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Sample records for included careful selection

  1. Benefits of including methane measurements in selection strategies.

    Science.gov (United States)

    Robinson, D L; Oddy, V H

    2016-09-01

    Estimates of genetic/phenotypic covariances and economic values for slaughter weight, growth, feed intake and efficiency, and three potential methane traits were compiled to explore the effect of incorporating methane measurements in breeding objectives for cattle and meat sheep. The cost of methane emissions was assumed to be zero (scenario A), A$476/t (based on A$14/t CO equivalent and methane's 100-yr global warming potential [GWP] of 34; scenario B), or A$2,580/t (A$30/t CO equivalent combined with methane's 20-yr GWP of 86; scenario C). Methane traits were methane yield (MY; methane production divided by feed intake based on measurements over 1 d in respiration chambers) or short-term measurements of methane production adjusted for live weight (MPadjWt) in grazing animals, e.g., 40-60 min measurements in portable accumulation chambers (PAC) on 1 or 3 occasions, or measurements for 1 wk using a GreenFeed Emissions Monitor (GEM) on 1 or 3 occasions. Feed costs included the cost of maintaining the breeding herd and growth from weaning to slaughter. Sheep were assumed to be grown and finished on pasture (A$50/t DM). Feed costs for cattle included 365 d on pasture for the breeding herd and averages of 200 d postweaning grow-out on pasture and 100 d feedlot finishing. The greatest benefit of including methane in the breeding objective for both sheep and cattle was as a proxy for feed intake. For cattle, 3 GEM measurements were estimated to increase profit from 1 round of selection in scenario A (no payment for methane) by A$6.24/animal (from A$20.69 to A$26.93) because of reduced feed costs relative to gains in slaughter weight and by A$7.16 and A$12.09/animal, respectively, for scenarios B and C, which have payments for reduced methane emissions. For sheep, the improvements were more modest. Returns from 1 round of selection (no methane measurements) were A$5.06 (scenario A), A$4.85 (scenario B), and A$3.89 (scenario C) compared to A$5.26 (scenario A), A$5

  2. Child Care Teachers' Perspectives on Including Children with Challenging Behavior in Child Care Settings

    Science.gov (United States)

    Quesenberry, Amanda C.; Hemmeter, Mary Louise; Ostrosky, Michaelene M.; Hamann, Kira

    2014-01-01

    In this study, 9 teachers from 5 child care centers were interviewed to examine their perceptions on including children with challenging behavior in their classrooms. The findings provide a firsthand view into how child care teachers support children's social and emotional development and address challenging behavior. Results confirm previous…

  3. Quality Control in Child Care Staff Selection

    Science.gov (United States)

    Crow, Merwin R.

    1975-01-01

    This paper focuses on the process of staff selection of child care staff at a residential treatment center for children, ages 8-16. Phases of candidate selection, an "open-door" interview procedure, the orientation of hired candidates and the agency's philosophy, procedures and practices are discussed. (GO)

  4. Selection Component Analysis of Natural Polymorphisms using Population Samples Including Mother-Offspring Combinations, II

    DEFF Research Database (Denmark)

    Jarmer, Hanne Østergaard; Christiansen, Freddy Bugge

    1981-01-01

    Population samples including mother-offspring combinations provide information on the selection components: zygotic selection, sexual selection, gametic seletion and fecundity selection, on the mating pattern, and on the deviation from linkage equilibrium among the loci studied. The theory...

  5. Optimising multistage dairy cattle breeding schemes including genomic selection using decorrelated or optimum selection indices

    Directory of Open Access Journals (Sweden)

