rasch analysis, allowing to objectively measuring both performances of facilities and quality indicators' difficulty on the same metric, using 14 quality indicators identified by the observatory's steering committee. Globally, 195 home care teams were registered in the observatory reporting globally 40 955 cured patients in 2013 representing 66% of the population of home palliative care units active in Italy in 2013. Rasch analysis identifies 5 indicators ("interview" with caregivers, continuous training provided to medical and nursing staff, provision of specialized multidisciplinary interventions, psychological support to the patient and family, and drug supply at home) easy to endorse by health care providers and 3 problematic indicators (presence of a formally established Local Network of Palliative care in the area of reference, provision of the care for most problematic patient requiring high intensity of the care, and the percentage of cancer patient dying at Home). The lack of Local Network of Palliative care, required by law 38/2010, is, at the present, the main barrier to its application. However, the adopted methodology suggests that a clear roadmap for health facilities

The Effect of Community-Based Specialist Palliative Care Teams on Place of Care.

Science.gov (United States)

Seow, Hsien; Dhaliwal, Gagan; Fassbender, Konrad; Rangrej, Jagadish; Brazil, Kevin; Fainsinger, Robin

2016-01-01

Prior research on community-based specialist palliative care teams used outcome measures of place of death and/or dichotomous outcome measures of acute care use in the last two weeks of life. However, existing research seldom measured the diverse places of care used and their timing prior to death. The study objective was to examine the place of care in the last 30 days of life. In this retrospective cohort study, patients who received care from a specialist palliative care team (exposed) were matched by propensity score to patients who received usual care in the community (unexposed) in Ontario, Canada. Measured was the percentage of patients in each place of care in the last month of life as a proportion of the total cohort. After matching, 3109 patients were identified in each group, where 79% had cancer and 77% received end-of-life home care. At 30 days compared to 7 days before death, the exposed group's proportions rose from 33% to 41% receiving home care and 14% to 15% in hospital, whereas the unexposed group's proportions rose from 28% to 32% receiving home care and 16% to 22% in hospital. Linear trend analysis (proportion over time) showed that the exposed group used significantly more home care services and fewer hospital days (p care. Examining place of care in the last month can effectively illustrate the service use trajectory over time.

Music Therapy Clinical Practice in Hospice: Differences Between Home and Nursing Home Delivery.

Science.gov (United States)

Liu, Xiaodi; Burns, Debra S; Hilliard, Russell E; Stump, Timothy E; Unroe, Kathleen T

2015-01-01

Hospice music therapy is delivered in both homes and nursing homes (NH). No studies to date have explored differences in music therapy delivery between home and NH hospice patients. To compare music therapy referral reasons and delivery for hospice patients living in NH versus home. A retrospective, electronic medical record review was conducted from a large U.S. hospice of patients receiving music therapy between January 1, 2006, and December 31, 2010. Among the 4,804 patients, 2,930 lived in an NH and 1,847 patients lived at home. Compared to home, NH hospice patients were more likely to be female, older, unmarried, and Caucasian. For home hospice patients, the top referral reasons were patient/family emotional and spiritual support, quality of life, and isolation. The most frequent referral reasons for NH hospice patients were isolation, quality of life, and patient/family emotional and spiritual support. Differences in music therapy delivery depended mainly on patients' primary diagnosis and location of care. Results suggest differences in referral reasons and delivery based on an interaction between location of care and patient characteristics. Delivery differences are likely a result of individualized assessment and care plans developed by the music therapist and other interdisciplinary team members to address the unique needs of the patient. Thus, it is important to have professionally trained music therapists assess and provide tailored music-based interventions for patients with different referral reasons and personal characteristics. This study also supports staffing decisions based on patient need rather than average daily census. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Forget (a while) the World Cup... support the CERN football team

CERN Multimedia

2006-01-01

Teammates celebrate their victory and bring home the trophy. During this year's World Cup, it seems unlikely that there could exist a team that everyone would unanimously cheer for...at least, at CERN. Yet, the CERN FC team made up of various nationalities (Austrian, Belgian, English, French, Italian, Norwegian, Portuguese, Spanish, Swedish, Swiss,) won this year's Association Genevoise de Football Corporatif (AGFC) Championship, a championship for companies in Geneva. In 2002 the CERN Football team was re-formed and entered in the AGFC after a number of years in the wilderness. The team quickly progressed from Division D as a result of three successive promotions and competed in League A (the top flight) for the first time in 2005. CERN FC history was made two weeks ago. Having qualified for the end-of-season playoffs by finishing second in its regular season group, on Thursday 15 June the team qualified for the AGFC Division A Championship final by beating the Geneva Police 2-0 in the semi-final at Stade M...

Teamwork and delegation in medical homes: primary care staff perspectives in the Veterans Health Administration.

Science.gov (United States)

True, Gala; Stewart, Greg L; Lampman, Michelle; Pelak, Mary; Solimeo, Samantha L

2014-07-01

The patient-centered medical home (PCMH) relies on a team approach to patient care. For organizations engaged in transitioning to a PCMH model, identifying and providing the resources needed to promote team functioning is essential. To describe team-level resources required to support PCMH team functioning within the Veterans Health Administration (VHA), and provide insight into how the presence or absence of these resources facilitates or impedes within-team delegation. Semi-structured interviews with members of pilot teams engaged in PCMH implementation in 77 primary care clinics serving over 300,000 patients across two VHA regions covering the Mid-Atlantic and Midwest United States. A purposive sample of 101 core members of pilot teams, including 32 primary care providers, 42 registered nurse care managers, 15 clinical associates, and 12 clerical associates. Investigators from two evaluation sites interviewed frontline primary care staff separately, and then collaborated on joint analysis of parallel data to develop a broad, comprehensive understanding of global themes impacting team functioning and within-team delegation. We describe four themes key to understanding how resources at the team level supported ability of primary care staff to work as effective, engaged teams. Team-based task delegation was facilitated by demarcated boundaries and collective identity; shared goals and sense of purpose; mature and open communication characterized by psychological safety; and ongoing, intentional role negotiation. Our findings provide a framework for organizations to identify assets already in place to support team functioning, as well as areas in need of improvement. For teams struggling to make practice changes, our results indicate key areas where they may benefit from future support. In addition, this research sheds light on how variation in medical home implementation and outcomes may be associated with variation in team-based task delegation.

Early Home Supported Discharge of Stroke Patients:

DEFF Research Database (Denmark)

Larsen, Torben; Olsen, T. Skyhøj; Sørensen, Jan

2006-01-01

OBJECTIVES: A comprehensive and systematic assessment (HTA) of early home-supported discharge by a multidisciplinary team that plans, coordinates, and delivers care at home (EHSD) was undertaken and the results were compared with that of conventional rehabilitation at stroke units. METHODS......: A systematic literature search for randomized trials (RCTs) on "early supported discharge" was closed in April 2005. RCTs on EHSD without information on (i) death or institution at follow-up, (ii) change in Barthél Index, (iii) length of hospital stay, (iv) intensity of home rehabilitation, or (v) baseline...... are discussed. CONCLUSIONS: EHSD is evidenced as a dominant health intervention. However, financial barriers between municipalities and health authorities have to be overcome. For qualitative reasons, a learning path of implementation is recommended where one stroke unit in a region initiates EHSD...

[Pilot-experience in home care: bedridden aged patients of a basic health unit, Porto Alegre, Brazil].

Science.gov (United States)

Marques, Giselda Quintana; Freitas, Ivani Bueno de Almeida

2009-12-01

The objectives of this study were to describe the development of a pilot-project in home care to bedridden aged patients at a Basic Health Unit, and identify demographic, social and health aspects of these patients, as well as relevant aspects reported by the health team that implemented the home care. The study had descriptive and evaluative characteristics. The patients' enrollment forms and health records and the project's records were analyzed. The pilot-experience permitted to develop the team's skills, in addition to being enriching and of great responsibility for the professionals and caregivers involved. The results indicated the need for continuous home care and adjustments in its organization with the purpose of increasing the areas for health care and improving the population's quality of life.

A Home-Based Palliative Care Consult Service for Veterans.

Science.gov (United States)

Golden, Adam G; Antoni, Charles; Gammonley, Denise

2016-11-01

We describe the development and implementation of a home-based palliative care consult service for Veterans with advanced illness. A retrospective chart review was performed on 73 Veterans who received a home-based palliative care consult. Nearly one-third were 80 years of age or older, and nearly one-third had a palliative diagnosis of cancer. The most common interventions of the consult team included discussion of advance directives, completion of a "do not resuscitate" form, reduction/stoppage of at least 1 medication, explanation of diagnosis, referral to home-based primary care program, referral to hospice, and assessment/support for caregiver stress. The home-based consult service was therefore able to address clinical and psychosocial issues that can demonstrate a direct benefit to Veterans, families, and referring clinicians. © The Author(s) 2015.

Home-based versus centre-based cardiac rehabilitation.

Science.gov (United States)

Taylor, Rod S; Dalal, Hayes; Jolly, Kate; Moxham, Tiffany; Zawada, Anna

2010-01-20

The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Traditionally centre-based cardiac rehabilitation (CR) programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. To determine the effectiveness of home-based cardiac rehabilitation programmes compared with supervised centre-based cardiac rehabilitation on mortality and morbidity, health-related quality of life and modifiable cardiac risk factors in patients with coronary heart disease. We updated the search of a previous review by searching the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2007, Issue 4), MEDLINE, EMBASE and CINAHL from 2001 to January 2008. We checked reference lists and sought advice from experts. No language restrictions were applied. Randomised controlled trials (RCTs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes, in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. Studies were selected independently by two reviewers, and data extracted by a single reviewer and checked by a second one. Authors were contacted where possible to obtain missing information. Twelve studies (1,938 participants) met the inclusion criteria. The majority of studies recruited a lower risk patient following an acute myocardial infarction (MI) and revascularisation. There was no difference in outcomes of home- versus centre-based cardiac rehabilitation in mortality risk ratio (RR) was1.31 (95% confidence interval (C) 0.65 to 2.66), cardiac events, exercise capacity standardised mean difference (SMD) -0.11 (95% CI -0.35 to 0.13), as well as in modifiable risk factors (systolic blood pressure; diastolic blood pressure; total cholesterol

45 King: A Story of the Southern Home

OpenAIRE

Deluca, Paul Matthew Webb

2014-01-01

The house at 45 King St. in Charleston, South Carolina is more than a home. It is a story of the home. A story told through history, through a vision exhibited in architectural drawings, and through the social heritage closest to my heart. 45 King is a story for the South; the story of its grandeur, its climate, its natural beauty, its hospitality, its comfort, and its veils. It is a story that was told yesterday and one that is still told today. Like an oral history, the telling of it may...

Who is on the primary care team? Professionals' perceptions of the conceptualization of teams and the underlying factors: a mixed-methods study.

Science.gov (United States)

Doekhie, Kirti D; Buljac-Samardzic, Martina; Strating, Mathilde M H; Paauwe, Jaap

2017-12-28

Due to the growing prevalence of elderly patients with multi-morbidity living at home, there is an increasing need for primary care professionals from different disciplinary backgrounds to collaborate as primary care teams. However, it is unclear how primary care professionals conceptualize teams and what underlying factors influence their perception of being part of a team. Our research question is: What are primary care professionals' perceptions of teams and team membership among primary care disciplines and what factors influence their perceptions? We conducted a mixed-methods study in the Dutch primary care setting. First, a survey study of 152 professionals representing 12 primary care disciplines was conducted, focusing on their perceptions of which disciplines are part of the team and the degree of relational coordination between professionals from different disciplinary backgrounds. Subsequently, we conducted semi-structured interviews with 32 professionals representing 5 primary care disciplines to gain a deeper understanding of the underlying factors influencing their perceptions and the (mis)alignment between these perceptions. Misalignments were found between perceptions regarding which disciplines are members of the team and the relational coordination between disciplines. For example, general practitioners were viewed as part of the team by helping assistants, (district) nurses, occupational therapists and geriatric specialized practice nurses, whereas the general practitioners themselves only considered geriatric specialized practice nurses to be part of their team. Professionals perceive multidisciplinary primary care teams as having multiple inner and outer layers. Three factors influence their perception of being part of a team and acting accordingly: a) knowing the people you work with, b) the necessity for knowledge exchange and c) sharing a holistic view of caregiving. Research and practice should take into account the misalignment between

Exploring the concept of a team approach to wound care: Managing wounds as a team.

Science.gov (United States)

Moore, Zena; Butcher, Gillian; Corbett, Lisa Q; McGuiness, William; Snyder, Robert J; van Acker, Kristien

2014-05-01

Background - The growing prevalence and incidence of nonhealing acute and chronic wounds is a worrying concern. A major challenge is the lack of united services aimed at addressing the complex needs of individuals with wounds. However, the WHO argues that interprofessional collaboration in education and practice is key to providing the best patient care, enhancing clinical and health-related outcomes and strengthening the health system. It is based on this background that the team approach to wound care project was conceptualised. The project was jointly initiated and realised by the Association for the Advancement of Wound Care (AAWC-USA), the Australian Wound Management Association (AWMA) and the European Wound Management Association (EWMA). Aim - The aim of this project was to develop a universal model for the adoption of a team approach to wound care. Objective The overarching objective of this project was to provide recommendations for implementing a team approach to wound care within all clinical settings and through this to develop a model for advocating the team approach toward decision makers in national government levels. Method An integrative literature review was conducted. Using this knowledge, the authors arrived at a consensus on the most appropriate model to adopt and realise a team approach to wound care. Results - Eighty four articles met the inclusion criteria. Following data extraction, it was evident that none of the articles provided a definition for the terms multidisciplinary, interdisciplinary or transdisciplinary in the context of wound care. Given this lack of clarity within the wound care literature, the authors have here developed a Universal Model for the Team Approach to Wound Care to fill this gap in our current understanding. Conclusion - We advocate that the patient should be at the heart of all decision-making, as working with the Universal Model for the Team Approach to Wound Care begins with the needs of the patient. To

Family Members’ Experience with Hospice in Nursing Homes

Science.gov (United States)

Gage, L. Ashley; Washington, Karla T.; Oliver, Debra Parker; Lewis, Alexandra; Kruse, Robin L.; Demiris, George

2014-01-01

Research has documented numerous benefits and challenges associated with receipt of hospice care in nursing homes; however, study of this partnership from the perspective of residents’ family members has been limited. The purpose of this qualitative investigation was to explore family members’ experience with hospice services received in the nursing home setting. Researchers conducted a secondary data analysis of 175 family member interviews using a thematic analytic approach. Findings highlighted the critical role of communication in supporting residents and their family members. Care coordination, support and oversight, and role confusion also impacted family members’ experience of hospice care in the nursing home. Efforts directed at enhancing communication and more clearly articulating the roles of members of the health care team are indicated. PMID:25422516

Parental experiences with a paediatric palliative care team: A qualitative study.

Science.gov (United States)

Verberne, Lisa M; Schouten-van Meeteren, Antoinette Yn; Bosman, Diederik K; Colenbrander, Derk A; Jagt, Charissa T; Grootenhuis, Martha A; van Delden, Johannes Jm; Kars, Marijke C

2017-12-01

Parents of children with a life-limiting disease have to rely on themselves at home while adequate paediatric palliative care is lacking. In several countries, paediatric palliative care teams are introduced to ensure continuity and quality of care and to support the child and the family. Yet, little is known about how parents experience such multidisciplinary teams. To obtain insight into the support provided by a new paediatric palliative care team from the parents' perspective. An interpretative qualitative interview study using thematic analysis was performed. A total of 47 single or repeated interviews were undertaken with 42 parents of 24 children supported by a multidisciplinary paediatric palliative care team located at a university children's hospital. The children suffered from malignant or non-malignant diseases. In advance, parents had limited expectations of the paediatric palliative care team. Some had difficulty accepting the need for palliative care for their child. Once parents experienced what the team achieved for their child and family, they valued the team's involvement. Valuable elements were as follows: (1) process-related aspects such as continuity, coordination of care, and providing one reliable point of contact; (2) practical support; and (3) the team members' sensitive and reliable attitude. As a point of improvement, parents suggested more concrete clarification upfront of the content of the team's support. Parents feel supported by the paediatric palliative care team. The three elements valued by parents probably form the structure that underlies quality of paediatric palliative care. New teams should cover these three valuable elements.

When Teams Fail to Self-Regulate: Predictors and Outcomes of Team Procrastination Among Debating Teams.

Science.gov (United States)

Van Hooft, Edwin A J; Van Mierlo, Heleen

2018-01-01

Models of team development have indicated that teams typically engage in task delay during the first stages of the team's life cycle. An important question is to what extent this equally applies to all teams, or whether there is variation across teams in the amount of task delay. The present study introduces the concept of team procrastination as a lens through which we can examine whether teams collectively engage in unplanned, voluntary, and irrational delay of team tasks. Based on theory and research on self-regulation, team processes, and team motivation we developed a conceptual multilevel model of predictors and outcomes of team procrastination. In a sample of 209 student debating teams, we investigated whether and why teams engage in collective procrastination as a team, and what consequences team procrastination has in terms of team member well-being and team performance. The results supported the existence of team procrastination as a team-level construct that has some stability over time. The teams' composition in terms of individual-level trait procrastination, as well as the teams' motivational states (i.e., team learning goal orientation, team performance-approach goal orientation in interaction with team efficacy) predicted team procrastination. Team procrastination related positively to team members' stress levels, especially for those low on trait procrastination. Furthermore, team procrastination had an indirect negative relationship with team performance, through teams' collective stress levels. These findings add to the theoretical understanding of self-regulatory processes of teams, and highlight the practical importance of paying attention to team-level states and processes such as team goal orientation and team procrastination.