    Börner Vinzent

    2012-01-01

    Full Text Available Abstract Background The prediction of the outcomes from multistage breeding schemes is especially important for the introduction of genomic selection in dairy cattle. Decorrelated selection indices can be used for the optimisation of such breeding schemes. However, they decrease the accuracy of estimated breeding values and, therefore, the genetic gain to an unforeseeable extent and have not been applied to breeding schemes with different generation intervals and selection intensities in each selection path. Methods A grid search was applied in order to identify optimum breeding plans to maximise the genetic gain per year in a multistage, multipath dairy cattle breeding program. In this program, different values of the accuracy of estimated genomic breeding values and of their costs per individual were applied, whereby the total breeding costs were restricted. Both decorrelated indices and optimum selection indices were used together with fast multidimensional integration algorithms to produce results. Results In comparison to optimum indices, the genetic gain with decorrelated indices was up to 40% less and the proportion of individuals undergoing genomic selection was different. Additionally, the interaction between selection paths was counter-intuitive and difficult to interpret. Independent of using decorrelated or optimum selection indices, genomic selection replaced traditional progeny testing when maximising the genetic gain per year, as long as the accuracy of estimated genomic breeding values was ≥ 0.45. Overall breeding costs were mainly generated in the path "dam-sire". Selecting males was still the main source of genetic gain per year. Conclusion Decorrelated selection indices should not be used because of misleading results and the availability of accurate and fast algorithms for exact multidimensional integration. Genomic selection is the method of choice when maximising the genetic gain per year but genotyping females may not

  6. 78 FR 25304 - Siemens Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology), Including On...

    Science.gov (United States)

    2013-04-30

    ..., USA, Inc., Oncology Care Systems (Radiation Oncology), Including On-Site Leased Workers From Source... Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology), including on- site leased... of February 2013, Siemens Medical Solutions, USA, Inc., Oncology Care Systems (Radiation Oncology...

  7. Supportive and palliative care for patients with chronic mental illness including dementia.

    Science.gov (United States)

    Lloyd-Williams, Mari; Abba, Katharine; Crowther, Jacqueline

    2014-09-01

    People with preexisting mental illness are known to have difficulty accessing healthcare services including palliative care and people with dementia have similar issues accessing palliative care. The review addressed the time period from January 2013 to March 2014. There were few articles addressing issues for palliative and supportive care for patients with preexisting mental health issues. The main factor that would improve care is interdisciplinary working between mental healthcare teams and palliative care teams. In contrast, there were many published articles on the palliative and supportive care needs for people with dementia. These articles included consensus statements, models of care; studies of why models of care, for example Advanced Care Planning were not being implemented; and carer reports of care in the last year of life. Urgent research is required as to how support for people with preexisting mental illness who require palliative care can be improved--excellent liaison between mental health and palliative care teams is essential. There is much research on palliative care needs for people with dementia but an apparent lack of innovative approaches to care including care of people within their family home.

  8. Meeting the milestones. Strategies for including high-value care education in pulmonary and critical care fellowship training.

    Science.gov (United States)

    Courtright, Katherine R; Weinberger, Steven E; Wagner, Jason

    2015-04-01

    Physician decision making is partially responsible for the roughly 30% of U.S. healthcare expenditures that are wasted annually on low-value care. In response to both the widespread public demand for higher-quality care and the cost crisis, payers are transitioning toward value-based payment models whereby physicians are rewarded for high-value, cost-conscious care. Furthermore, to target physicians in training to practice with cost awareness, the Accreditation Council for Graduate Medical Education has created both individual objective milestones and institutional requirements to incorporate quality improvement and cost awareness into fellowship training. Subsequently, some professional medical societies have initiated high-value care educational campaigns, but the overwhelming majority target either medical students or residents in training. Currently, there are few resources available to help guide subspecialty fellowship programs to successfully design durable high-value care curricula. The resource-intensive nature of pulmonary and critical care medicine offers unique opportunities for the specialty to lead in modeling and teaching high-value care. To ensure that fellows graduate with the capability to practice high-value care, we recommend that fellowship programs focus on four major educational domains. These include fostering a value-based culture, providing a robust didactic experience, engaging trainees in process improvement projects, and encouraging scholarship. In doing so, pulmonary and critical care educators can strive to train future physicians who are prepared to provide care that is both high quality and informed by cost awareness.

  9. Psychotherapy treatment decisions supported by SelectCare

    NARCIS (Netherlands)

    Witteman, C.L.M.

    1999-01-01

    SelectCare is a computerized decision support system for psychotherapists who decide how to treat their depressed patients. This paper descibes the decision making model that is implemented in SelectCare and the decision elements it uses to give advice to its users. The system itself is then

  10. The effects of selective decontamination in Dutch Intensive Care Units

    NARCIS (Netherlands)

    Oostdijk, E.A.N.