Early home-supported discharge after stroke

DEFF Research Database (Denmark)

Langhorne, P.; Jepsen, Birgitte G.; Larsen, Torben

2014-01-01

benefit most are likely to have moderate stroke severity and may be able to cooperate with rehabilitation in the home setting. Staffing requirements will vary according to several factors. These will include (a) the severity and complexity of stroke impairments, (b) the current level of community support......This report is a brief practical problem-based guide to support clinical management in the implementation of early home-supported discharge as an integrated part of stroke care. However, it is clear that skilled members of a multidisciplinary team are needed and they need to work in a coordinated......, (c) the duration of rehabilitation input, and (d) the rehabilitation targets planned. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins....

Climate Prediction Center - El Niño/La Niña Home

Science.gov (United States)

Weather Service NWS logo - Click to go to the NWS home page Climate Prediction Center Site Map News Information CPC Web Team HOME > El Niño/La Niña Forecasts Current U.S. Climate Outlook SST Forecasts Temperature and Anomalies NOAA/ National Weather Service National Centers for Environmental Prediction Climate

Dysfunction of an On-X Heart Valve by Pannus.

Science.gov (United States)

Abad, Cipriano; Urso, Stefano; Gomez, Elsa; De la Vega, Maria

2016-09-01

A 68-year-old woman with a history of previous double-valve replacement with On-X mechanical heart valves presented with clinical, echocardiographic and cardiac catheterization signs of obstruction of the On-X tricuspid heart valve prosthesis. The patient was successfully reoperated, but at surgery the valve was seen to be invaded by an abnormal overgrowth of pannus that blocked one of the leaflets. A small amount of non-obstructive fresh thrombus was also observed. The valve was successfully replaced with a biological heart valve prosthesis. The patient was discharged home, and is doing well four months after the operation, when echocardiography demonstrated normal function in the tricuspid valve. The present case represents the first ever report of pannus formation and subsequent dysfunction in an On-X heart valve, and also the first case of tricuspid valve malfunction and obstruction using this type of heart valve substitute.

Supply chain partnership in construction a field study on project team level factors

NARCIS (Netherlands)

Koolwijk, J.S.J.; Van Oel, C.J.; Wamelink, J.W.F.

2015-01-01

People and their relationship are at the heart of supply chain partnerships, however there is a lack of qualitative studies focusing on how integrated relationships may be developed. Therefore, the purpose of this study was to conduct field research to deepen our understanding of team level

The role of the hospice social worker in the nursing home setting.

Science.gov (United States)

Amar, D F

1994-01-01

Data and case examples from two major metropolitan hospice programs are examined in order to arrive at a definition of the hospice social worker's role in the nursing home, and how it differs from that of the hospice social worker in home care. The nursing home population tends to be older, frailer, and with poorer mental status, making them less available to "talk therapies". The nursing home environment itself needs to be assessed as a significant part of the patient/family system. Social work interventions may focus on the patient, the family, the nursing home staff, or any combination of these elements. The hospice social worker on a nursing home team may do less counseling with patients, but the role draws on diverse other skills such as groupwork, negotiation, education, and advocacy.

Linking Structure, Process, and Outcome to Improve Group Home Services for Foster Youth in California

Science.gov (United States)

Green, Rex S.; Ellis, Peter T.

2007-01-01

The California Youth Connection obtained funding from two foundations to evaluate the performance of group homes serving foster youth in Alameda County, California, in order to inform state policy-making. The evaluation team initially included 14 foster youth that personally experienced group home living. Three inter-related aspects of service…

When Teams Fail to Self-Regulate: Predictors and Outcomes of Team Procrastination Among Debating Teams

Science.gov (United States)

Van Hooft, Edwin A. J.; Van Mierlo, Heleen

2018-01-01

Models of team development have indicated that teams typically engage in task delay during the first stages of the team’s life cycle. An important question is to what extent this equally applies to all teams, or whether there is variation across teams in the amount of task delay. The present study introduces the concept of team procrastination as a lens through which we can examine whether teams collectively engage in unplanned, voluntary, and irrational delay of team tasks. Based on theory and research on self-regulation, team processes, and team motivation we developed a conceptual multilevel model of predictors and outcomes of team procrastination. In a sample of 209 student debating teams, we investigated whether and why teams engage in collective procrastination as a team, and what consequences team procrastination has in terms of team member well-being and team performance. The results supported the existence of team procrastination as a team-level construct that has some stability over time. The teams’ composition in terms of individual-level trait procrastination, as well as the teams’ motivational states (i.e., team learning goal orientation, team performance-approach goal orientation in interaction with team efficacy) predicted team procrastination. Team procrastination related positively to team members’ stress levels, especially for those low on trait procrastination. Furthermore, team procrastination had an indirect negative relationship with team performance, through teams’ collective stress levels. These findings add to the theoretical understanding of self-regulatory processes of teams, and highlight the practical importance of paying attention to team-level states and processes such as team goal orientation and team procrastination. PMID:29674991

When Teams Fail to Self-Regulate: Predictors and Outcomes of Team Procrastination Among Debating Teams

Directory of Open Access Journals (Sweden)

Edwin A. J. Van Hooft

2018-04-01

Full Text Available Models of team development have indicated that teams typically engage in task delay during the first stages of the team’s life cycle. An important question is to what extent this equally applies to all teams, or whether there is variation across teams in the amount of task delay. The present study introduces the concept of team procrastination as a lens through which we can examine whether teams collectively engage in unplanned, voluntary, and irrational delay of team tasks. Based on theory and research on self-regulation, team processes, and team motivation we developed a conceptual multilevel model of predictors and outcomes of team procrastination. In a sample of 209 student debating teams, we investigated whether and why teams engage in collective procrastination as a team, and what consequences team procrastination has in terms of team member well-being and team performance. The results supported the existence of team procrastination as a team-level construct that has some stability over time. The teams’ composition in terms of individual-level trait procrastination, as well as the teams’ motivational states (i.e., team learning goal orientation, team performance-approach goal orientation in interaction with team efficacy predicted team procrastination. Team procrastination related positively to team members’ stress levels, especially for those low on trait procrastination. Furthermore, team procrastination had an indirect negative relationship with team performance, through teams’ collective stress levels. These findings add to the theoretical understanding of self-regulatory processes of teams, and highlight the practical importance of paying attention to team-level states and processes such as team goal orientation and team procrastination.

Nurses' reflections on pain management in a nursing home setting.

Science.gov (United States)

Clark, Lauren; Fink, Regina; Pennington, Karen; Jones, Katherine

2006-06-01

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

Team Learning and Team Composition in Nursing

Science.gov (United States)

Timmermans, Olaf; Van Linge, Roland; Van Petegem, Peter; Elseviers, Monique; Denekens, Joke

2011-01-01

Purpose: This study aims to explore team learning activities in nursing teams and to test the effect of team composition on team learning to extend conceptually an initial model of team learning and to examine empirically a new model of ambidextrous team learning in nursing. Design/methodology/approach: Quantitative research utilising exploratory…

The Research of Self-Management Team and Superior-Direction Team in Team Learning Influential Factors

OpenAIRE

Zhang Wei

2013-01-01

Team learning is a cure for bureaucracy; it facilitates team innovation and team performance. But team learning occurs only when necessary conditions were met. This research focused on differences of team learning influential factors between self-management team and superior-direction team. Four variables were chosen as predictors of team learning though literature review and pilot interview. The 4 variables are team motivation, team trust, team conflict and team leadership. Selected 54 self ...

Optimal procedures for home visits — A case study

Science.gov (United States)

Alves, Filipe; Fernandes, Florbela P.; Pereira, Ana I.; Fernandes, Adília

2017-07-01

In Portugal the population is ageing. Therefore, the provision of health care at patients' home is becoming an important social and health area; this health service is provided by professional teams (usually composed by nurses) of the Health Centers. Nowadays, the scheduling of the visits is made manually. The proposal of this work is to do the scheduling automatically in order to minimize the overall time spent by the professional teams in the visiting activity. In this work the genetic algorithm was used to solve the optimization problem. Some numerical results are presented.

[Management of valvular heart disease : ESC/EACTS guidelines 2017].

Science.gov (United States)

Haude, M

2017-12-01

After 5 years the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery have released an update on the guidelines for the management of valvular heart diseases. In recent years published results of randomized trials in patients with aortic valve stenosis have resulted in updated recommendations for catheter-based prosthesis implantation (TAVI), which is now extended to patients presenting without a low risk for conventional surgical valve replacement. In mitral or tricuspid valvular disease, the recommendations for catheter-based therapies are less strong because of a lack of supportive scientific data. A special focus of these updated guidelines is on concomitant antithrombotic therapy in valvular heart disease and in the context of a combination with coronary artery disease and/or accompanying arrhythmia. Special emphasis was again put on the multidisciplinary heart team for the diagnostics and treatment of patients with valvular heart disease. In order to support the quality of treatment for patients with valvular heart disease, it is suggested that heart valve centers of excellence should be established, which have to fulfil complex personnel, structural and technological prerequisites.

Airtightness Results of Roof-Only Air Sealing Strategies on 1 ½-Story Homes in Cold Climates

Energy Technology Data Exchange (ETDEWEB)

Ojczyk, C.; Murry, T.; Mosiman, G.

2014-07-01

In this second study on solutions to ice dams in 1-1/2 story homes, the NorthernSTAR Building America Partnership team analyzed five test homes located in both cold and very cold climates for air leakage reduction rates following modifications by independent contractors on owner-occupied homes. These homes were chosen for testing as they are common in Minnesota and very difficult to air seal and insulate effectively. Two projects followed a roof-only Exterior Thermal Moisture Management System (ETMMS) process. One project used an interior-only approach to roof air sealing and insulation. The remaining two projects used a deep energy retrofit approach for whole house (foundation wall, above grade wall, roof) air leakage and heat loss reduction. All were asked to provide information regarding project goals, process, and pre and post-blower door test results. Additional air leakage reduction data was provided by several NorthernSTAR industry partners for interior-applied, roof-only modifications on 1-1/2 story homes. The data represents homes in the general market as well as homes that were part of the state of Minnesota weatherization program. A goal was to compare exterior air sealing methods with interior approaches. This pool of data enabled the team to compare air tightness data from over 220 homes using similar air seal methods.

New Whole-House Solutions Case Study: The Impact of Thermostat Placement in Low-Load Homes in Sunny Climates

Energy Technology Data Exchange (ETDEWEB)

None

2016-02-23

The Building America team IBACOS has found that low-load homes (zero energy ready homes) have differing room-to-room load densities and highly variable load densities throughout the day and year because of solar gains and internal gains.

The impact of team familiarity and team leader experience on team coordination errors: A panel analysis of professional basketball teams

NARCIS (Netherlands)

Sieweke, Jost; Zhao, B.

2015-01-01

To explore the dynamics involved in team coordination, we examine the impact of team familiarity and team leader experience on team coordination errors (TCEs). We argue that team familiarity has a U-shaped effect on TCEs. We study the moderating effects of team leader prior experience and team

[Palliative home care in Westfalia-Lippe--baseline study 12 and 36 months after coming into effect of the "agreement to the implementation of ambulant home palliative careforterminally ill patients"].

Science.gov (United States)

Lux, E A; Althaus, A; Classen, B; Hilscher, H; Hofmeister, U; Holtappels, P; Mansfeld-Nies, R; Weller, H U

2013-07-25

On 2009-04-01 the Association of Statutory Health Insurance Physicians Westfalia-Lippe and health insurance organizations made an agreement to implement palliative home care for terminally ill patients. Based on this agreement, family doctors and palliativecardoctorscooperate,supported by coordinators. 12 and 36 months after coming into effect of the agreement a questionnaire was sent to the regional palliative care networks to collect data about supply structure, number of patients and their place of death. In the year 2011 85,410 people died in Westfalia-Lippe, 9.0% of them were included in palliative care structures. 69.5% of the included patients died at home, 9.9% in hospital (in 2010: 68.7% at home, 14.7% in hospital). A correlation between the population density or the number of included patients per palliative networkcould not be detected. Low-threshold access to palliative care networks(bothfamilydoctorand patientcancontact the palliative care team at any time) improves ambulant palliative care. Non-bureaucratic change from general home palliative care (German abbreviation: AAPV) to specialized home palliative care (SAPV) has proven successful in Westfalia-Lippe. Well-trained and experienced coordinators guarantee multidisciplinary and multiprofessional working of palliative care teams. In order to enhance palliative care in Westfalia-Lippe, data for quality assurance should be defined, periodically collected and evaluated in the future.

Final Scientific/Technical Report: Context-Aware Smart Home Energy Manager (CASHEM)

Energy Technology Data Exchange (ETDEWEB)

Foslien, Wendy K. [Honeywell International Inc., Golden Valley, MN (United States); Curtner, Keith L. [Honeywell International Inc., Golden Valley, MN (United States)

2013-01-15

Because of growing energy demands and shortages, residential home owners are turning to energy conservation measures and smart home energy management devices to help them reduce energy costs and live more sustainably. In this context, the Honeywell team researched, developed, and tested the Context Aware Smart Home Energy Manager (CASHEM) as a trusted advisor for home energy management. The project focused on connecting multiple devices in a home through a uniform user interface. The design of the user interface was an important feature of the project because it provided a single place for the homeowner to control all devices and was also where they received coaching. CASHEM then used data collected from homes to identify the contexts that affect operation of home appliances. CASHEM's goal was to reduce energy consumption while keeping the user's key needs satisfied. Thus, CASHEM was intended to find the opportunities to minimize energy consumption in a way that fit the user's lifestyle.

Implementing the patient-centered medical home in complex adaptive systems: Becoming a relationship-centered patient-centered medical home.

Science.gov (United States)

Flieger, Signe Peterson

This study explores the implementation experience of nine primary care practices becoming patient-centered medical homes (PCMH) as part of the New Hampshire Citizens Health Initiative Multi-Stakeholder Medical Home Pilot. The purpose of this study is to apply complex adaptive systems theory and relationship-centered organizations theory to explore how nine diverse primary care practices in New Hampshire implemented the PCMH model and to offer insights for how primary care practices can move from a structural PCMH to a relationship-centered PCMH. Eighty-three interviews were conducted with administrative and clinical staff at the nine pilot practices, payers, and conveners of the pilot between November and December 2011. The interviews were transcribed, coded, and analyzed using both a priori and emergent themes. Although there is value in the structural components of the PCMH (e.g., disease registries), these structures are not enough. Becoming a relationship-centered PCMH requires attention to reflection, sensemaking, learning, and collaboration. This can be facilitated by settings aside time for communication and relationship building through structured meetings about PCMH components as well as the implementation process itself. Moreover, team-based care offers a robust opportunity to move beyond the structures to focus on relationships and collaboration. (a) Recognize that PCMH implementation is not a linear process. (b) Implementing the PCMH from a structural perspective is not enough. Although the National Committee for Quality Assurance or other guidelines can offer guidance on the structural components of PCMH implementation, this should serve only as a starting point. (c) During implementation, set aside structured time for reflection and sensemaking. (d) Use team-based care as a cornerstone of transformation. Reflect on team structures and also interactions of the team members. Taking the time to reflect will facilitate greater sensemaking and learning and

Applicability of structured telephone monitoring to follow up heart ...

African Journals Online (AJOL)

Pilly Chillo

Keywords: heart failure, structured telephone, home monitoring, Tanzania ... in a parallel increase in HF admissions and a major impact on health care systems. ... was entered in Statistical Package for Social Sciences (SPSS) version 20 software for analysis. ..... Failure (DIAL): study design and preliminary observations.

Challenges for Infants’ Home Care: a Qualitative Study

Directory of Open Access Journals (Sweden)

Zeinab Hemati

2016-06-01

Full Text Available Background Home care is an acceptable strategy for the relationship between family and healthcare team and implementation of healthcare interventions, and infants’ nurses could play an important role in enhancing the capability of families and promoting child health in this area. This study examined challenges facing infants’ home care from nurses’ viewpoints in Iranian culture.Materials and MethodsA qualitative design was used to explain challenges facing infants’ home care from nurses’ viewpoints. Participants included 20 nurses’ working in the neonatal units of University hospitals in Isfahan, Iran in 2015. Data collection was done by interviewing nurses working in neonatal units of Shahid Beheshti and Alzahra hospitals. All the data were analyzed by qualitative content analysis.ResultsFour main categories of “The need to warn the community ", “culture",” need for security " and ” legal support" were extracted from the participants' explanations, indicating the dimensions of Challenges for Infants’ Home Care.Conclusion Nursing policy makers and managers are able to help to facilitate home care and improve the infants’ health through correcting the infrastructure and eliminating current obstacles.

Comparison of Home Retrofit Programs in Wisconsin

Energy Technology Data Exchange (ETDEWEB)

Cunningham, Kerrie [Univ. of Minnesota, St. Paul, MN (United States). NorthernSTAR Building America Partnership; Hannigan, Eileen [Univ. of Minnesota, St. Paul, MN (United States). NorthernSTAR Building America Partnership

2013-03-01

To explore ways to reduce customer barriers and increase home retrofit completions, several different existing home retrofit models have been implemented in the state of Wisconsin. This study compared these programs' performance in terms of savings per home and program cost per home to assess the relative cost-effectiveness of each program design. However, given the many variations in these different programs, it is difficult to establish a fair comparison based on only a small number of metrics. Therefore, the overall purpose of the study is to document these programs' performance in a case study approach to look at general patterns of these metrics and other variables within the context of each program. This information can be used by energy efficiency program administrators and implementers to inform home retrofit program design. Six different program designs offered in Wisconsin for single-family energy efficiency improvements were included in the study. For each program, the research team provided information about the programs' approach and goals, characteristics, achievements and performance. The program models were then compared with performance results-program cost and energy savings-to help understand the overall strengths and weaknesses or challenges of each model.