    2013-01-01

    Infections are an important complication in the treatment of critical ill patients in Intensive Care Units (ICUs) and are associated with increased mortality, morbidity and health care costs. Selective Decontamination of the Digestive Tract (SDD) and Selective Oropharyngeal Decontamination (SOD) are

  11. PRIMARY HEALTH CARE, SELECTIVE OR COMPREHENSIVE ...

    African Journals Online (AJOL)

    hi-tech

    2003-01-01

    Jan 1, 2003 ... E.M. Obimbo, MBChB, MMed, Lecturer, Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, ... Objective: To critically review the advantages and disadvantages of selective versus ... and basic sanitation, health education in prevention and.

  12. The financial burden of HIV care, including antiretroviral therapy, on patients in three sites in Indonesia.

    Science.gov (United States)

    Riyarto, Sigit; Hidayat, Budi; Johns, Benjamin; Probandari, Ari; Mahendradhata, Yodi; Utarini, Adi; Trisnantoro, Laksono; Flessenkaemper, Sabine

    2010-07-01

    This paper assesses the extent of the financial burden due to out-of-pocket payments for health care incurred by people living with HIV (PLHIV) and the effect of this burden on their financial capacity. Data were collected in a cross-sectional survey of 353 PLHIV from three cities in Indonesia (Jakarta, Jogjakarta and Merauke). Respondents in Jakarta were sampled from one hospital and one non-governmental organization working with PLHIV. In Jogjakarta and Merauke, all HIV patients on antiretroviral therapy (ART) who came to selected hospitals during the interview period were asked to participate in the survey. The survey collected data on the frequency and extent of payments for HIV-related care, with answers cross-checked against medical records. Results show that PLHIV had different burdens of payments in the different geographical areas. On average, respondents in Jogjakarta spent 68%, and PLHIV on ART in Jakarta spent 96%, of monthly expenditure for HIV-related care, indicating a substantial financial burden for many ART patients. These patients depended on several sources of finance to cover the costs of their care, with donations from their immediate family being the most common method, selling assets and payments from personal income being the second most common method in Jakarta and Jogjakarta, respectively. Most PLHIV in these two areas did not have insurance. In Merauke, there were little observed out-of-pocket payments because the government covers medical costs via the local budget and health insurance for the poor. The results of this study confirm previous findings that providing subsidized ART drugs alone does not ensure financial accessibility to HIV care. Thus, the government of Indonesia at central and local levels should consider covering HIV care additional to providing antiretroviral drugs free of charge. Social health insurance should also be encouraged.

  13. Cleanup and treatment of radioactively contaminated land including areas near nuclear facilities. A selected bibliography

    International Nuclear Information System (INIS)

    Fore, C.S.; Faust, R.A.; Brewster, R.H.

    1982-09-01

    This annotated bibliography of 337 references summarizes the literature published on the cleanup and treatment of radioactively contaminated land. Specifically, this bibliography focuses on literature concerned with the methods of cleanup and treatment being applied - chemical, physical, or vegetative stabilization; the types of equipment being used; and the influence of climatic conditions on the method selected for use. The emphasis in such literature is placed on hazardous site cleanup efforts that have been completed as well as those that are in progress and are being planned. Appendix A includes 135 additional references to literature identified but not included in the bibliography because of time and funding constraints. Appendix B consists of a table that identifies the cleanup and treatment research conducted at specific sites. All of the information included in this bibliography is stored in a computerized form that is readily available upon request

  14. An instrument for broadened risk assessment in antenatal health care including non-medical issues

    Directory of Open Access Journals (Sweden)

    Amber Amanda Vos

    2015-03-01

    Full Text Available Introduction: Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenatal detection of risk factors and tailored prevention in an integrated care setting.Methods: A review of published instruments complemented with evidence from cohort studies. Selection and standardization of risk factors associated with small for gestational age, preterm birth, congenital anomalies and perinatal mortality. Risk factors were weighted to obtain a cumulative risk score. Responses were then connected to corresponding care pathways. A cumulative risk threshold was defined, which can be adapted to the population and the availability of preventive facilities. A score above the threshold implies multidisciplinary consultation between caregivers.Results: The resulting digital score card consisted of 70 items, subdivided into four non-medical and two medical domains. Weighing of risk factors was based on existing evidence. Pilot-evidence from a cohort of 218 pregnancies in a multi-practice urban setting showed a cut-off of 16 points would imply 20% of all pregnant women to be assessed in a multidisciplinary setting. A total of 28 care pathways were defined.Conclusion: The resulting score card is a universal risk screening instrument which incorporates recent evidence on non-medical risk factors for adverse pregnancy outcomes and enables systematic risk management in an integrated antenatal health care setting.