Comparison of Home Retrofit Programs in Wisconsin

Energy Technology Data Exchange (ETDEWEB)

Cunningham, K.; Hannigan, E.

2013-03-01

To explore ways to reduce customer barriers and increase home retrofit completions, several different existing home retrofit models have been implemented in the state of Wisconsin. This study compared these programs' performance in terms of savings per home and program cost per home to assess the relative cost-effectiveness of each program design. However, given the many variations in these different programs, it is difficult to establish a fair comparison based on only a small number of metrics. Therefore, the overall purpose of the study is to document these programs' performance in a case study approach to look at general patterns of these metrics and other variables within the context of each program. This information can be used by energy efficiency program administrators and implementers to inform home retrofit program design. Six different program designs offered in Wisconsin for single-family energy efficiency improvements were included in the study. For each program, the research team provided information about the programs' approach and goals, characteristics, achievements and performance. The program models were then compared with performance results -- program cost and energy savings -- to help understand the overall strengths and weaknesses or challenges of each model.

In vitro and in vivo assessment of heart-homing porous silicon nanoparticles.

Science.gov (United States)

Ferreira, Mónica P A; Ranjan, Sanjeev; Correia, Alexandra M R; Mäkilä, Ermei M; Kinnunen, Sini M; Zhang, Hongbo; Shahbazi, Mohammad-Ali; Almeida, Patrick V; Salonen, Jarno J; Ruskoaho, Heikki J; Airaksinen, Anu J; Hirvonen, Jouni T; Santos, Hélder A

2016-07-01

Chronic heart failure, predominantly developed after myocardial infarction, is a leading cause of high mortality worldwide. As existing therapies have still limited success, natural and/or synthetic nanomaterials are emerging alternatives for the therapy of heart diseases. Therefore, we aimed to functionalize undecylenic acid thermally hydrocarbonized porous silicon nanoparticles (NPs) with different targeting peptides to improve the NP's accumulation in different cardiac cells (primary cardiomyocytes, non-myocytes, and H9c2 cardiomyoblasts), additionally to investigate the behavior of the heart-targeted NPs in vivo. The toxicity profiles of the NPs evaluated in the three heart-type cells showed low toxicity at concentrations up to 50 μg/mL. Qualitative and quantitative cellular uptake revealed a significant increase in the accumulation of atrial natriuretic peptide (ANP)-modified NPs in primary cardiomyocytes, non-myocytes and H9c2 cells, and in hypoxic primary cardiomyocytes and non-myocytes. Competitive uptake studies in primary cardiomyocytes showed the internalization of ANP-modified NPs takes place via the guanylate cyclase-A receptor. When a myocardial infarction rat model was induced by isoprenaline and the peptide-modified [(111)In]NPs administered intravenously, the targeting peptides, particularly peptide 2, improved the NPs' accumulation in the heart up to 3.0-fold, at 10 min. This study highlights the potential of these peptide-modified nanosystems for future applications in heart diseases. Copyright © 2016 Elsevier Ltd. All rights reserved.

Better team management--better team care?

Science.gov (United States)

Shelley, P; Powney, B

1994-01-01

Team building should not be a 'bolt-on' extra, it should be a well planned, integrated part of developing teams and assisting their leaders. When asked to facilitate team building by a group of NHS managers we developed a framework which enabled individual members of staff to become more effective in the way they communicated with each other, their teams and in turn within the organization. Facing the challenge posed by complex organizational changes, staff were able to use 3 training days to increase and develop their awareness of the principles of teamwork, better team management, and how a process of leadership and team building could help yield better patient care.

Getting home with artifical heart – what is the everyday life experience of people with mechanical circulatory Support. A qualitative study

Science.gov (United States)

Braunsdorf, Sandy

2017-07-01

Background: The growing number of mechanical circulatory support systems implanted with successful results in terms of quality of life and physical resilience means that more and more people are being discharged from hospital to live at home with an artificial heart. This puts high requirements on affected persons’ disease and therapy management – a subject which has attracted very little qualitative research to date. Aim: This study therefore sought to shed light on how people with mechanical circulatory support experience their everyday lives. The aim was to document the subjective associations of those affected from an insider perspective. Methods: Following the interpretative phenomenological paradigm, narrative interviews were conducted with two female and eight male participants. For qualitative analysis, a multi-step process guided by the methodology of hermeneutic philosophy was used. Results: The qualitative data analysis revealed five main topic areas. These describe patients’ state of health after implantation and the various adjustments, constraints and pressures necessitated by their illness and therapeutic requirements. On this basis, coping and management strategies are identified. Other significant aspects of patients’ everyday lives are social interaction and environment and health care with an artificial heart. Conclusions: The findings add to our knowledge of the day-to-day lives of people with mechanical circulatory support systems, giving us a better understanding of their specific situation.

Team responsibility structure and team performance

NARCIS (Netherlands)

Doorewaard, J.A.C.M.; Hootegem, G. van; Huys, R.

2002-01-01

The purpose is to analyse the impact of team responsibility (the division of job regulation tasks between team leader and team members) on team performance. It bases an analysis on 36 case studies in The Netherlands which are known to have implemented team‐based work. The case studies were executed

The first experience of mobile pediatric palliative team in Ukraine

Directory of Open Access Journals (Sweden)

O. О. Riga

2016-12-01

Full Text Available The aim of the study was to identify needs among young children with life-limiting diseases under 4 years old and their parents living in rural area of Kharkiv region Ukraine during home visiting. Materials and methods. After the creation of the first mobile pediatric palliative team, we reviewed the visits of 31 families at home to define their clinical, and psychological, and social needs. The first mobile pediatric palliative care team has been created for 2015. 31 families who have young children with life –threating diseases were visited to determine their clinical, and psychological, and social needs. Results. All children (31 had severe pathology of the central nervous system: congenital birth defects (29 %; cerebral palsy (35.4 %; genetic disorders (12.9 %. Parental and children’s needs were divided into three categories. Medical needs: orthopedic (93.5 %, vaccination (93.5 %, food (80.6 %, posture (61.3 %, salivation (32.2 %, anticonvulsant therapy (16 %. Psychological problems: communication with siblings (100 %; socialization of children (90.3 %; sensory activity (83.8 %, parental relationships (74.2 %. Social issues: the need for support/social worker or volunteers (58.1 %, poverty (58.1 %, communication with local rehabilitation centers (54.8 %, the need for medical equipment (41.9 %. Along with high medical, social and psychological needs of children with incurable diseases, both they and their families feel the lack of pediatric palliative care, and at present they have no access to it. The authors suggest that pediatric palliative care in Ukraine requires its development, application and inclusion in the general health care at all levels of the health system. The establishment of a national concept of modern educational programs, protocols and standards, dissemination of public information communities is also very necessary due to author’s point of view. Conclusions. Mobile team that performs home visits may be one of the

Indirect Solar Water Heating in Single-Family, Zero Energy Ready Homes

Energy Technology Data Exchange (ETDEWEB)

Aldrich, Robb [Steven Winters Associates, Inc., Norwalk, CT (United States)

2016-02-01

In western Massachusetts, an affordable housing developer built a community of 20 homes with the goal of approaching zero energy consumption. In addition to excellent thermal envelopes and photovoltaic systems, the developer installed a solar domestic hot water (SDHW) system on each home. The Consortium for Advanced Residential Buildings (CARB), a U.S. Department of Energy Building America research team, commissioned some of the systems, and CARB was able to monitor detailed performance of one system for 28 months.

Team cohesion and team success in sport.

Science.gov (United States)

Carron, Albert V; Bray, Steven R; Eys, Mark A

2002-02-01

The main aim of this study was to examine the relationship between task cohesiveness and team success in elite teams using composite team estimates of cohesion. A secondary aim was to determine statistically the consistency (i.e. 'groupness') present in team members' perceptions of cohesion. Elite university basketball teams (n = 18) and club soccer teams (n = 9) were assessed for cohesiveness and winning percentages. Measures were recorded towards the end of each team's competitive season. Our results indicate that cohesiveness is a shared perception, thereby providing statistical support for the use of composite team scores. Further analyses indicated a strong relationship between cohesion and success (r = 0.55-0.67). Further research using multi-level statistical techniques is recommended.

Sustainability of Physical Activity Promoting Environments and Influences on Sustainability Following a Structural Intervention in Residential Children's Homes

Science.gov (United States)

Dominick, Gregory M.; Tudose, Alina; Pohlig, Ryan T.; Saunders, Ruth P.

2016-01-01

Research examining sustainability of health promotion programs within organizational settings is limited. The Environmental Interventions in Residential Children's Homes (ENRICH) was a structural intervention that trained Wellness Teams (WTs) within residential children's homes (RCH) to target environmental changes that promote physical activity…

National Structural Survey of Veterans Affairs Home-Based Primary Care Programs.

Science.gov (United States)

Karuza, Jurgis; Gillespie, Suzanne M; Olsan, Tobie; Cai, Xeuya; Dang, Stuti; Intrator, Orna; Li, Jiejin; Gao, Shan; Kinosian, Bruce; Edes, Thomas

2017-12-01

To describe the current structural and practice characteristics of the Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program. We designed a national survey and surveyed HBPC program directors on-line using REDCap. We received 236 surveys from 394 identified HBPC sites (60% response rate). HBPC site characteristics were quantified using closed-ended formats. HBPC program directors were most often registered nurses, and HBPC programs primarily served veterans with complex chronic illnesses that were at high risk of hospitalization and nursing home care. Primary care was delivered using interdisciplinary teams, with nurses, social workers, and registered dietitians as team members in more than 90% of the sites. Most often, nurse practitioners were the principal primary care providers (PCPs), typically working with nurse case managers. Nearly 60% of the sites reported dual PCPs involving VA and community-based physicians. Nearly all sites provided access to a core set of comprehensive services and programs (e.g., case management, supportive home health care). At the same time, there were variations according to site (e.g., size, location (urban, rural), use of non-VA hospitals, primary care models used). HBPC sites reflected the rationale and mission of HBPC by focusing on complex chronic illness of home-based veterans and providing comprehensive primary care using interdisciplinary teams. Our next series of studies will examine how HBPC site structural characteristics and care models are related to the processes and outcomes of care to determine whether there are best practice standards that define an optimal HBPC structure and care model or whether multiple approaches to HBPC better serve the needs of veterans. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Heart rate measurement based on face video sequence

Science.gov (United States)

Xu, Fang; Zhou, Qin-Wu; Wu, Peng; Chen, Xing; Yang, Xiaofeng; Yan, Hong-jian

2015-03-01

This paper proposes a new non-contact heart rate measurement method based on photoplethysmography (PPG) theory. With this method we can measure heart rate remotely with a camera and ambient light. We collected video sequences of subjects, and detected remote PPG signals through video sequences. Remote PPG signals were analyzed with two methods, Blind Source Separation Technology (BSST) and Cross Spectral Power Technology (CSPT). BSST is a commonly used method, and CSPT is used for the first time in the study of remote PPG signals in this paper. Both of the methods can acquire heart rate, but compared with BSST, CSPT has clearer physical meaning, and the computational complexity of CSPT is lower than that of BSST. Our work shows that heart rates detected by CSPT method have good consistency with the heart rates measured by a finger clip oximeter. With good accuracy and low computational complexity, the CSPT method has a good prospect for the application in the field of home medical devices and mobile health devices.

A comparative study of a new wireless continuous cardiorespiratory monitor for the diagnosis and management of patients with congestive heart failure at home.

Science.gov (United States)

Andrews, D; Gouda, M S; Higgins, S; Johnson, P; Williams, A; Vandenburg, M

2002-01-01

Congestive heart failure (CHF) is a major and increasing chronic disease in Western society, with a high mortality, morbidity and cost for unplanned hospital admissions. Continuous cardiorespiratory monitoring is required to detect Cheyne-Stokes respiration (CSR). We have tested a new wireless monitoring system and compared it with polysomnography (PSG) and respiratory inductance plethysmography (RIP) in six CHF patients with CSR in a sleep laboratory. The wireless system compared well with RIP for the detection of CSR but less well with PSG, which had unexpected but significant respiratory sensing errors that led to misclassification of the respiratory disorder present. The wireless system could be used to select CHF patients for better-customized treatment at home as part of a specialist-supported community telemedicine programme.

Improving Care Teams' Functioning: Recommendations from Team Science.

Science.gov (United States)

Fiscella, Kevin; Mauksch, Larry; Bodenheimer, Thomas; Salas, Eduardo

2017-07-01

Team science has been applied to many sectors including health care. Yet there has been relatively little attention paid to the application of team science to developing and sustaining primary care teams. Application of team science to primary care requires adaptation of core team elements to different types of primary care teams. Six elements of teams are particularly relevant to primary care: practice conditions that support or hinder effective teamwork; team cognition, including shared understanding of team goals, roles, and how members will work together as a team; leadership and coaching, including mutual feedback among members that promotes teamwork and moves the team closer to achieving its goals; cooperation supported by an emotionally safe climate that supports expression and resolution of conflict and builds team trust and cohesion; coordination, including adoption of processes that optimize efficient performance of interdependent activities among team members; and communication, particularly regular, recursive team cycles involving planning, action, and debriefing. These six core elements are adapted to three prototypical primary care teams: teamlets, health coaching, and complex care coordination. Implementation of effective team-based models in primary care requires adaptation of core team science elements coupled with relevant, practical training and organizational support, including adequate time to train, plan, and debrief. Training should be based on assessment of needs and tasks and the use of simulations and feedback, and it should extend to live action. Teamlets represent a potential launch point for team development and diffusion of teamwork principles within primary care practices. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Relationships among Team Trust, Team Cohesion, Team Satisfaction and Project Team Effectiveness as Perceived by Project Managers in Malaysia

OpenAIRE

Han-Ping Fung

2014-01-01

Today, more and more project teams are formed to achieve organizational objectives as organizations generally recognized the importance and benefits of project teams. There is a compelling reason to study what are the team outcome factors that can predict project team effectiveness as it is unclear whether these team outcome factors can yield the same result in project setting whereby there is resource and time constraint compare to normal work teams which are ongoing and operational in natur...

Challenges for heart disease stem cell therapy

Directory of Open Access Journals (Sweden)

Hoover-Plow J

2012-02-01

Full Text Available Jane Hoover-Plow, Yanqing GongDepartments of Cardiovascular Medicine and Molecular Cardiology, Joseph J Jacobs Center for Thrombosis and Vascular Biology, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USAAbstract: Cardiovascular diseases (CVDs are the leading cause of death worldwide. The use of stem cells to improve recovery of the injured heart after myocardial infarction (MI is an important emerging therapeutic strategy. However, recent reviews of clinical trials of stem cell therapy for MI and ischemic heart disease recovery report that less than half of the trials found only small improvements in cardiac function. In clinical trials, bone marrow, peripheral blood, or umbilical cord blood cells were used as the source of stem cells delivered by intracoronary infusion. Some trials administered only a stem cell mobilizing agent that recruits endogenous sources of stem cells. Important challenges to improve the effectiveness of stem cell therapy for CVD include: (1 improved identification, recruitment, and expansion of autologous stem cells; (2 identification of mobilizing and homing agents that increase recruitment; and (3 development of strategies to improve stem cell survival and engraftment of both endogenous and exogenous sources of stem cells. This review is an overview of stem cell therapy for CVD and discusses the challenges these three areas present for maximum optimization of the efficacy of stem cell therapy for heart disease, and new strategies in progress.Keywords: mobilization, expansion, homing, survival, engraftment

Mini-Split Heat Pump Evaluation and Zero Energy Ready Home Support

Energy Technology Data Exchange (ETDEWEB)

Herk, Anastasia [IBACOS, Inc., Pittsburgh, PA (United States)

2017-01-01

This project was created from a partnership between the U.S. Department of Energy’s (DOE’s) Building America research team IBACOS, Inc. and Imagine Homes, a production homebuilder of high-performance homes in San Antonio, Texas—a hot-humid climate. The primary purpose was to evaluate the performance of a multihead mini-split heat pump (MSHP) space-conditioning system, which consists of ducted and ductless indoor units, in maintaining uniform comfort in an occupied test house. The research team evaluated the MSHP space-conditioning strategy for its effectiveness in achieving uniform temperature and relative humidity (RH) levels throughout the test house and for overall constructability and cost. This evaluation was based on data that were collected from short-term tests and monitoring during 1 year of occupancy, as well as from builder and occupant feedback. Design considerations for integrating an MSHP system into the builder’s full range of production home designs were also explored, with a focus on minimizing the cost and complexity of the system design while meeting the thermal loads of the house and providing occupant comfort according to ANSI/ASHRAE Standard 55-2010 (ASHRAE 2010a).