  15. An instrument for broadened risk assessment in antenatal health care including non-medical issues

    Directory of Open Access Journals (Sweden)

    Amber Amanda Vos

    2015-03-01

    Full Text Available Introduction: Growing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed a non-invasive, standardized instrument for comprehensive antenatal risk assessment. The current study presents the application-oriented development of a risk screening instrument for early antenatal detection of risk factors and tailored prevention in an integrated care setting. Methods: A review of published instruments complemented with evidence from cohort studies. Selection and standardization of risk factors associated with small for gestational age, preterm birth, congenital anomalies and perinatal mortality. Risk factors were weighted to obtain a cumulative risk score. Responses were then connected to corresponding care pathways. A cumulative risk threshold was defined, which can be adapted to the population and the availability of preventive facilities. A score above the threshold implies multidisciplinary consultation between caregivers. Results: The resulting digital score card consisted of 70 items, subdivided into four non-medical and two medical domains. Weighing of risk factors was based on existing evidence. Pilot-evidence from a cohort of 218 pregnancies in a multi-practice urban setting showed a cut-off of 16 points would imply 20% of all pregnant women to be assessed in a multidisciplinary setting. A total of 28 care pathways were defined. Conclusion: The resulting score card is a universal risk screening instrument which incorporates recent evidence on non-medical risk factors for adverse pregnancy outcomes and enables systematic risk management in an integrated antenatal health care setting.

  16. The need to include obstetric nurses in prenatal care visits in the public health system

    Directory of Open Access Journals (Sweden)

    Selma Aparecida Lagrosa Garcia

    2010-06-01

    Full Text Available Objective: To investigate, with a qualitative approach, the role of Obstetric Nurses at the primary level of care given to women’s health as a vital component of the multidisciplinary team, which today is fundamental for providing care, prevention as well as health education and promotion, especially in programs whose activities are geared towards primary care of pregnant, parturient, and puerpera women. Methods: Brazilian laws and the determinations of Nursing Councils in reference to the activities of the obstetric nurse were researched, including the nurse’s responsibilities and limits. The bibliographic search was conducted in health-related journals, lay publications, and the Internet. Results: The conflicts between professional physicians and nurses were discussed. Conclusions: It was concluded that the activities of the nurse, conducting low-risk prenatal clinical visits in the basic healthcare network, has legal and ethical support and provides true benefit to the clients.

  17. Integrative therapies for low back pain that include complementary and alternative medicine care: a systematic review.

    Science.gov (United States)

    Kizhakkeveettil, Anupama; Rose, Kevin; Kadar, Gena E

    2014-09-01

    Systematic review of the literature. To evaluate whether an integrated approach that includes different Complementary and Alternative Medicine (CAM) therapies combined or CAM therapies combined with conventional medical care is more effective for the management of low back pain (LBP) than single modalities alone. LBP is one of the leading causes of disability worldwide, yet its optimal management is still unresolved. The PRISMA Statement guidelines were followed. The Cochrane Back Review Group scale was used to rate the quality of the studies found. Twenty-one studies were found that met the inclusion criteria. The CAM modalities used in the studies included spinal manipulative therapy, acupuncture, exercise therapy, physiotherapy, massage therapy, and a topical ointment. Twenty studies included acupuncture and/or spinal manipulative therapy. Nine high quality studies showed that integrative care was clinically effective for the management of LBP. Spinal manipulative therapy combined with exercise therapy and acupuncture combined with conventional medical care or with exercise therapy appears to be promising approaches to the management of chronic cases of LBP. There is support in the literature for integrated CAM and conventional medical therapy for the management of chronic LBP. Further research into the integrated management of LBP is clearly needed to provide better guidance for patients and clinicians.