Advancing Replicable Solutions for High-Performance Homes in the Southeast

Energy Technology Data Exchange (ETDEWEB)

Roberts, S. G. [Southface Energy Inst., Upper Marlboro, MD (United States); Sweet, M. L. [Southface Energy Inst., Upper Marlboro, MD (United States); Francisco, A. [Southface Energy Inst., Upper Marlboro, MD (United States)

2016-03-01

Southface Energy Institute (Southface) partnered with owners and/or builders with various market constraints and ultimate goals for three projects in different climate zones: Savannah, GA (CZ 2), Clemson, SC (CZ 3), and LaFayette, GA (CZ 4). This report documents the design process, computational energy modeling, construction, envelope performance metrics, long-term monitoring results, and successes and failures of the design and execution of these high performance homes. The three bedroom/two bathroom test home in Savannah Gardens on an elevated slab foundation has a semi-conditioned, encapsulated attic. A neighboring home built to EarthCraft specifications was also monitored as a control for exterior foam insulation and a heat pump water heater (HPWH). For the JMC Patrick Square, a single-story project in Clemson, the small-scale production builder wanted to increase their level of energy efficiency beyond their current green building practices, including bringing ducts into conditioned space. Through a combination of upgrade measures the team met this goal and achieved many Zero Energy Ready Home requirements. LaFayette Housing Authority undertook a development of 30 affordable rental housing units in 15 duplexes in LaFayette, GA. Because they would be long-term owners, their priorities were low utility bills for the residents and durable, maintainable buildings. The team employed BEopt to optimize buildling envelope and systems choices, including 2x6 advanced framed walls, insulated slab, and heat pump water heater in a utility closet which was ducted to/from an encapsulated attic.

Spirit's View Beside 'Home Plate' on Sol 1823 (Stereo)

Science.gov (United States)

2009-01-01

[figure removed for brevity, see original site] Left-eye view of a color stereo pair for PIA11971 [figure removed for brevity, see original site] Right-eye view of a color stereo pair for PIA11971 NASA's Mars Exploration Rover Spirit used its navigation camera to take the images that have been combined into this stereo, 180-degree view of the rover's surroundings during the 1,823rd Martian day, or sol, of Spirit's surface mission (Feb. 17, 2009). This view combines images from the left-eye and right-eye sides of the navigation camera. It appears three-dimensional when viewed through red-blue glasses with the red lens on the left. The center of the view is toward the south-southwest. The rover had driven 7 meters (23 feet) eastward earlier on Sol 1823, part of maneuvering to get Spirit into a favorable position for climbing onto the low plateau called 'Home Plate.' However, after two driving attempts with negligible progress during the following three sols, the rover team changed its strategy for getting to destinations south of Home Plate. The team decided to drive Spirit at least partway around Home Plate, instead of ascending the northern edge and taking a shorter route across the top of the plateau. Layered rocks forming part of the northern edge of Home Plate can be seen near the center of the image. Rover wheel tracks are visible at the lower edge. This view is presented as a cylindrical-perspective projection with geometric seam correction.

Making Teamwork Work: Team Knowledge for Team Effectiveness.

Science.gov (United States)

Guchait, Priyanko; Lei, Puiwa; Tews, Michael J

2016-01-01

This study examined the impact of two types of team knowledge on team effectiveness. The study assessed the impact of taskwork knowledge and teamwork knowledge on team satisfaction and performance. A longitudinal study was conducted with 27 service-management teams involving 178 students in a real-life restaurant setting. Teamwork knowledge was found to impact both team outcomes. Furthermore, team learning behavior was found to mediate the relationships between teamwork knowledge and team outcomes. Educators and managers should therefore ensure these types of knowledge are developed in teams along with learning behavior for maximum effectiveness.

A team approach in palliative care: enhancing outcomes.

Science.gov (United States)

Schrader, Susan L; Horner, Arlene; Eidsness, LuAnn; Young, Sandy; Wright, Chris; Robinson, Michael

2002-07-01

While most Americans envision a "good death" as one occurring quickly and painlessly at home surrounded by loved ones, many people do not die in this fashion. Palliative care focuses on holistic treatment of patients whose disease is not responsive to curative treatment, and strives to improve quality of life for patients and families at end-of-life (EOL). This hospital-based study examines the extent to which a palliative care consultant team makes a difference in EOL for patients and families. Data were collected from a convenience sample of 50 hospitalized patients referred to an interdisciplinary palliative care consulting team at a South Dakota tertiary hospital during 2001. Various palliative care interventions were introduced during the course of hospitalization, and data were collected two days later to see if quality of life had improved. Statistically significant improvements were found in pain levels, non-pain symptom management, numerous psychosocial measures of quality of life, change in code status, and perceptions of communication and treatment during hospitalization. The study demonstrates that consultations with a palliative care team are beneficial and enhance the EOL experience for patients and families.

Northwest Energy Efficient Manufactured Housing Program High-Performance Test Homes

Energy Technology Data Exchange (ETDEWEB)

Hewes, Tom; Peeks, Brady

2015-09-15

?This project represents the third phase of a multi-year effort to develop and bring to market a High Performance Manufactured Home (HPMH). The scope of this project involved building four HPMH prototypes, resulting in what is expected to be a 30% savings relative to the Building America Benchmark. (The actual % savings varies depending on choice of heating equipment and climate zone). The HPMH home is intended to make significant progress toward performing as zero-net-energy ready. Previous phases of this project created a HPMH specification and prototyped individual measures from the package to obtain engineering approvals and develop preliminary factory construction processes. This report describes the project team's work during 2014 to build prototype homes to the HPMH specifications and to monitor the homes for energy performance and durability during 2014. Monitoring is expected to continue into 2016.

When Teams Break Down: A Study of the Active Army/National Guard Feud of 1997

National Research Council Canada - National Science Library

Collins, Ruth

1998-01-01

Teamwork is at the heart of all that is good and successful about the U.S. Army. Because it is so critical to warfighting and to all other missions, peacetime and wartime, we are taught not to expect anything good when teams break down...

Ultra-Short-Term Heart Rate Variability is Sensitive to Training Effects in Team Sports Players.

Science.gov (United States)

Nakamura, Fabio Y; Flatt, Andrew A; Pereira, Lucas A; Ramirez-Campillo, Rodrigo; Loturco, Irineu; Esco, Michael R

2015-09-01

The aim of this study was to test the possibility of the ultra-short-term lnRMSSD (measured in 1-min post-1-min stabilization period) to detect training induced adaptations in futsal players. Twenty-four elite futsal players underwent HRV assessments pre- and post-three or four weeks preseason training. From the 10-min HRV recording period, lnRMSSD was analyzed in the following time segments: 1) from 0-5 min (i.e., stabilization period); 2) from 0-1 min; 1-2 min; 2-3 min; 3-4 min; 4-5 min and; 3) from 5-10 min (i.e., criterion period). The lnRMSSD was almost certainly higher (100/00/00) using the magnitude-based inference in all periods at the post- moment. The correlation between changes in ultra-short-term lnRMSSD (i.e., 0-1 min; 1-2 min; 2-3 min; 3-4 min; 4-5 min) and lnRMSSDCriterion ranged between 0.45-0.75, with the highest value (p = 0.75; 90% CI: 0.55 - 0.85) found between ultra-short-term lnRMDSSD at 1-2 min and lnRMSSDCriterion. In conclusion, lnRMSSD determined in a short period of 1-min is sensitive to training induced changes in futsal players (based on the very large correlation to the criterion measure), and can be used to track cardiac autonomic adaptations. Key pointsThe ultra-short-term (1 min) natural log of the root-mean-square difference of successive normal RR intervals (lnRMSSD) is sensitive to training effects in futsal playersThe ultra-short-term lnRMSSD may simplify the assessment of the cardiac autonomic changes in the field compared to the traditional and lengthier (10 min duration) analysisCoaches are encouraged to implement the ultra-short-term heart rate variability in their routines to monitor team sports athletes.

HEART FAILURE – KEEPING STEP WITH THE PROGRESS

Directory of Open Access Journals (Sweden)

Camelia Diaconu

2018-06-01

Full Text Available Chronic heart failure continues to represent a major problem for the healthcare systems worldwide, because of high prevalence and impact on patients’ quality of life. Between May 25-28, 2018, in Vienna, Austria, took place the European Congress of Heart Failure and the World Congress on Acute Heart Failure, organized by the European Society of Cardiology. The congress was a forum of exchanging expertise in diagnosis and treatment of heart failure, and also an opportunity to present the latest progresses regarding the management of this pathology. It seems that an integrated, multidisciplinary team approach is the future for heart failure management. This team should include internists, cardiologists, general practitioners, and nurses. The new President of the Heart Failure Association of the European Society of Cardiology is from a Balkan country, Prof. Petar M. Seferovic, from the Belgrade University Medical Center, Serbia. In one of his presentations, Prof. Seferovic highlighted that the treatment of chronic heart failure should explore new frontiers. Recently, there is much interest in established antidiabetic drugs to treat cardiovascular complications of diabetes. Introduction of sodium-glucose transport protein 2 (SGLT2 inhibitors in the late 1990s was a major breakthrough in the treatment of diabetes complications. These drugs are the only antidiabetic drugs with good results in the treatment of cardiovascular diseases, demonstrated by several large randomized controlled trials, such as EMPA-REG (the first study to demonstrate a significant reduction in both cardiovascular mortality and heart failure-related hospitalization in patients treated with empaglifozin, a SGLT2 inhibitor. SGLT2 inhibitors are now recommended by some guidelines for the prevention of heart failure and associated mortality in patients with type 2 diabetes. The international registry REPORT HF, presented in Vienna, enrolled more than 18,000 patients from 44

Self-care in Patients with Heart Failure

Directory of Open Access Journals (Sweden)

Maria do Céu Mendes Pinto Marques

2016-04-01

Full Text Available Objectives: To adapt the Self-Care of Heart Failure Index V6.2 to Portuguese and analyze self-care capability in maintenance, management and self-confidence in patients with heart failure attending nursing care services at two Portuguese hospitals. Method: Exploratory study, sample of 110 patients who attended the nursing care service for patients with heart failure at two Portuguese hospitals, carried out over a six-month period. Descriptive statistics and psychometric tests were used. Results: Internal consistency similar to the original scale. The patients consisted mostly of older adults with low self-care literacy, low values associated with physical activity and salt control in meals taken outside the home, and inadequate control of signs and symptoms. Conclusion: Patients present difficulties in maintenance and management of the disease, and are self-confident regarding it. This instrument enables individualized assessment leading to decision-making and adjusted action.

The determinants of home and nursing home death: a systematic review and meta-analysis.

Science.gov (United States)

Costa, Vania; Earle, Craig C; Esplen, Mary Jane; Fowler, Robert; Goldman, Russell; Grossman, Daphna; Levin, Leslie; Manuel, Douglas G; Sharkey, Shirlee; Tanuseputro, Peter; You, John J

2016-01-20

Most Canadians die in hospital, and yet, many express a preference to die at home. Place of death is the result of the interaction among sociodemographic, illness- and healthcare-related factors. Although home death is sometimes considered a potential indicator of end-of-life/palliative care quality, some determinants of place of death are more modifiable than others. The objective of this systematic review was to evaluate the determinants of home and nursing home death in adult patients diagnosed with an advanced, life-limiting illness. A systematic literature search was performed for studies in English published from January 1, 2004 to September 24, 2013 that evaluated the determinants of home or nursing home death compared to hospital death in adult patients with an advanced, life-limiting condition. The adjusted odds ratios, relative risks, and 95% confidence intervals of each determinant were extracted from the studies. Meta-analyses were performed if appropriate. The quality of individual studies was assessed using the Newcastle-Ottawa scale and the body of evidence was assessed according to the GRADE Working Group criteria. Of the 5,900 citations identified, 26 retrospective cohort studies were eligible. The risk of bias in the studies identified was considered low. Factors associated with an increased likelihood of home versus hospital death included multidisciplinary home palliative care, preference for home death, cancer as opposed to other diagnoses, early referral to palliative care, not living alone, having a caregiver, and the caregiver's coping skills. Knowledge about the determinants of place of death can be used to inform care planning between healthcare providers, patients and family members regarding the feasibility of dying in the preferred location and may help explain the incongruence between preferred and actual place of death. Modifiable factors such as early referral to palliative care, presence of a multidisciplinary home palliative care

2015 ACC Health Policy Statement on Cardiovascular Team-Based Care and the Role of Advanced Practice Providers.

Science.gov (United States)

Brush, John E; Handberg, Eileen M; Biga, Cathleen; Birtcher, Kim K; Bove, Alfred A; Casale, Paul N; Clark, Michael G; Garson, Arthur; Hines, Jerome L; Linderbaum, Jane A; Rodgers, George P; Shor, Robert A; Thourani, Vinod H; Wyman, Janet F

2015-05-19

The mission of the American College of Cardiology is "to transform cardiovascular care and improve heart health." Cardiovascular team-based care is a paradigm for practice that can transform care, improve heart health, and help meet the demands of the future. One strategic goal of the College is to help members successfully transition their clinical practices to the future, with all its complexity, challenges, and opportunities. The ACC's strategic plan is aligned with the triple aim of improved care, improved population health, and lower costs per capita. The traditional understanding of quality, access, and cost is that you cannot improve one component without diminishing the others. With cardiovascular team-based care, it is possible to achieve the triple aim of improving quality, access, and cost simultaneously to also improve cardiovascular health. Striving to serve the best interests of patients is the true north of our guiding principles. Cardiovascular team-based care is a model that can improve care coordination and communication and allow each team member to focus more on the quality of care. In addition, the cardiovascular team-based care model increases access to cardiovascular care and allows expansion of services to populations and geographic areas that are currently underserved. This document will increase awareness of the important components of cardiovascular team-based care and create an opportunity for more discussion about the most creative and effective means of implementing it. We hope that this document will stimulate further discussions and activities within the ACC and beyond about team-based care. We have identified areas that need improvement, specifically in APP education and state regulation. The document encourages the exploration of collaborative care models that should enable team members to optimize their education, training, experience, and talent. Improved team leadership, coordination, collaboration, engagement, and efficiency

Broken Heart Syndrome – An intra operative complication

Directory of Open Access Journals (Sweden)

Zara Wani

2018-03-01

Full Text Available We report a case of Broken Heart Syndrome in a 56 year old Postmenopausal woman suffered while undergoing simple biopsy procedure for vocal cord polyp that lead to physical, mental and financial burden both for the patient as well as the doctors. A team of cardiologists based on clinical and echocardiographic findings made the diagnosis of this case.

The role and organisation of community palliative specialist nursing teams in rural England.

Science.gov (United States)

Leadbeater, Maria; Staton, Wendy

2014-11-01

This article describes a study that used a qualitative approach, purposive sampling and semi-structured telephone interviews conducted with specialist palliative care nurses from six rural community teams in England. The study investigated how services were organised and the issues of delivering specialist palliative nursing care in a rural area. Qualitative content analysis was used to analyse the data. The findings showed many similarities in that the majority of patients in rural areas were not accessing hospice services and there was a greater reliance on care at home. However, the challenges in delivering care ranged from managing patient expectations, geographical distance, lack of technology to support remote working and education for the specialist palliative care teams. The study makes specific recommendations for rural community specialist palliative care teams.

Poor Reliability of Wrist Blood Pressure Self-Measurement at Home: A Population-Based Study.

Science.gov (United States)

Casiglia, Edoardo; Tikhonoff, Valérie; Albertini, Federica; Palatini, Paolo

2016-10-01

The reliability of blood pressure measurement with wrist devices, which has not previously been assessed under real-life circumstances in general population, is dependent on correct positioning of the wrist device at heart level. We determined whether an error was present when blood pressure was self-measured at the wrist in 721 unselected subjects from the general population. After training, blood pressure was measured in the office and self-measured at home with an upper-arm device (the UA-767 Plus) and a wrist device (the UB-542, not provided with a position sensor). The upper-arm-wrist blood pressure difference detected in the office was used as the reference measurement. The discrepancy between office and home differences was the home measurement error. In the office, systolic blood pressure was 2.5% lower at wrist than at arm (P=0.002), whereas at home, systolic and diastolic blood pressures were higher at wrist than at arm (+5.6% and +5.4%, respectively; Pblood pressure values likely because of a poor memory and rendition of the instructions, leading to the wrong position of the wrist. © 2016 American Heart Association, Inc.

An analytics approach to designing patient centered medical homes.

Science.gov (United States)

Ajorlou, Saeede; Shams, Issac; Yang, Kai

2015-03-01

Recently the patient centered medical home (PCMH) model has become a popular team based approach focused on delivering more streamlined care to patients. In current practices of medical homes, a clinical based prediction frame is recommended because it can help match the portfolio capacity of PCMH teams with the actual load generated by a set of patients. Without such balances in clinical supply and demand, issues such as excessive under and over utilization of physicians, long waiting time for receiving the appropriate treatment, and non-continuity of care will eliminate many advantages of the medical home strategy. In this paper, by using the hierarchical generalized linear model with multivariate responses, we develop a clinical workload prediction model for care portfolio demands in a Bayesian framework. The model allows for heterogeneous variances and unstructured covariance matrices for nested random effects that arise through complex hierarchical care systems. We show that using a multivariate approach substantially enhances the precision of workload predictions at both primary and non primary care levels. We also demonstrate that care demands depend not only on patient demographics but also on other utilization factors, such as length of stay. Our analyses of a recent data from Veteran Health Administration further indicate that risk adjustment for patient health conditions can considerably improve the prediction power of the model.

Use of a virtual environment to facilitate instruction of an interprofessional home assessment.