  18. Balancing the role of the dental school in teaching, research and patient care; including care for underserved areas.

    Science.gov (United States)

    Holbrook, W P; Brodin, P; Balciuniene, I; Brukiene, V; Bucur, M V; Corbet, E; Dillenberg, J; Djukanovic, D; Ekanayake, K; Eriksen, H; Fisher, J; Goffin, G; Hull, P; Kumchai, T; Lumley, P; Lund, J; Mathur, V; Novaes, A; Puriene, A; Roger-Leroi, V; Saito, I; Turner, S; Mabelya, L

    2008-02-01

    Inequalities within dentistry are common and are reflected in wide differences in the levels of oral health and the standard of care available both within and between countries and communities. Furthermore there are patients, particularly those with special treatment needs, who do not have the same access to dental services as the general public. The dental school should aim to recruit students from varied backgrounds into all areas covered by the oral healthcare team and to train students to treat the full spectrum of patients including those with special needs. It is essential, however, that the dental student achieves a high standard of clinical competence and this cannot be gained by treating only those patients with low expectations for care. Balancing these aspects of clinical education is difficult. Research is an important stimulus to better teaching and better clinical care. It is recognized that dental school staff should be active in research, teaching, clinical work and frequently administration. Maintaining a balance between the commitments to clinical care, teaching and research while also taking account of underserved areas in each of these categories is a difficult challenge but one that has to be met to a high degree in a successful, modern dental school.

  19. THE ROLES OF INDUSTRY AND SCIENCE, INCLUDING GENETIC SELECTION, IN IMPROVING ANIMAL WELFARE

    Directory of Open Access Journals (Sweden)

    D.M. BROOM

    2009-10-01

    Full Text Available Animal producers have to predict future situations and be aware of changing public views. At present, those in the animal industry are often trying to fight off change rather than preparing for and pre-empting it. As a consequence, many animal producers have bad public images. It is better to be proactive than reactive. Producer groups should be aware of new developments in knowledge and in public attitudes to animal-related activities. They should inform their members about how to manage animals in such a way that the welfare of the animals is good and the people involved in animal care are well-respected in society. This is especially important also for those who design and manufacture housing and equipment and those who breed animals for they can have substantial effects on animal welfare. It is important for animal welfare scientists to provide objective information about the welfare of animals, so that decisions can be taken about how animals should be bred, housed and treated. Animals use a wide range of coping mechanisms and these involve high-level brain function, with associated good and bad feelings. Where welfare is poor, the best overall assessment of welfare is a function of how bad is the effect on the individual and the duration of that effect. Conventional breeding, cloning and transgenesis can all have effects on the welfare of the animals produced. Selection for fast growth and high feed conversion efficiency in broiler chickens and other meat producing animals leads to too high an incidence of leg and other disorders. Selection for high milk yield in dairy cows leads to poor welfare associated with leg disorders, mastitis and reproductive disorders. These effects should be evaluated using a range of animal welfare measures and if there are adverse effects of genetic engineering, the usage of the animals should not be permitted except for research. In the case of genetically modified or cloned animals, any effects on function

  20. Including Children with Selective Mutism in Mainstream Schools and Kindergartens: Problems and Possibilities

    Science.gov (United States)

    Omdal, Heidi

    2008-01-01

    There is little research on inclusion of children with selective mutism in school/kindergarten. Moreover, few studies have tried to understand selectively mute children's interactions in the natural surroundings of their home and school/kindergarten. Five children meeting the DSM-IV criteria for selective mutism were video-observed in social…

  1. Selective mutism: a consensus based care pathway of good practice.

    Science.gov (United States)

    Keen, D V; Fonseca, S; Wintgens, A

    2008-10-01

    Selective mutism (SM) now acknowledged as an anxiety condition, tends to be a poorly understood, highly complex and vastly under-recognised clinical entity. Children with SM are a vulnerable group as the condition is not the remit of any one professional group. This inevitably leads to delay in formal diagnosis and management. There is a lack of systematic research on which to base guidelines for management. To develop, agree and validate key principles underlying the management of SM through a consensus process involving international experts, in order to create a local care pathway. A local multi-agency consultation process developed 11 statements, which were felt to be the key principles underpinning a potential care pathway for managing SM. Thirteen recognised experts from North America, Europe and Australia participated in a modified Delphi process involving two rounds using a Likert-scale and free commentary. Both quantitative and qualitative analyses were used in the validation or revision of the statements at each stage. Response rates were 100% for Round 1 and 84.6% for Round 2. Despite the differing professional backgrounds and service contexts, by successive revision and/or revalidation of statements, it was possible to arrive at a consensus about key principles relating to early recognition, assessment and intervention. The agreed key principles are presented together with the resulting local care pathway. Through a Delphi process, agreement was reached by a multidisciplinary group of professionals, on key principles that underpin the timely identification, assessment and management of children with SM. These include the potential for staff in school/preschool settings to identify SM and that intervention programmes should generally be based in these settings. Children with SM should receive assessment for possible coexisting disorders, whether developmental, emotional or behavioural and additional specific intervention given for these. Agreement was

  2. Closed-form solutions for linear regulator design of mechanical systems including optimal weighting matrix selection

    Science.gov (United States)

    Hanks, Brantley R.; Skelton, Robert E.

    1991-01-01

    Vibration in modern structural and mechanical systems can be reduced in amplitude by increasing stiffness, redistributing stiffness and mass, and/or adding damping if design techniques are available to do so. Linear Quadratic Regulator (LQR) theory in modern multivariable control design, attacks the general dissipative elastic system design problem in a global formulation. The optimal design, however, allows electronic connections and phase relations which are not physically practical or possible in passive structural-mechanical devices. The restriction of LQR solutions (to the Algebraic Riccati Equation) to design spaces which can be implemented as passive structural members and/or dampers is addressed. A general closed-form solution to the optimal free-decay control problem is presented which is tailored for structural-mechanical system. The solution includes, as subsets, special cases such as the Rayleigh Dissipation Function and total energy. Weighting matrix selection is a constrained choice among several parameters to obtain desired physical relationships. The closed-form solution is also applicable to active control design for systems where perfect, collocated actuator-sensor pairs exist.

  3. Use of selective digestive tract decontamination in European intensive cares

    DEFF Research Database (Denmark)

    Reis Miranda, D; Citerio, G; Perner, A

    2015-01-01

    BACKGROUND: Several studies have shown that the use of selective digestive tract decontamination (SDD) reduces mortality. However, fear for increasing multi drug resistance might prevent wide acceptance. A survey was performed among the units registered in the European Registry for Intensive Care...

  4. Economic evaluation of angiographic interventions including a whole-radiology in- and outpatient care

    International Nuclear Information System (INIS)

    Nolte-Ernsting, C.; Abel, K.; Krupski, G.; Lorenzen, J.; Adam, G.

    2006-01-01

    Purpose: To determine the economic efficiency of a whole-radiology in- and outpatient treatment with angiographic interventions performed as the main or sole therapy. Materials and Methods: The calculations represent the data of a university radiology department, including the following angiographic interventions (neuroradiology not considered): Vascular intervention (PTA, stent implantation) of kidneys and extremities, recanalization of hemodialysis access, chemoembolization, diagnostic arterioportal liver CT, port implantation, varicocele embolization, PTCD, percutaneous implantation of biliary stent. First, the different angiographic interventions are categorized with reference to the German DRG system 2005. Considering the example of a university hospital, the individual cost of each intervention is calculated and correlated with reimbursements by G-DRG2005 and so-called ''ambulant operation'' (EBM200plus). With these data, profits and losses are calculated for both in- and outpatient care. Results: Radiologic interventions of inpatients yield a profit in the majority of cases. With a base rate of 2900 Euro, the profits in our university hospital range between -872 Euro and +3411 Euro (mean: +1348 Euro). On the other hand, those angiographic interventions suitable for ''ambulant operation'' generate average profits of +372 Euro, if only direct costs are considered. The data of outpatient radiological interventions average between 381 Euro up to 1612 Euro lower than compared with profits obtained from in patient care. (orig.)