Science.gov (United States)

Sabus, Carla; Sabata, Dory; Antonacci, David

2011-01-01

Technology has become a ubiquitous part of our society and is largely embedded in today's educational system. 3D virtual reality technology can be used to simulate environments and activities and may be used as an instructional technology. The purpose of this research was to better understand the utility of a web-based virtual environment as a teaching tool to represent clinical assessment and interventions in the home environment. Specifically, students' learning outcomes related to interprofessional collaboration, patient-centered decision-making, and appreciation of the environmental and social context of functional mobility and occupational performance will be described through descriptive analysis. Thirty-four physical therapist students and 35 occupational therapist students participated in an instructor-guided virtual assessment of a client's function in a home environment utilizing a virtual environment, Second Life®. Teams formulated task-specific, functional client goals and home modification recommendations. Students revisited a solution virtual environment to view and evaluate recommendations in a follow-up instructor-guided tour. Students completed a web-based survey capturing student perception of the experience. Team assignments were analyzed based on a rubric representing learning objectives. Descriptive analysis was conducted on the survey. Assignment analysis revealed contextual and client-centered recommendations. Student surveys revealed that students found the virtual environment supportive of learning. Student surveys and reflection statements were supportive of the interprofessional collaboration. Use of a virtual environment in instruction allows an authentic means of representing interprofessional home assessment. The virtual environment allowed a temporal depiction of home environment issues and solutions providing the unique opportunity for students to evaluate home recommendations.

Faculty and Student Teams and National Laboratories: Expanding the Reach of Research Opportunities and Workforce Development

Energy Technology Data Exchange (ETDEWEB)

Blackburn,N.; White, K.; Stegman, M.

2009-08-05

The Faculty and Student Teams (FaST) Program, a cooperative effort between the US Department of Energy (DOE) Office of Science and the National Science Foundation (NSF), brings together collaborative research teams composed of a researcher at Brookhaven National Laboratory, and a faculty member with two or three undergraduate students from a college or university. Begun by the Department of Energy in 2000 with the primary goal of building research capacity at a faculty member's home institution, the FaST Program focuses its recruiting efforts on faculty from colleges and universities with limited research facilities and those institutions that serve populations under-represented in the fields of science, engineering and technology, particularly women and minorities. Once assembled, a FaST team spends a summer engaged in hands-on research working alongside a laboratory scientist. This intensely collaborative environment fosters sustainable relationships between the faulty members and BNL that allow faculty members and their BNL colleagues to submit joint proposals to federal agencies, publish papers in peer-reviewed journals, reform local curriculum, and develop new or expand existing research labs at their home institutions.

Characteristics, quality of care, and in-hospital outcomes of Asian-American heart failure patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program.

Science.gov (United States)

Qian, Feng; Fonarow, Gregg C; Krim, Selim R; Vivo, Rey P; Cox, Margueritte; Hannan, Edward L; Shaw, Benjamin A; Hernandez, Adrian F; Eapen, Zubin J; Yancy, Clyde W; Bhatt, Deepak L

2015-01-01

Because little was previously known about Asian-American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian-American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program. We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3774 Asian-Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program (2005-2012). Baseline characteristics, quality of care metrics, in-hospital mortality, discharge to home, and length of stay were examined. Relative to white patients, Asian-American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency, but similar ejection fraction. Overall, Asian-American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk , 0.88; 95% confidence interval , 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Compared with white patients, Asian-American patients had comparable risk adjusted in-hospital mortality (RR, 1.11; 95% CI, 0.91-1.35), length of stay>4 days (RR, 1.01; 95% CI, 0.95-1.08), and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11). Despite some differences in clinical profiles, Asian-American patients hospitalized with HF receive very similar quality of care and have comparable health outcomes to their white counterparts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Groups Meet . . . Teams Improve: Building Teams That Learn

Science.gov (United States)

Hillier, Janet; Dunn-Jensen, Linda M.

2013-01-01

Although most business students participate in team-based projects during undergraduate or graduate course work, the team experience does not always teach team skills or capture the team members' potential: Students complete the task at hand but the explicit process of becoming a team is often not learned. Drawing from organizational learning…

Information Cyberspace and Future Cyber Homes

Directory of Open Access Journals (Sweden)

Eduard Babulak

2006-04-01

Full Text Available The current Internet combines very complex communications infrastructures, while connecting users globally and at the same time creating information cyberspace systems. Large companies such as Philips are working on communications technologies that will facilitate fully automated households (i.e., Cyber Homes. Today, people are using are using small digital pagers and phones with embedded computers and displays, palm-size computers such as Palm Pilot, notebook-size panel computers and wall-size displays. Current research and development trends in the field of Telecommunications and computing industries continues towards a human centric computing, smart spaces, smart devices, clothing, fully automated houses etc. This new technology creates environment where computers are everywhere and provide online access to information at any time to anyone. In this paper, the author discusses new technological trends directions in the Internet, E-commerce and Automation Industries, while presenting his own vision on application of ubiquitous computing in the future cyber home automation. In support of creating future fully automated cyber homes, the author promotes creation of interdisciplinary and multinational research and development teams world-wide.

Teams make it work: how team work engagement mediates between social resources and performance in teams.

Science.gov (United States)

Torrente, Pedro; Salanova, Marisa; Llorens, Susana; Schaufeli, Wilmar B

2012-02-01

In this study we analyze the mediating role of team work engagement between team social resources (i.e., supportive team climate, coordination, teamwork), and team performance (i.e., in-role and extra-role performance) as predicted by the Job Demands-Resources Model. Aggregated data of 533 employees nested within 62 teams and 13 organizations were used, whereas team performance was assessed by supervisor ratings. Structural equation modeling revealed that, as expected, team work engagement plays a mediating role between social resources perceived at the team level and team performance as assessed by the supervisor.

Beyond Self-Monitoring: Understanding Non-functional Aspects of Home-based Healthcare Technology

DEFF Research Database (Denmark)

Grönvall, Erik; Verdezoto, Nervo

2013-01-01

the appropriation of healthcare technologies and people with comorbidity may have diverse but co-existing monitoring needs. In this paper, we seek to understand home-based health monitoring practices to better design and integrate them into people’s everyday life. We perform an analysis of socio......-technical complexities in home-based healthcare technologies through three case studies of self-monitoring: 1) pre-eclampsia (i.e. pregnancy poisoning), 2) heart conditions, and 3) preventive care. Through the analysis seven themes emerged (people, resources, places, routines, knowledge, control and motivation) that can...... facilitate the understanding of home-based healthcare activities. We present three modes of self-monitoring use and provide a set of design recommendations for future Ubicomp designs of home-based healthcare technology....

Does adding a dietician to the liaison team after discharge of geriatric patients improve nutritional outcome

DEFF Research Database (Denmark)

Beck, Anne Marie; Tolstrup Andersen, Ulla; Leedo, Eva

2015-01-01

(70 + years and at nutritional risk) at discharge. INTERVENTIONS: Participants were randomly allocated to receive discharge Liaison-Team vs. discharge Liaison-Team in cooperation with a dietician. The dietician performed a total of three home visits with the aim of developing and implementing......OBJECTIVES: The objective was to test whether adding a dietician to a discharge Liaison-Team after discharge of geriatric patients improves nutritional status, muscle strength and patient relevant outcomes. DESIGN: Twelve-week randomized controlled trial. SETTING AND SUBJECTS: Geriatric patients...... an individual nutritional care plan. The first visit took place at the day of discharge together with the discharge Liaison-Team while the remaining visits took place approximately three and eight weeks after discharge and were performed by a dietician alone. MAIN MEASURES: Nutritional status (weight...

Management of single-ventricle patients with Berlin Heart EXCOR Ventricular Assist Device: single-center experience.

Science.gov (United States)

Mackling, Tracey; Shah, Tejas; Dimas, Vivian; Guleserian, Kristine; Sharma, Mahesh; Forbess, Joseph; Ardura, Monica; Gross-Toalson, Jami; Lee, Ying; Journeycake, Janna; Barnes, Aliessa

2012-06-01

There are minimal data regarding chronic management of single-ventricle ventricular assist device (VAD) patients. This study aims to describe our center's multidisciplinary team management of single-ventricle patients supported long term with the Berlin Heart EXCOR Pediatric VAD. Patient #1 was a 4-year-old with double-outlet right ventricle with aortic atresia, L-looped ventricles, and heart block who developed heart failure 1 year after Fontan. She initially required extracorporeal membrane oxygenation support and was transitioned to Berlin Heart systemic VAD. She was supported for 363 days (cardiac intensive care unit [CICU] 335 days, floor 28 days). The postoperative course was complicated by intermittent infection including methicillin-resistant Staphylococcus aureus, intermittent hepatic and renal insufficiencies, and transient antithrombin, protein C, and protein S deficiencies resulting in multiple thrombi. She had a total of five pump changes over 10 months. Long-term medical management included anticoagulation with enoxaparin, platelet inhibition with aspirin and dipyridamole, and antibiotic prophylaxis using trimethoprim/sulfamethoxazole. She developed sepsis of unknown etiology and subsequently died from multiorgan failure. Patient #2 was a 4-year-old with hypoplastic left heart syndrome who developed heart failure 2 years after bidirectional Glenn shunt. At systemic VAD implantation, he was intubated with renal insufficiency. Post-VAD implantation, his renal insufficiency resolved, and he was successfully extubated to daytime nasal cannula and biphasic positive airway pressure at night. He was supported for 270 days (CICU 143 days, floor 127 days). The pump was upsized to a 50-mL pump in May 2011 for increased central venous pressures (29 mm Hg). Long-term medical management included anticoagulation with warfarin and single-agent platelet inhibition using dipyridamole due to aspirin resistance. He developed increased work of breathing requiring

Team Learning Beliefs and Behaviours in Response Teams

Science.gov (United States)

Boon, Anne; Raes, Elisabeth; Kyndt, Eva; Dochy, Filip

2013-01-01

Purpose: Teams, teamwork and team learning have been the subject of many research studies over the last decades. This article aims at investigating and confirming the Team Learning Beliefs and Behaviours (TLB&B) model within a very specific population, i.e. police and firemen teams. Within this context, the paper asks whether the team's…

Personality and community prevention teams: Dimensions of team leader and member personality predicting team functioning.

Science.gov (United States)

Feinberg, Mark E; Kim, Ji-Yeon; Greenberg, Mark T

2008-11-01

The predictors and correlates of positive functioning among community prevention teams have been examined in a number of research studies; however, the role of personality has been neglected. In this study, we examined whether team member and leader personality dimensions assessed at the time of team formation predicted local prevention team functioning 2.5-3.5 years later. Participants were 159 prevention team members in 14 communities participating in the PROSPER study of prevention program dissemination. Three aspects of personality, aggregated at the team level, were examined as predictors: Openness to Experience, Conscientiousness, and Agreeableness. A series of multivariate regression analyses were performed that accounted for the interdependency of five categories of team functioning. Results showed that average team member Openness was negatively, and Conscientiousness was positively linked to team functioning. The findings have implications for decisions about the level and nature of technical assistance support provided to community prevention teams.

Beta-blocker withdrawal among patients presenting for surgery from home

Science.gov (United States)

Schonberger, Robert B.; Lukens, Carrie L.; Turkoglu, O. Dicle; Feinleib, Jessica L.; Haspel, Kenneth L.; Burg, Matthew M.

2012-01-01

Structured Abstract Objective This study sought to measure the incidence of perioperative beta-blocker non-compliance by patients who were prescribed chronic beta blocker therapy and presented for surgery from home. The effect of patient non-compliance on day of surgery presenting heart rate was also examined. Design Prospective observational study with outcome data obtained from review of the medical record. Setting The preoperative clinic and operating rooms of a Veterans Administration hospital. Participants Patients on chronic beta blocker therapy who presented from home for surgery. Interventions None. Measurements and Main Results Demographic and comorbidity data as well as data on self-reported compliance to beta-blocker therapy, initial day of surgery vital signs, and recent ambulatory vital signs were collected. Ten out of fifty subjects (20%; 95% CI = 9-31%) reported not taking their day of surgery beta-blocker. These self-reported non-adherers demonstrated a higher presenting heart rate on the day of surgery vs. adherent subjects (median of 78 beats per minute vs. 65 beats per minute, p=0.02 by Wilcoxon Rank-Sum Test). The difference-in-difference between baseline primary care and day of surgery heart rate was also statistically significant between compliant and non-compliant subjects (-7 beats per minute vs. +12.5 beats per minute, p<0.00001). Conclusions Patient self-report and physiologic data documented failure to take beta-blockers and possible beta-blocker withdrawal in 20% of patients who presented for surgery from home. If these findings are confirmed in larger studies, improved patient understanding of and compliance with medication instructions during preoperative visits should be a focus of future quality improvement initiatives. PMID:22418043

Managing Your Team's Weakest Link.

Science.gov (United States)

Hills, Laura

2015-01-01

Do you have a poor-performing employee on your medical practice team? If so, you're not alone. Unfortunately, this is a problem that many medical practice managers face. This article describes the best strategies for managing your team's weakest link. It explores common yet very difficult circumstances that cause low employee performance and that test the patience, heart, and skills of a practice manager. It guides readers through a process of self-discovery to determine whether their negative biases or grudges may be causing employees to perform poorly. It suggests several possible other reasons for weak employee performance, including problems with the job, practice, leadership, communication, and fit between the employee and the job. This article also suggests the best strategy for communicating concerns about performance to the weakest-link employee. It offers guidance to practice managers about protecting their time and energy when handling a poor performer. It provides a simple formula for calculating the cost of a low-performing employee, 10 possible personal reasons for the employee's poor work performance, specific questions to ask to uncover the reasons for poor performance, and an eight-rule strategy for confronting poor performance effectively. Finally, this article offers practice managers a practical strategy for handling resistance from their weakest link, illustrated with a sample dialogue.

Minority healthcare providers experience challenges, trust, and interdependency in a multicultural team.

Science.gov (United States)

Egede-Nissen, Veslemøy; Sellevold, Gerd Sylvi; Jakobsen, Rita; Sørlie, Venke

2018-01-01

The nursing community in the Nordic countries has become multicultural because of migration from European, Asian and African countries. In Norway, minority health care providers are recruited in to nursing homes which have become multicultural workplaces. They overcome challenges such as language and strangeness but as a group they are vulnerable and exposed to many challenges. The aim is to explore minority healthcare providers, trained nurses and nurses' assistants, and their experiences of challenges when working in a multicultural team in a Norwegian context. The study has a qualitative design, using narrative interviews, and a phenomenological-hermeneutic analysis method to explore the experiences of challenges in dementia care. Ethical considerations: The study was approved by The Norwegian Regional Ethics Committee, and the Norwegian Social Science Data Services. Participation and research context: Five informants from different African, Asian and European countries participated in the study. The study was conducted in a Norwegian nursing home, in a dementia care unit. The results show that minority health care providers experience and find meaning in being a member of a team, they overcome challenges, characterized by the interdependency in the team, appreciating new cultural experiences and striving to belong. They must overcome challenges such as language problems and the feeling of strangeness. The findings are discussed considering Løgstrup's ethic of proximity, the ethical demand of trust, and interdependency. The ethical demand is an answer to a common, transparent, unspoken agreement to be met, seen, and understood. The study shows that cooperation in a multi-professional and multi-ethnic team is important, and secures the quality of care to persons with dementia. Further research is necessary to examine the relation between a multi-ethnic staff and the patients experiencing dementia. Further research is necessary to examine ethnicity, the relation

Consequences of team charter quality: Teamwork mental model similarity and team viability in engineering design student teams

Science.gov (United States)

Conway Hughston, Veronica

Since 1996 ABET has mandated that undergraduate engineering degree granting institutions focus on learning outcomes such as professional skills (i.e. solving unstructured problems and working in teams). As a result, engineering curricula were restructured to include team based learning---including team charters. Team charters were diffused into engineering education as one of many instructional activities to meet the ABET accreditation mandates. However, the implementation and execution of team charters into engineering team based classes has been inconsistent and accepted without empirical evidence of the consequences. The purpose of the current study was to investigate team effectiveness, operationalized as team viability, as an outcome of team charter implementation in an undergraduate engineering team based design course. Two research questions were the focus of the study: a) What is the relationship between team charter quality and viability in engineering student teams, and b) What is the relationship among team charter quality, teamwork mental model similarity, and viability in engineering student teams? Thirty-eight intact teams, 23 treatment and 15 comparison, participated in the investigation. Treatment teams attended a team charter lecture, and completed a team charter homework assignment. Each team charter was assessed and assigned a quality score. Comparison teams did not join the lecture, and were not asked to create a team charter. All teams completed each data collection phase: a) similarity rating pretest; b) similarity posttest; and c) team viability survey. Findings indicate that team viability was higher in teams that attended the lecture and completed the charter assignment. Teams with higher quality team charter scores reported higher levels of team viability than teams with lower quality charter scores. Lastly, no evidence was found to support teamwork mental model similarity as a partial mediator of the team charter quality on team viability

When teams fail to self-regulate: Predictors and outcomes of team procrastination among debating teams

NARCIS (Netherlands)

E.A.J. van Hooft (Edwin); H. van Mierlo (Heleen)

2018-01-01

textabstractModels of team development have indicated that teams typically engage in task delay during the first stages of the team's life cycle. An important question is to what extent this equally applies to all teams, or whether there is variation across teams in the amount of task delay. The

On teams, teamwork, and team performance: discoveries and developments.