  5. Extending "Continuity of Care" to include the Contribution of Family Carers.

    Science.gov (United States)

    Wong-Cornall, Cecilia; Parsons, John; Sheridan, Nicolette; Kenealy, Timothy; Peckham, Allie

    2017-06-27

    Family carers, as a "shadow workforce", are foundational to the day-to-day integration of health service delivery for older family members living with complex health needs. This paper utilises Haggerty's model of continuity of care to explore the contribution of family carers' to the provision of care and support for an older family member's chronic condition within the context of health service delivery. We analysed data from interviews of 13 family carers in a case study of primary health care in New Zealand - a Maori Provider Organisation - to determine the alignment of family caregiving with the three levels of continuity of care (relational continuity, informational continuity, and management continuity). We found alignment of family caregiving tasks, responsibilities, and relationships with the three levels of continuity of care. Family carers 1) partnered with providers to extend chronic care to the home; 2) transferred and contributed information from one provider/service to another; 3) supported consistent and flexible management of care. The Maori Provider Organisation supported family carer-provider partnership enabled by shared Maori cultural values and social mandate of building family-centred wellbeing. Relational continuity was the most important level of continuity of care; it sets precedence for family carers and providers to establish the other levels - informational and management - continuity of care for their family member cared for. Family carers need to be considered as active partners working alongside responsive primary health care providers and organisation in the implementation of chronic care.

  6. The surgical care improvement project and prevention of post-operative infection, including surgical site infection.

    Science.gov (United States)

    Rosenberger, Laura H; Politano, Amani D; Sawyer, Robert G

    2011-06-01

    In response to inconsistent compliance with infection prevention measures, the Centers for Medicare & Medicaid Services collaborated with the U.S. Centers for Disease Control and Prevention on the Surgical Infection Prevention (SIP) project, introduced in 2002. Quality improvement measures were developed to standardize processes to increase compliance. In 2006, the Surgical Care Improvement Project (SCIP) developed out of the SIP project and its process measures. These initiatives, published in the Specifications Manual for National Inpatient Quality Measures, outline process and outcome measures. This continually evolving manual is intended to provide standard quality measures to unify documentation and track standards of care. Seven of the SCIP initiatives apply to the peri-operative period: Prophylactic antibiotics should be received within 1 h prior to surgical incision (1), be selected for activity against the most probable antimicrobial contaminants (2), and be discontinued within 24 h after the surgery end-time (3); (4) euglycemia should be maintained, with well-controlled morning blood glucose concentrations on the first two post-operative days, especially in cardiac surgery patients; (6) hair at the surgical site should be removed with clippers or by depilatory methods, not with a blade; (9) urinary catheters are to be removed within the first two post-operative days; and (10) normothermia should be maintained peri-operatively. There is strong evidence that implementation of protocols that standardize practices reduce the risk of surgical infection. The SCIP initiative targets complications that account for a significant portion of preventable morbidity as well as cost. One of the goals of the SCIP guidelines was a 25% reduction in the incidence of surgical site infections from implementation through 2010. Process measures are becoming routine, and as we practice more evidence-based medicine, it falls to us, the surgeons and scientists, to be active

  7. Simulated selection responses for breeding programs including resistance and resilience to parasites in Creole goats

    NARCIS (Netherlands)

    Gunia, M.; Phocas, F.; Gourdine, J.L.; Bijma, P.; Mandonnet, N.

    2013-01-01

    The Creole goat is a local breed used for meat production in Guadeloupe (French West Indies). As in other tropical countries, improvement of parasite resistance is needed. In this study, we compared predicted selection responses for alternative breeding programs with or without parasites resistance

  8. Selecting, adapting, and sustaining programs in health care systems.

    Science.gov (United States)

    Zullig, Leah L; Bosworth, Hayden B

    2015-01-01

    Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA) Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities.

  9. Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes

    Directory of Open Access Journals (Sweden)

    Graeme Kohler

    2017-11-01

    Full Text Available n a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. Methods The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs at decision-making points in primary healthcare (PHC based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. Results The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. Conclusion This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainability.