Science.gov (United States)

Salas, Eduardo; Cooke, Nancy J; Rosen, Michael A

2008-06-01

We highlight some of the key discoveries and developments in the area of team performance over the past 50 years, especially as reflected in the pages of Human Factors. Teams increasingly have become a way of life in many organizations, and research has kept up with the pace. We have characterized progress in the field in terms of eight discoveries and five challenges. Discoveries pertain to the importance of shared cognition, the measurement of shared cognition, advances in team training, the use of synthetic task environments for research, factors influencing team effectiveness, models of team effectiveness, a multidisciplinary perspective, and training and technological interventions designed to improve team effectiveness. Challenges that are faced in the coming decades include an increased emphasis on team cognition; reconfigurable, adaptive teams; multicultural influences; and the need for naturalistic study and better measurement. Work in human factors has contributed significantly to the science and practice of teams, teamwork, and team performance. Future work must keep pace with the increasing use of teams in organizations. The science of teams contributes to team effectiveness in the same way that the science of individual performance contributes to individual effectiveness.

Team player styles, team design variables and team work effectiveness in Egypt

OpenAIRE

El-Kot, Ghada Awed Hassan

2001-01-01

The literature has revealed few studies of management in Arab countries in general and particularly in Egypt. Many Egyptian organisations implemented the team concept a number of years ago, however, there do not appear to be any studies investicitaýt inc",D team work effectiveness in Egypt. The literature review and the findings of a pilot study emphasised the need for empirical research in team work in Egypt. Team effectiveness models are examined in order to identify the fact...

University of Calgary students in 2011 solar home competition

International Nuclear Information System (INIS)

Anon.

2010-01-01

This article described a solar home designed by University of Calgary students for the 2011 Solar Decathlon competition hosted by the United States Department of Energy and the National Renewable Energy Laboratory. The home features an Aboriginal design that will produces at least as much energy as it consumes. Designed as a collaborative project between First Nations, industry, and the University of Calgary, the entry will compete against teams from throughout the world. The entry will be judged in several categories, including architecture, engineering, affordability, and market appeal. In 2009, students from the university collaborated with other Canadian educational facilities to place sixth overall in the competition. 1 fig.

Empowerment interventions, knowledge translation and exchange: perspectives of home care professionals, clients and caregivers

Directory of Open Access Journals (Sweden)

Voyer Louis

2008-08-01

Full Text Available Abstract Background Few studies have examined empowerment interventions as they actually unfold in home care in the context of chronic health problems. This study aims to document the empowerment process as it plays out in interventions with adults receiving home care services. Methods/design The qualitative design chosen is a fourth generation evaluation combined with case studies. A home care team of a health and social services center situated in the Eastern Townships (Québec, Canada will be involved at every step in the study. A sample will be formed of 15 health care professionals and 30 of their home care clients and caregiver. Semi-structured interviews, observations of home care interventions and socio-demographic questionnaires will be used to collect the data. Nine instruments used by the team in prior studies will be adapted and reviewed. A personal log will document the observers' perspectives in order to foster objectivity and the focus on the intervention. The in-depth qualitative analysis of the data will illustrate profiles of enabling interventions and individual empowerment. Discussion The ongoing process to transform the health care and social services network creates a growing need to examine intervention practices of health care professionals working with clients receiving home care services. This study will provide the opportunity to examine how the intervention process plays out in real-life situations and how health care professionals, clients and caregivers experience it. The intervention process and individual empowerment examined in this study will enhance the growing body of knowledge about empowerment.

In-Home Care for Optimizing Chronic Disease Management in the Community

Science.gov (United States)

2013-01-01

Background The emerging attention on in-home care in Canada assumes that chronic disease management will be optimized if it takes place in the community as opposed to the health care setting. Both the patient and the health care system will benefit, the latter in terms of cost savings. Objectives To compare the effectiveness of care delivered in the home (i.e., in-home care) with no home care or with usual care/care received outside of the home (e.g., health care setting). Data Sources A literature search was performed on January 25, 2012, using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published from January 1, 2006, until January 25, 2012. Review Methods An evidence-based analysis examined whether there is a difference in mortality, hospital utilization, health-related quality of life (HRQOL), functional status, and disease-specific clinical measures for in-home care compared with no home care for heart failure, atrial fibrillation, coronary artery disease, stroke, chronic obstructive pulmonary disease, diabetes, chronic wounds, and chronic disease / multimorbidity. Data was abstracted and analyzed in a pooled analysis using Review Manager. When needed, subgroup analysis was performed to address heterogeneity. The quality of evidence was assessed by GRADE. Results The systematic literature search identified 1,277 citations from which 12 randomized controlled trials met the study criteria. Based on these, a 12% reduced risk for in-home care was shown for the outcome measure of combined events including all-cause mortality and hospitalizations (relative risk [RR]: 0.88; 95% CI: 0.80–0.97). Patients receiving in-home care had an average of 1 less unplanned hospitalization (mean difference [MD]: –1.03; 95% CI: –1.53 to –0.53) and an average of 1 less

Code Team Training: Demonstrating Adherence to AHA Guidelines During Pediatric Code Blue Activations.

Science.gov (United States)

Stewart, Claire; Shoemaker, Jamie; Keller-Smith, Rachel; Edmunds, Katherine; Davis, Andrew; Tegtmeyer, Ken

2017-10-16

Pediatric code blue activations are infrequent events with a high mortality rate despite the best effort of code teams. The best method for training these code teams is debatable; however, it is clear that training is needed to assure adherence to American Heart Association (AHA) Resuscitation Guidelines and to prevent the decay that invariably occurs after Pediatric Advanced Life Support training. The objectives of this project were to train a multidisciplinary, multidepartmental code team and to measure this team's adherence to AHA guidelines during code simulation. Multidisciplinary code team training sessions were held using high-fidelity, in situ simulation. Sessions were held several times per month. Each session was filmed and reviewed for adherence to 5 AHA guidelines: chest compression rate, ventilation rate, chest compression fraction, use of a backboard, and use of a team leader. After the first study period, modifications were made to the code team including implementation of just-in-time training and alteration of the compression team. Thirty-eight sessions were completed, with 31 eligible for video analysis. During the first study period, 1 session adhered to all AHA guidelines. During the second study period, after alteration of the code team and implementation of just-in-time training, no sessions adhered to all AHA guidelines; however, there was an improvement in percentage of sessions adhering to ventilation rate and chest compression rate and an improvement in median ventilation rate. We present a method for training a large code team drawn from multiple hospital departments and a method of assessing code team performance. Despite subjective improvement in code team positioning, communication, and role completion and some improvement in ventilation rate and chest compression rate, we failed to consistently demonstrate improvement in adherence to all guidelines.

Ethical Analysis of Withdrawing Total Artificial Heart Support.

Science.gov (United States)

DeMartino, Erin S; Wordingham, Sara E; Stulak, John M; Boilson, Barry A; Fuechtmann, Kayla R; Singh, Nausheen; Sulmasy, Daniel P; Pajaro, Octavio E; Mueller, Paul S

2017-05-01

To describe the characteristics of patients who undergo withdrawal of total artificial heart support and to explore the ethical aspects of withdrawing this life-sustaining treatment. We retrospectively reviewed the medical records of all adult recipients of a total artificial heart at Mayo Clinic from the program's inception in 2007 through June 30, 2015. Management of other life-sustaining therapies, approach to end-of-life decision making, engagement of ethics and palliative care consultation, and causes of death were analyzed. Of 47 total artificial heart recipients, 14 patients or their surrogates (30%) requested withdrawal of total artificial heart support. No request was denied by treatment teams. All 14 patients were supported with at least 1 other life-sustaining therapy. Only 1 patient was able to participate in decision making. It is widely held to be ethically permissible to withdraw a life-sustaining treatment when the treatment no longer meets the patient's health care-related goals (ie, the burdens outweigh the benefits). These data suggest that some patients, surrogates, physicians, and other care providers believe that this principle extends to the withdrawal of total artificial heart support. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Changing Landscape of Congenital Heart Disease.

Science.gov (United States)

Bouma, Berto J; Mulder, Barbara J M

2017-03-17

Congenital heart disease is the most frequently occurring congenital disorder affecting ≈0.8% of live births. Thanks to great efforts and technical improvements, including the development of cardiopulmonary bypass in the 1950s, large-scale repair in these patients became possible, with subsequent dramatic reduction in morbidity and mortality. The ongoing search for progress and the growing understanding of the cardiovascular system and its pathophysiology refined all aspects of care for these patients. As a consequence, survival further increased over the past decades, and a new group of patients, those who survived congenital heart disease into adulthood, emerged. However, a large range of complications raised at the horizon as arrhythmias, endocarditis, pulmonary hypertension, and heart failure, and the need for additional treatment became clear. Technical solutions were sought in perfection and creation of new surgical techniques by developing catheter-based interventions, with elimination of open heart surgery and new electronic devices enabling, for example, multisite pacing and implantation of internal cardiac defibrillators to prevent sudden death. Over time, many pharmaceutical studies were conducted, changing clinical treatment slowly toward evidence-based care, although results were often limited by low numbers and clinical heterogeneity. More attention has been given to secondary issues like sports participation, pregnancy, work, and social-related difficulties. The relevance of these issues was already recognized in the 1970s when the need for specialized centers with multidisciplinary teams was proclaimed. Finally, research has become incorporated in care. Results of intervention studies and registries increased the knowledge on epidemiology of adults with congenital heart disease and their complications during life, and at the end, several guidelines became easily accessible, guiding physicians to deliver care appropriately. Over the past decades

TEAM.

Science.gov (United States)

National Highway Traffic Safety Administration (DOT), Washington, DC.

This document presents materials covering the television campaign against drunk driving called "TEAM" (Techniques for Effective Alcohol Management). It is noted that TEAM's purpose is to promote effective alcohol management in public facilities and other establishments that serve alcoholic beverages. TEAM sponsors are listed, including…

Team dynamics within quality improvement teams: a scoping review.

Science.gov (United States)

Rowland, Paula; Lising, Dean; Sinclair, Lynne; Baker, G Ross

2018-03-31

This scoping review examines what is known about the processes of quality improvement (QI) teams, particularly related to how teams impact outcomes. The aim is to provide research-informed guidance for QI leaders and to inform future research questions. Databases searched included: MedLINE, EMBASE, CINAHL, Web of Science and SCOPUS. Eligible publications were written in English, published between 1999 and 2016. Articles were included in the review if they examined processes of the QI team, were related to healthcare QI and were primary research studies. Studies were excluded if they had insufficient detail regarding QI team processes. Descriptive detail extracted included: authors, geographical region and health sector. The Integrated (Health Care) Team Effectiveness Model was used to synthesize findings of studies along domains of team effectiveness: task design, team process, psychosocial traits and organizational context. Over two stages of searching, 4813 citations were reviewed. Of those, 48 full-text articles are included in the synthesis. This review demonstrates that QI teams are not immune from dysfunction. Further, a dysfunctional QI team is not likely to influence practice. However, a functional QI team alone is unlikely to create change. A positive QI team dynamic may be a necessary but insufficient condition for implementing QI strategies. Areas for further research include: interactions between QI teams and clinical microsystems, understanding the role of interprofessional representation on QI teams and exploring interactions between QI team task, composition and process.

An analysis of home advantage in Iranian football super league

Directory of Open Access Journals (Sweden)

Rasool Hemayat TALAB

2016-12-01

Full Text Available Aim: The purpose of this study was to investigate home advantage in Iranian Football Super League. Methods: The information regarding wins, losses, goals for, goals against, yellow cards, red cards and gained points in matches at home and away of Super League teams of Iran was obtained using the internet website www.Soccerway.com and was analyzed. Results: The results showed that the mean of wins, goals for and points gained from matches in the home have been more than matches away, but in matches away, the mean of losses, yellow cards, red cards and goals against have been higher. Also, the percentage of home advantage in Iranian Football Super League was close to international norms.  Conclusion: According to the results, sport psychologist, coaches and people who are involved in football are recommended to pay more attention to this advantage and make short and long term plans to do psychological readiness and competitive performance.

Physiological capacity and physical testing in male elite team handball

DEFF Research Database (Denmark)

Michalsik, Lars Bojsen; Madsen, K.; Aagaard, P.

2015-01-01

and by subsequent physical testing. RESULTS: Mean heart rate and relative workload during match-play (N.=41) were 163 ± 5 beats·min⁻¹ (group means±SD) and 70.9 ± 6.0% of VO(2-max), respectively. Relative workload was lower (P... and high demands on the anaerobic energy systems during certain periods of the match. Indications of temporary fatigue and a subsequent decline in performance were observed, since the relative workload decreased both in the first and in the second half of the match. Physiological profiles and physical test......AIM: The aim of the present study was to examine the physical demands placed on male elite team handball players in relation to playing position. METHODS: Male elite team handball field players were evaluated during match-play over a six season time span using physiological measurements...

Increasing Student-Learning Team Effectiveness with Team Charters

Science.gov (United States)

Hunsaker, Phillip; Pavett, Cynthia; Hunsaker, Johanna

2011-01-01

Because teams are a ubiquitous part of most organizations today, it is common for business educators to use team assignments to help students experientially learn about course concepts and team process. Unfortunately, students frequently experience a number of problems during team assignments. The authors describe the results of their research and…

Performance Verification of Production-Scalable Energy-Efficient Solutions: Winchester/Camberley Homes Mixed-Humid Climate

Energy Technology Data Exchange (ETDEWEB)

Mallay, D. [Partnership for Home Innovation, Upper Marlboro, MD (United States); Wiehagen, J. [Partnership for Home Innovation, Upper Marlboro, MD (United States)

2014-07-01

Winchester/Camberley Homes collaborated with the Building America team Partnership for Home Innovation to develop a new set of high performance home designs that could be applicable on a production scale. The new home designs are to be constructed in the mixed humid climate zone and could eventually apply to all of the builder's home designs to meet or exceed future energy codes or performance-based programs. However, the builder recognized that the combination of new wall framing designs and materials, higher levels of insulation in the wall cavity, and more detailed air sealing to achieve lower infiltration rates changes the moisture characteristics of the wall system. In order to ensure long term durability and repeatable successful implementation with few call-backs, the project team demonstrated through measured data that the wall system functions as a dynamic system, responding to changing interior and outdoor environmental conditions within recognized limits of the materials that make up the wall system. A similar investigation was made with respect to the complete redesign of the HVAC systems to significantly improve efficiency while maintaining indoor comfort. Recognizing the need to demonstrate the benefits of these efficiency features, the builder offered a new house model to serve as a test case to develop framing designs, evaluate material selections and installation requirements, changes to work scopes and contractor learning curves, as well as to compare theoretical performance characteristics with measured results.

Effects of team emotional authenticity on virtual team performance

Directory of Open Access Journals (Sweden)

Catherine E Connelly

2016-08-01

Full Text Available Members of virtual teams lack many of the visual or auditory cues that are usually used as the basis for impressions about fellow team members. We focus on the effects of the impressions formed in this context, and use social exchange theory to understand how these impressions affect team performance. Our pilot study, using content analysis (n = 191 students, suggested that most individuals believe that they can assess others’ emotional authenticity in online settings by focusing on the content and tone of the messages. Our quantitative study examined the effects of these assessments. Structural equation modeling (SEM analysis (n = 81 student teams suggested that team-level trust and teamwork behaviors mediate the relationship between team emotional authenticity and team performance, and illuminate the importance of team emotional authenticity for team processes and outcomes.

Heart to heart - a custodian journal on grassroots ergonomics

Energy Technology Data Exchange (ETDEWEB)

Zalk, D. M., LLNL

1998-03-04

When we first requested to speak at the American Society of Safety Engineer`s Professional Development Conference in Seattle, Washington, the theme we had in mind for this program paper was quite different. It definitely was not anything like our title, `Heart to Heart` implies. It was more formal and traditional. Give you figures, diagrams and the like. But two years later, we have come to another conclusion, to tell you the story about how a group of custodians and health & safety professionals dreamed big dreams and they came true. In order to understand what occurred, we first need to start at the very beginning with the Custodian Quality Improvement Team (CQIT). This group had been formed by the Plant Engineering Department at the Lawrence Livermore National Laboratory (LLNL) located in Livermore, California. LLNL is operated by the University of California for The U.S.Department of Energy. It is the premier applied physics research laboratory in the world. Plant Engineering (PE) is much like a Public Works Department. PE has all of the crafts, such as plumbers and electricians, who do maintenance-type work, as well as the engineering and construction employees. PE maintain the utilities, constructs new buildings and takes care of old ones. They take of the roads and clean the buildings and landscape the campus. So the Custodian Shop and its some 150 employees is a member of the PE family so to speak. The CQIT had decided to investigate ways they could reduce the number of injuries they were having. They invited health and safety professionals, David Zalk (an Industrial Hygienist) and Jack Tolley (Safety Engineer) to consult with them about this. They are both Hazards Control Team 4 members at LLNL. They were both interested in ergonomics and suggested that an approach to reducing their injuries might lie in studying how the custodians actually do their work. David has extensive training in ergonomics, and Jack simply had a long-time interest in ergonomics for

Measuring Team Learning Behaviours through Observing Verbal Team Interaction

Science.gov (United States)

Raes, Elisabeth; Boon, Anne; Kyndt, Eva; Dochy, Filip

2015-01-01

Purpose: This study aims to explore, as an answer to the observed lack of knowledge about actual team learning behaviours, the characteristics of the actual observed basic team learning behaviours and facilitating team learning behaviours more in-depth of three project teams. Over time, team learning in an organisational context has been…

Cuffless and Continuous Blood Pressure Estimation from the Heart Sound Signals

Directory of Open Access Journals (Sweden)

Rong-Chao Peng

2015-09-01

Full Text Available Cardiovascular disease, like hypertension, is one of the top killers of human life and early detection of cardiovascular disease is of great importance. However, traditional medical devices are often bulky and expensive, and unsuitable for home healthcare. In this paper, we proposed an easy and inexpensive technique to estimate continuous blood pressure from the heart sound signals acquired by the microphone of a smartphone. A cold-pressor experiment was performed in 32 healthy subjects, with a smartphone to acquire heart sound signals and with a commercial device to measure continuous blood pressure. The Fourier spectrum of the second heart sound and the blood pressure were regressed using a support vector machine, and the accuracy of the regression was evaluated using 10-fold cross-validation. Statistical analysis showed that the mean correlation coefficients between the predicted values from the regression model and the measured values from the commercial device were 0.707, 0.712, and 0.748 for systolic, diastolic, and mean blood pressure, respectively, and that the mean errors were less than 5 mmHg, with standard deviations less than 8 mmHg. These results suggest that this technique is of potential use for cuffless and continuous blood pressure monitoring and it has promising application in home healthcare services.

The Relationship between Management Team Size and Team Performance: The Mediating Effect of Team Psychological Safety

OpenAIRE

Midthaug, Mari Bratterud

2017-01-01

The purpose of this thesis is to explore the relationship between team size (number of team members) and team performance in management teams. There is a lack of empirical research exploring the potential links between these two elements within management teams. Further, little attention has been paid to potential mechanisms affecting this relationship. In this study, team psychological safety has been examined as a potential mediator in the size-performance relationship, hypothesizing that t...

Structured telephone support or non-invasive telemonitoring for patients with heart failure.

Science.gov (United States)

Inglis, Sally C; Clark, Robyn A; Dierckx, Riet; Prieto-Merino, David; Cleland, John G F

2015-10-31

Specialised disease management programmes for heart failure aim to improve care, clinical outcomes and/or reduce healthcare utilisation. Since the last version of this review in 2010, several new trials of structured telephone support and non-invasive home telemonitoring have been published which have raised questions about their effectiveness. To review randomised controlled trials (RCTs) of structured telephone support or non-invasive home telemonitoring compared to standard practice for people with heart failure, in order to quantify the effects of these interventions over and above usual care. We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology AsseFssment Database (HTA) on the Cochrane Library; MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index- Science (CPCI-S) on Web of Science (Thomson Reuters), AMED, Proquest Theses and Dissertations, IEEE Xplore and TROVE in January 2015. We handsearched bibliographies of relevant studies and systematic reviews and abstract conference proceedings. We applied no language limits. We included only peer-reviewed, published RCTs comparing structured telephone support or non-invasive home telemonitoring to usual care of people with chronic heart failure. The intervention or usual care could not include protocol-driven home visits or more intensive than usual (typically four to six weeks) clinic follow-up. We present data as risk ratios (RRs) with 95% confidence intervals (CIs). Primary outcomes included all-cause mortality, all-cause and heart failure-related hospitalisations, which we analysed using a fixed-effect model. Other outcomes included length of stay, health-related quality of life, heart failure knowledge and self care, acceptability and cost; we described and tabulated these. We performed meta-regression to assess homogeneity (the

[Costs with personnel and productivity analysis of family health program teams in Fortaleza, Ceará].

Science.gov (United States)

Rocha Filho, Fernando dos Santos; da Silva, Marcelo Gurgel Carlos

2009-01-01

The research verified the productivity and the operational personnel costs of eight teams of the Family Health Program (PSF) of two Basic Units of Family Health (UBASF) in Fortaleza, Ceará, through the methodology of costs by absorption, in 2004. The largest expenses were with personnel (75%), mainly with the PSF teams, and medicines (18%). The federal allocations received in September, 2004, by each PSF team, were R$ 9,543.33. The total cost by team was R$ 15,719.00. Some professionals of various PSF teams showed productivity above the set objectives, but the average productivity by doctor and nurse was below fifty per cent of objectives, with high idle time making the work onerous. The unity cost of home visits by doctor and prenatal attendance by nurses were checked, and, would be less expensive if the idle time were reduced. Various alternatives of cost reduction were observed, such as scale savings of some resources and services and re-negotiation of contracts with suppliers and cooperatives. The data obtained will contribute to more accurate planning for the installation and maintenance of PSF teams as well as alternatives of cost reductions, higher productivity, and better quality.

Can specially trained community care workers effectively support patients and their families in the home setting at the end of life?

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Poulos, Roslyn G; Harkin, Damian; Poulos, Christopher J; Cole, Andrew; MacLeod, Rod

2018-03-01

Surveys indicate that many Australians would prefer to die at home, but relatively few do. Recognising that patients and their families may not have the support they need to enable end-of-life care at home, a consortium of care providers developed, and received funding to trial, the Palliative Care Home Support Program (PCHSP) across seven health districts in New South Wales, Australia. The programme aimed to supplement end-of-life care in the home provided by existing multidisciplinary community palliative care teams, with specialist supportive community care workers (CCWs). An evaluation of the service was undertaken, focussing on the self-reported impact of the service on family carers (FCs), with triangulation of findings from community palliative care teams and CCWs. Service evaluation data were obtained through postal surveys and/or qualitative interviews with FCs, community palliative care teams and CCWs. FCs also reported the experience of their loved one based on 10 items drawn from the Quality of Death and Dying Questionnaire (QODD). Thematic analysis of surveys and interviews found that the support provided by CCWs was valued by FCs for: enabling choice (i.e. to realise end-of-life care in the home); providing practical assistance ("hands-on"); and for emotional support and reassurance. This was corroborated by community palliative care teams and CCWs. Responses by FCs on the QODD items indicated that in the last week of life, effective control of symptoms was occurring and quality of life was being maintained. This study suggests that satisfactory outcomes for patients and their families who wish to have end-of-life care in the home can be enabled with the additional support of specially trained CCWs. A notable benefit of the PCHSP model, which provided specific palliative care vocational training to an existing community care workforce, was a relatively rapid increase in the palliative care workforce across the state. © 2017 John Wiley & Sons Ltd.

Leading Teams of Leaders: What Helps Team Member Learning?

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Higgins, Monica; Young, Lissa; Weiner, Jennie; Wlodarczyk, Steven

2010-01-01

School districts are moving toward a new form of management in which superintendents need to form and nurture leadership teams. A study of 25 such teams in Connecticut suggests that a team's effectiveness is maximized when the team members are coached by other team members, not the superintendent, and when they are coached on task-related…

Where heart and home reside: changing constructions of place and identity

Science.gov (United States)

Daniel R. Williams; Norman McIntyre

2001-01-01

Globalization has expanded the scope and geographic scale of leisure and tourism practices and their consequent impacts on society. Yet studies of such topics as community, home, migration, and tourism remain infused with outdated assumptions of a geographically rooted subject. In the future, the changing nature of employment, retirement, and lifestyles are likely to...

A Volunteer Program to Connect Primary Care and the Home to Support the Health of Older Adults: A Community Case Study

Directory of Open Access Journals (Sweden)

Doug Oliver

2018-02-01

Full Text Available Primary care providers are critical in providing and optimizing health care to an aging population. This paper describes the volunteer component of a program (Health TAPESTRY which aims to encourage the delivery of effective primary health care in novel and proactive ways. As part of the program, volunteers visited older adults in their homes and entered information regarding health risks, needs, and goals into an electronic application on a tablet computer. A total of 657 home visits were conducted by 98 volunteers, with 22.45% of volunteers completing at least 20 home visits over the course of the program. Information was summarized in a report and electronically sent to the health care team via clients’ electronic medical records. The report was reviewed by the interprofessional team who then plan ongoing care. Volunteer recruitment, screening, training, retention, and roles are described. This paper highlights the potential role of a volunteer in a unique connection between primary care providers and older adult patients in their homes.

A Project Team: a Team or Just a Group?

Directory of Open Access Journals (Sweden)

Kateřina

2014-06-01

Full Text Available This paper deals with issues related to work in either teams or groups. The theoretical part discusses a team and a group with regards to its definition, classification and basic distinction, brings in more on the typology of team roles, personality assessment and sociometric methods. The analytical part tests the project (work team of a medical center represented in terms of personality and motivational types, team roles and interpersonal team relations concerning the willingness of cooperation and communication. The main objective of this work is to verify the validity of the assumptions that the analyzed team represents a very disparate group as for its composition from the perspective of personality types, types of motivation, team roles and interpersonal relations in terms of the willingness of cooperation and communication. A separate output shall focus on sociometric investigation of those team members where willingness to work together and communicate is based on the authors’ assumption of tight interdependence.

Technology Solutions for New Homes Case Study: Columbia County Habitat for Humanity Passive Townhomes

Energy Technology Data Exchange (ETDEWEB)

None

2016-04-01

The Columbia County (New York) Habitat for Humanity (Columbia County Habitat) affiliate has been experimenting with high-performance building since 2012, starting with ENERGY STAR® Certified Homes. In 2013, they constructed their first homes aimed at the Passive House standards. Building off of this effort, in 2014 they began work on a second set of Passive Townhomes in Hudson, New York, in partnership with the Advanced Residential Integrated Energy Solutions (ARIES) Building America team and BarlisWedlick Architects.

Phased Retrofits in Existing Homes in Florida Phase II: Shallow Plus Retrofits

Energy Technology Data Exchange (ETDEWEB)

Sutherland, K. [Building America Partnership for Improved Residential Construction, Cocoa, FL (United States); Parker, D. [Building America Partnership for Improved Residential Construction, Cocoa, FL (United States); Martin, E. [Building America Partnership for Improved Residential Construction, Cocoa, FL (United States); Chasar, D. [Building America Partnership for Improved Residential Construction, Cocoa, FL (United States); Amos, B. [Building America Partnership for Improved Residential Construction, Cocoa, FL (United States)

2016-02-03

The BAPIRC team and Florida Power and Light (FPL) electric utility pursued a pilot phased energy-efficiency retrofit program in Florida by creating detailed data on the energy and economic performance of two levels of retrofit - simple and deep. For this Phased Deep Retrofit (PDR) project, a total of 56 homes spread across the utility partner's territory in east central Florida, southeast Florida, and southwest Florida were instrumented between August 2012 and January 2013, and received simple pass-through retrofit measures during the period of March 2013 - June 2013. Ten of these homes received a deeper package of retrofits during August 2013 - December 2013. A full account of Phase I of this project, including detailed home details and characterization, is found in Parker et al, 2015 (currently in draft). Phase II of this project, which is the focus of this report, applied the following additional retrofit measures to select homes that received a shallow retrofit in Phase I: a) Supplemental mini-split heat pump (MSHP) (6 homes); b) Ducted and space coupled Heat Pump Water Heater (8 homes); c) Exterior insulation finish system (EIFS) (1 homes); d) Window retrofit (3 homes); e) Smart thermostat (21 homes: 19 NESTs; 2 Lyrics); f) Heat pump clothes dryer (8 homes); g) Variable speed pool pump (5 homes).

[The analysis of a mobile mental health outreach team activity: from psychiatric emergencies on the street to practice of hospitalization at home for homeless people].

Science.gov (United States)

Girard, Vincent; Sarradon-Eck, Aline; Payan, Noura; Bonin, Jean-Pierre; Perrot, Sylvain; Vialars, Vanessa; Boyer, Laurent; Tinland, Aurélie; Simeoni, Marie-Claude

2012-05-01

psychiatric disorders and 43% were forced. In about one third of the cases, hospitalizations were motivated by a double indication - psychiatric and physical - and in 13.5% for only a physical indication. Thirty people of the actively followed people had stayed in a halfway house as an alternative to hospitalization, restoring a continuity of care and allowing to resolve social problems that had until then been hopeless. The strategies developed by this Mobile Health Outreach Team ensure local community medical, psychiatric and social care for "hard to reach" people. The results confirm the interest of the link between the street work, the hospital and the halfway home, both as a living facility and an alternative to hospitalization. They suggest the importance of a critical minimum size for these EMPP that allows them a street work with doctors providing guidance. The presence of a GP is another welcome development because of the severity and the entanglement of somatic and psychiatric problems of these populations. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

The Team Climate Inventory: application in hospital teams and methodological considerations.

Science.gov (United States)

Ouwens, M; Hulscher, M; Akkermans, R; Hermens, R; Grol, R; Wollersheim, H

2008-08-01

To test the validity, reliability and discriminating capacity of an instrument to assess team climate, the Team Climate Inventory (TCI), in a sample of Dutch hospital teams. The TCI is based on a four-factor theory of team climate for innovation. Validation study. Hospital teams in The Netherlands. 424 healthcare professionals; 355 nurses working in 22 nursing teams and 69 nurses and doctors working in 14 quality-improvement teams. Exploratory and confirmatory factor analyses, Pearson's product moment correlations, internal homogeneity of the TCI scales based on Cronbach alpha, and the TCI capability to discriminate between two types of healthcare teams, namely nursing teams and quality-improvement teams. The validity test revealed the TCI's five-factor structure and moderate data fit. The Cronbach alphas of the five scales showed acceptable reliabilities. The TCI discriminated between nursing teams and quality-improvement teams. The mean scores of quality-improvement teams were all significantly higher than those of the nursing teams. Patient care teams are essential for high-quality patient care, and team climate is an important characteristic of successful teams. This study shows that the TCI is a valid, reliable and discriminating self-report measure of team climate in hospital teams. The TCI can be used as a quality-improvement tool or in quality-of-care research.

Team Psychological Safety and Team Learning: A Cultural Perspective

Science.gov (United States)

Cauwelier, Peter; Ribière, Vincent M.; Bennet, Alex

2016-01-01

Purpose: The purpose of this paper was to evaluate if the concept of team psychological safety, a key driver of team learning and originally studied in the West, can be applied in teams from different national cultures. The model originally validated for teams in the West is applied to teams in Thailand to evaluate its validity, and the views team…

Management Teams

CERN Document Server

Belbin, R Meredith Meredith

2012-01-01

Meredith Belbin's work on teams has become part of everyday language in organizations all over the world. All kinds of teams and team behaviours are covered. At the end of the book is a self-perception inventory so that readers can match their own personalities to particular team roles. Management Teams is required reading for managers concerned with achieving results by getting the best from their key personnel.

Home Palliative Care for Patients with Advanced Chronic Kidney Disease: Preliminary Results

Directory of Open Access Journals (Sweden)

José L. Teruel

2015-10-01

Full Text Available Healthcare for patients with advanced chronic kidney disease (ACKD on conservative treatment very often poses healthcare problems that are difficult to solve. At the end of 2011, we began a program based on the care and monitoring of these patients by Primary Care Teams. ACKD patients who opted for conservative treatment were offered the chance to be cared for mainly at home by the Primary Care doctor and nurse, under the coordination of the Palliative Care Unit and the Nephrology Department. During 2012, 2013, and 2014, 76 patients received treatment in this program (mean age: 81 years; mean Charlson age-comorbidity index: 10, and mean glomerular filtration rate: 12.4 mL/min/1.73 m2. The median patient follow-up time (until death or until 31 December 2014 was 165 days. During this period, 51% of patients did not have to visit the hospital’s emergency department and 58% did not require hospitalization. Forty-eight of the 76 patients died after a median time of 135 days in the program; 24 (50% died at home. Our experience indicates that with the support of the Palliative Care Unit and the Nephrology Department, ACKD patients who are not dialysis candidates may be monitored at home by Primary Care Teams.

Home Palliative Care for Patients with Advanced Chronic Kidney Disease: Preliminary Results

Science.gov (United States)

Teruel, José L.; Rexach, Lourdes; Burguera, Victor; Gomis, Antonio; Fernandez-Lucas, Milagros; Rivera, Maite; Diaz, Alicia; Collazo, Sergio; Liaño, Fernando

2015-01-01

Healthcare for patients with advanced chronic kidney disease (ACKD) on conservative treatment very often poses healthcare problems that are difficult to solve. At the end of 2011, we began a program based on the care and monitoring of these patients by Primary Care Teams. ACKD patients who opted for conservative treatment were offered the chance to be cared for mainly at home by the Primary Care doctor and nurse, under the coordination of the Palliative Care Unit and the Nephrology Department. During 2012, 2013, and 2014, 76 patients received treatment in this program (mean age: 81 years; mean Charlson age-comorbidity index: 10, and mean glomerular filtration rate: 12.4 mL/min/1.73 m2). The median patient follow-up time (until death or until 31 December 2014) was 165 days. During this period, 51% of patients did not have to visit the hospital’s emergency department and 58% did not require hospitalization. Forty-eight of the 76 patients died after a median time of 135 days in the program; 24 (50%) died at home. Our experience indicates that with the support of the Palliative Care Unit and the Nephrology Department, ACKD patients who are not dialysis candidates may be monitored at home by Primary Care Teams. PMID:27417813

Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis.

Science.gov (United States)

Wax, Joseph R; Lucas, F Lee; Lamont, Maryanne; Pinette, Michael G; Cartin, Angelina; Blackstone, Jacquelyn

2010-09-01

We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth. We included English-language peer-reviewed publications from developed Western nations reporting maternal and newborn outcomes by planned delivery location. Outcomes' summary odds ratios with 95% confidence intervals were calculated. Planned home births were associated with fewer maternal interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. These women were less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation. Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with significantly elevated neonatal mortality rates. Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate. Copyright 2010 Mosby, Inc. All rights reserved.

New Whole-House Solutions Case Study: Performance and Costs of Ductless Heat Pumps in Marine Climate High-Performance Homes

Energy Technology Data Exchange (ETDEWEB)

None

2016-02-24

The Woods is a sustainable community built by Habitat for Humanity in 2013. This community comprises 30 homes that are high-performance and energy-efficient. With support from Tacoma Public Utilities and the Bonneville Power Administration, the BA-PIRC team is researching the energy performance of these homes and the ductless heat pumps they employ.

Virtual Team Governance: Addressing the Governance Mechanisms and Virtual Team Performance

Science.gov (United States)

Zhan, Yihong; Bai, Yu; Liu, Ziheng

As technology has improved and collaborative software has been developed, virtual teams with geographically dispersed members spread across diverse physical locations have become increasingly prominent. Virtual team is supported by advancing communication technologies, which makes virtual teams able to largely transcend time and space. Virtual teams have changed the corporate landscape, which are more complex and dynamic than traditional teams since the members of virtual teams are spread on diverse geographical locations and their roles in the virtual team are different. Therefore, how to realize good governance of virtual team and arrive at good virtual team performance is becoming critical and challenging. Good virtual team governance is essential for a high-performance virtual team. This paper explores the performance and the governance mechanism of virtual team. It establishes a model to explain the relationship between the performance and the governance mechanisms in virtual teams. This paper is focusing on managing virtual teams. It aims to find the strategies to help business organizations to improve the performance of their virtual teams and arrive at the objectives of good virtual team management.

Putting the "Team" in the Fine Arts Team: An Application of Business Management Team Concepts

Science.gov (United States)

Fisher, Ryan

2007-01-01

In this article, the author discusses current challenges to the idea of teamwork in fine arts teams, redefines the terms team and collaboration using a business management perspective, discusses the success of effective teams in the business world and the characteristics of those teams, and proposes the implementation of the business model of…

A Project Team: A Team or Just a Group?

Directory of Open Access Journals (Sweden)

Katerina Hrazdilova Bockova

2013-11-01

Full Text Available This paper deals with issues related to work in either teams or groups. The theoretical part which discusses a team and a group with regards to its definition, classification and basic distinction brings in more on the typology of team roles, personality assessment and sociometric methods. The analytical part tests the project (work team of a medical center represented in terms of personality and motivational types, team roles and interpersonal team relations concerning the willingness of cooperation and communication. The main objective of this work was to determine whether the existing team is not by its nature rather a working group that contributes to the generally perceived stagnation of that field.

Impact of a mobile health aplication in the nursing care plan compliance of a home care service in Belo Horizonte, Minas Gerais, Brazil.

Science.gov (United States)

de Britto, Felipe A; Martins, Tatiana B; Landsberg, Gustavo A P

2015-01-01

To assess impact of a mobile health solution in the nursing care plan compliance of a home care service. A retrospective cohort study was performed with 3,036 patients. Compliance rates before and after the implementation were compared. After the implementation of a mobile health aplication, compliance with the nursing care plan increased from 53% to 94%. The system reduced IT spending, increased the nursing team efficiency and prevented planned hiring. The use of a mobile health solution with geolocating feature by a nursing home care team increased compliance to the care plan.

Employee Knowledge Sharing in Work Teams: Effects of Team Diversity, Emergent States, and Team Leadership

Science.gov (United States)

Noh, Jae Hang

2013-01-01

Knowledge sharing in work teams is one of the critical team processes. Without sharing of knowledge, work teams and organizations may not be able to fully utilize the diverse knowledge brought into work teams by their members. The purpose of this study was to investigate antecedents and underlying mechanisms influencing the extent to which team…

Preparing palliative home care nurses to act as facilitators for physicians' learning: Evaluation of a training programme.

Science.gov (United States)

Pype, Peter; Mertens, Fien; Wens, Johan; Stes, Ann; Van den Eynden, Bart; Deveugele, Myriam

2015-05-01

Palliative care requires a multidisciplinary care team. General practitioners often ask specialised palliative home care teams for support. Working with specialised nurses offers learning opportunities, also called workplace learning. This can be enhanced by the presence of a learning facilitator. To describe the development and evaluation of a training programme for nurses in primary care. The programme aimed to prepare palliative home care team nurses to act as facilitators for general practitioners' workplace learning. A one-group post-test only design (quantitative) and semi-structured interviews (qualitative) were used. A multifaceted train-the-trainer programme was designed. Evaluation was done through assignments with individual feedback, summative assessment through videotaped encounters with simulation-physicians and individual interviews after a period of practice implementation. A total of 35 nurses followed the programme. The overall satisfaction was high. Homework assignments interfered with the practice workload but showed to be fundamental in translating theory into practice. Median score on the summative assessment was 7 out of 14 with range 1-13. Interviews revealed some aspects of the training (e.g. incident analysis) to be too difficult for implementation or to be in conflict with personal preferences (focus on patient care instead of facilitating general practitioners' learning). Training palliative home care team nurses as facilitator of general practitioners' workplace learning is a feasible but complex intervention. Personal characteristics, interpersonal relationships and contextual variables have to be taken into account. Training expert palliative care nurses to facilitate general practitioners' workplace learning requires careful and individualised mentoring. © The Author(s) 2014.

Home media server content management

Science.gov (United States)

Tokmakoff, Andrew A.; van Vliet, Harry

2001-07-01

With the advent of set-top boxes, the convergence of TV (broadcasting) and PC (Internet) is set to enter the home environment. Currently, a great deal of activity is occurring in developing standards (TV-Anytime Forum) and devices (TiVo) for local storage on Home Media Servers (HMS). These devices lie at the heart of convergence of the triad: communications/networks - content/media - computing/software. Besides massive storage capacity and being a communications 'gateway', the home media server is characterised by the ability to handle metadata and software that provides an easy to use on-screen interface and intelligent search/content handling facilities. In this paper, we describe a research prototype HMS that is being developed within the GigaCE project at the Telematica Instituut . Our prototype demonstrates advanced search and retrieval (video browsing), adaptive user profiling and an innovative 3D component of the Electronic Program Guide (EPG) which represents online presence. We discuss the use of MPEG-7 for representing metadata, the use of MPEG-21 working draft standards for content identification, description and rights expression, and the use of HMS peer-to-peer content distribution approaches. Finally, we outline explorative user behaviour experiments that aim to investigate the effectiveness of the prototype HMS during development.

Northwest Energy Efficient Manufactured Housing Program High-Performance Test Homes

Energy Technology Data Exchange (ETDEWEB)

Hewes, Tom [Building America Partnership for Improved Residential Construction, Corvallis, OR (United States); Peeks, Brady [Building America Partnership for Improved Residential Construction, Corvallis, OR (United States)

2015-09-01

This project represents the third phase of a multi-year effort to develop and bring to market a High Performance Manufactured Home (HPMH), which is intended to make significant progress toward performing as zero-net-energy ready. The scope of this project involved building four HPMH prototypes, resulting in what is expected to be a 30% savings relative to the Building America Benchmark. (The actual percent savings varies depending on choice of heating equipment and climate zone). Previous phases of this project created a HPMH specification and prototyped individual measures from the package to obtain engineering approvals and develop preliminary factory construction processes. This report describes the project team's work during 2014 to build prototype homes to the HPMH specifications and to monitor the homes for energy performance and durability during 2014. Monitoring is expected to continue into 2016.

[Investigation of team processes that enhance team performance in business organization].

Science.gov (United States)

Nawata, Kengo; Yamaguchi, Hiroyuki; Hatano, Toru; Aoshima, Mika

2015-02-01

Many researchers have suggested team processes that enhance team performance. However, past team process models were based on crew team, whose all team members perform an indivisible temporary task. These models may be inapplicable business teams, whose individual members perform middle- and long-term tasks assigned to individual members. This study modified the teamwork model of Dickinson and McIntyre (1997) and aimed to demonstrate a whole team process that enhances the performance of business teams. We surveyed five companies (member N = 1,400, team N = 161) and investigated team-level-processes. Results showed that there were two sides of team processes: "communication" and "collaboration to achieve a goal." Team processes in which communication enhanced collaboration improved team performance with regard to all aspects of the quantitative objective index (e.g., current income and number of sales), supervisor rating, and self-rating measurements. On the basis of these results, we discuss the entire process by which teamwork enhances team performance in business organizations.

Results of open heart surgery in Jehovah's Witness patients. Single centre experience.

Science.gov (United States)

Juraszek, Andrzej; Kołsut, Piotr; Szymański, Jarosław; Kuriata, Jarosław; Kuśmierski, Krzysztof; Sitkowska-Rysiak, Ewa; Jasińska, Małgorzata; Kuśmierczyk, Mariusz

2017-09-01

Evaluation the results in patients from the religious community of Jehovah's Witness (JW) undergoing open heart surgery at our institution. Between September 2011 and March 2015, 21 patients with a religious background of the JW church underwent open heart surgery at our institution performed by the same surgical team. Mean age was 68.43 ±8.93 years. There were 13 (61.9%) female patients. Recombinant human erythropoietin was administered to every patient with a hemoglobin value open heart surgery in JW were very good, including combined procedures. The decrease of hematocrit serum levels significantly characterizing the postoperative period was highly acceptable in this series. Nevertheless, the number of sternum wound infections was a limiting factor for prompt postoperative recovery.

Individual and team performance in team-handball: a review.

Science.gov (United States)

Wagner, Herbert; Finkenzeller, Thomas; Würth, Sabine; von Duvillard, Serge P

2014-12-01

Team handball is a complex sport game that is determined by the individual performance of each player as well as tactical components and interaction of the team. The aim of this review was to specify the elements of team-handball performance based on scientific studies and practical experience, and to convey perspectives for practical implication. Scientific studies were identified via data bases of PubMed, Web of Knowledge, SPORT Discus, Google Scholar, and Hercules. A total of 56 articles met the inclusion criteria. In addition, we supplemented the review with 13 additional articles, proceedings and book sections. It was found that the specific characteristics of team-handball with frequent intensity changes, team-handball techniques, hard body confrontations, mental skills and social factors specify the determinants of coordination, endurance, strength and cognition. Although we found comprehensive studies examining individual performance in team-handball players of different experience level, sex or age, there is a lack of studies, particularly for team-handball specific training, as well as cognition and social factors. Key PointsThe specific characteristics of team-handball with frequent intensity changes, specific skills, hard body confrontations, mental skills and social factors define the determinants of coordination, endurance, strength and cognition.To increase individual and team performance in team-handball specific training based on these determinants have been suggested.Although there are comprehensive studies examining individual performance in team-handball players of different experience level, sex, or age are published, there is a lack of training studies, particularly for team-handball specific techniques and endurance, as well as cognition and social factors.

Remote Patient Management for Home Dialysis Patients

Directory of Open Access Journals (Sweden)

Eric L. Wallace

2017-11-01

Full Text Available Remote patient management (RPM offers renal health care providers and patients with end-stage kidney disease opportunities to embrace home dialysis therapies with greater confidence and the potential to obtain better clinical outcomes. Barriers and evidence required to increase adoption of RPM by the nephrology community need to be clearly defined. Ten health care providers from specialties including nephrology, cardiology, pediatrics, epidemiology, nursing, and health informatics with experience in home dialysis and the use of RPM systems gathered in Vienna, Austria to discuss opportunities for, barriers to, and system requirements of RPM as it applies to the home dialysis patient. Although improved outcomes and cost-effectiveness of RPM have been demonstrated in patients with diabetes mellitus and heart disease, only observational data on RPM have been gathered in patients on dialysis. The current review focused on RPM systems currently in use, on how RPM should be integrated into future care, and on the evidence needed for optimized implementation to improve clinical and economic outcomes. Randomized controlled trials and/or large observational studies could inform the most effective and economical use of RPM in home dialysis. These studies are needed to establish the value of existing and/or future RPM models among patients, policy makers, and health care providers.

Home Energy Displays. Consumer Adoption and Response

Energy Technology Data Exchange (ETDEWEB)

LaMarche, Janelle [Fraunhofer Center for Sustainable Energy Systems, Cambridge, MA (United States); Cheney, K. [Fraunhofer Center for Sustainable Energy Systems, Cambridge, MA (United States); Akers, C. [Fraunhofer Center for Sustainable Energy Systems, Cambridge, MA (United States); Roth, K. [Fraunhofer Center for Sustainable Energy Systems, Cambridge, MA (United States); Sachs, O. [Fraunhofer Center for Sustainable Energy Systems, Cambridge, MA (United States)

2012-12-01

The focus of this project was to investigate the factors influencing consumer adoption of Home Energy Displays (HEDs) and to evaluate electricity consumption in households with basic HEDs versus enhanced feedback methods - web portals or alerts. The team hypothesized that providing flexible and relatable information to users, in addition to a basic HED, would make feedback more effective and achieve persistent energy savings. In Phase I, Fraunhofer conducted three user research studies and found preferences for aesthetically pleasing, easy to understand feedback that is accessible through multiple media and offered free of charge. The deployment of HEDs in 150 households planned for Phase II encountered major recruitment and HED field deployment problems. In light of these challenges, the team is pursuing a modified study investigating the energy savings of a web portal versus alert-based energy feedback instead of a physical HED.

The effects on team emotions and team effectiveness of coaching in interprofessional health and social care teams.

Science.gov (United States)

Dimas, Isabel Dórdio; Renato Lourenço, Paulo; Rebelo, Teresa

2016-07-01

The purpose of this study was to examine the effects of coaching behaviours provided by peers and by the leader on the emotions experienced by interprofessional health and social care teams and on members' satisfaction with the team, as well as on team performance. Data were obtained from a survey among 344 employees working in 52 interprofessional health and social care teams from nine Portuguese organizations. The results show that leader coaching and peer coaching have a positive effect on the level of team members' satisfaction with the team and on positive emotions, and a negative effect on negative emotions. Furthermore, coaching provided by peers presents a positive effect on team performance as assessed by the leader of the team. Our findings put forward the importance of engaging in coaching behaviours to promote quality of the team experience, as well as the achievement of team performance objectives. Further studies should explore how coaching behaviours impact the patient, whose well-being is the ultimate objective of a team in the health and social care system, namely in terms of the patient's perception of quality care or patient outcomes.

Home palliative care works: but how? A meta-ethnography of the experiences of patients and family caregivers.

Science.gov (United States)

Sarmento, Vera P; Gysels, Marjolein; Higginson, Irene J; Gomes, Barbara

2017-12-01

To understand patients and family caregivers' experiences with home palliative care services, in order to identify, explore and integrate the key components of care that shape the experiences of service users. We performed a meta-ethnography of qualitative evidence following PRISMA recommendations for reporting systematic reviews. The studies were retrieved in 5 electronic databases (MEDLINE, EMBASE, PsycInfo, BNI, CINAHL) using 3 terms and its equivalents ('Palliative', 'Home care', 'Qualitative research') combined with 'AND', complemented with other search strategies. We included original qualitative studies exploring experiences of adult patients and/or their family caregivers (≥18 years) facing life-limiting diseases with palliative care needs, being cared for at home by specialist or intermediate home palliative care services. 28 papers reporting 19 studies were included, with 814 participants. Of these, 765 were family caregivers and 90% were affected by advanced cancer. According to participants' accounts, there are 2 overarching components of home palliative care: presence (24/7 availability and home visits) and competence (effective symptom control and skilful communication), contributing to meet the core need for security. Feeling secure is central to the benefits experienced with each component, allowing patients and family caregivers to focus on the dual process of living life and preparing death at home. Home palliative care teams improve patients and caregivers experience of security when facing life-limiting illnesses at home, by providing competent care and being present. These teams should therefore be widely available and empowered with the resources to be present and provide competent care. 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/.

Teaming up

DEFF Research Database (Denmark)

Warhuus, Jan; Günzel-Jensen, Franziska; Robinson, Sarah

2016-01-01

types of team formation: random teacher pre-assigned, student selection, and teacher directed diversity. In each of these modules, ethnographic methods (interviews and observations) were employed. Additionally, we had access to students learning logs, formative and summative assessments, and final exams...... functioning entrepreneurial student teams as most teams lack personal chemistry which makes them anchor their work too much in a pre-defined project. In contrast, we find that students that can form their own teams aim for less diverse teams than what is achieved by random assignment. However, the homophily......Questions we care about (Objectives): When students have to work on challenging tasks, as it is often the case in entrepreneurship classrooms that leverage experiential learning, team success becomes central to the students learning. Yet, the formation of teams is often left up to the students...

Home-based mobile cardio-pulmonary rehabilitation consultant system.

Science.gov (United States)

Lee, Hsu-En; Wang, Wen-Chih; Lu, Shao-Wei; Wu, Bo-Yuan; Ko, Li-Wei

2011-01-01

Cardiovascular diseases are the most popular cause of death in the world recently. For postoperatives, cardiac rehabilitation is still asked to maintain at home (phase II) to improve cardiac function. However, only one third of outpatients do the exercise regularly, reflecting the difficulty for home-based healthcare: lacking of monitoring and motivation. Hence, a cardio-pulmonary rehabilitation system was proposed in this research to improve rehabilitation efficiency for better prognosis. The proposed system was built on mobile phone and receiving electrocardiograph (ECG) signal from a wireless ECG holter via Bluetooth connection. Apart from heart rate (HR) monitor, an ECG derived respiration (EDR) technique is also included to provide respiration rate (RR). Both HR and RR are the most important vital signs during exercise but only used one physiological signal recorder in this system. In clinical test, there were 15 subjects affording Bruce Task (treadmill) to simulate rehabilitation procedure. Correlation between this system and commercial product (Custo-Med) was up to 98% in HR and 81% in RR. Considering the prevention of sudden heart attack, an arrhythmia detection expert system and healthcare server at the backend were also integrated to this system for comprehensive cardio-pulmonary monitoring whenever and wherever doing the exercise.

Home Care Services as Teaching Sites for Geriatrics in Family Medicine Residencies.