  10. The perspectives on including palliative care in the Indian undergraduate physiotherapy curriculum.

    Science.gov (United States)

    Veqar, Zubia

    2013-04-01

    According to the guidelines which were published by WHO in 2008, palliative care has been defined as "An approach that improves the quality of life of the patients and their families who face the problems which are associated with life-threatening illnesses, through the prevention and relief of suffering by means of an early identification, an impeccable assessment and the treatment of pain and other problems, physical, psychosocial and spiritual". The intervention which is provided as a part of the palliative care has to be provided by health professionals who strictly work as a part of multidisciplinary team and have been specifically trained to an optimal level of competency in the field. The impairment of the physical function and pain are two key problem areas in palliative care, which a physiotherapist deals with. Is a physiotherapist who is trained in India, trained to work as an efficient member of the team in this field? THIS ARTICLE DEALS WITH THE FOLLOWING: What is palliative care and what is its importance?A multidisciplinary approach to palliative careThe scenario of palliative care in IndiaThe role of physiotherapy in palliative care.The current scenario of physiotherapy education vis a vis palliative care.

  11. Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes.

    Science.gov (United States)

    Kohler, Graeme; Sampalli, Tara; Ryer, Ashley; Porter, Judy; Wood, Les; Bedford, Lisa; Higgins-Bowser, Irene; Edwards, Lynn; Christian, Erin; Dunn, Susan; Gibson, Rick; Ryan Carson, Shannon; Vallis, Michael; Zed, Joanna; Tugwell, Barna; Van Zoost, Colin; Canfield, Carolyn; Rivoire, Eleanor

    2017-03-06

    Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to

  12. Contents of polyethylene microplastic in some selected personal care products in Denmark

    DEFF Research Database (Denmark)

    Strand, Jakob

    Some personal care products include primary microplastic particles as particulate material, which may not be efficiently removed in WWTPs and therefore they will probably end up in aquatic environments. Microplastics in personal care products were focus in a prime time program DR Kontant...... on national TV - April 30, 2013. For this program Aarhus University contributed with analyses of microplastic particles (>40 μm) in some selected products and in the field. The results for microplastic contents in the nine analysed personal care products are presented here....

  13. Selecting, adapting, and sustaining programs in health care systems

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-04-01

    Full Text Available Leah L Zullig,1,2 Hayden B Bosworth1–4 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University Medical Center, Durham, NC, USA; 3School of Nursing, 4Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA Abstract: Practitioners and researchers often design behavioral programs that are effective for a specific population or problem. Despite their success in a controlled setting, relatively few programs are scaled up and implemented in health care systems. Planning for scale-up is a critical, yet often overlooked, element in the process of program design. Equally as important is understanding how to select a program that has already been developed, and adapt and implement the program to meet specific organizational goals. This adaptation and implementation requires attention to organizational goals, available resources, and program cost. We assert that translational behavioral medicine necessitates expanding successful programs beyond a stand-alone research study. This paper describes key factors to consider when selecting, adapting, and sustaining programs for scale-up in large health care systems and applies the Knowledge to Action (KTA Framework to a case study, illustrating knowledge creation and an action cycle of implementation and evaluation activities. Keywords: program sustainability, diffusion of innovation, information dissemination, health services research, intervention studies 

  14. Improvement of prediction ability for genomic selection of dairy cattle by including dominance effects.

    Directory of Open Access Journals (Sweden)

    Chuanyu Sun

    Full Text Available Dominance may be an important source of non-additive genetic variance for many traits of dairy cattle. However, nearly all prediction models for dairy cattle have included only additive effects because of the limited number of cows with both genotypes and phenotypes. The role of dominance in the Holstein and Jersey breeds was investigated for eight traits: milk, fat, and protein yields; productive life; daughter pregnancy rate; somatic cell score; fat percent and protein percent. Additive and dominance variance components were estimated and then used to estimate additive and dominance effects of single nucleotide polymorphisms (SNPs. The predictive abilities of three models with both additive and dominance effects and a model with additive effects only were assessed using ten-fold cross-validation. One procedure estimated dominance values, and another estimated dominance deviations; calculation of the dominance relationship matrix was different for the two methods. The third approach enlarged the dataset by including cows with genotype probabilities derived using genotyped ancestors. For yield traits, dominance variance accounted for 5 and 7% of total variance for Holsteins and Jerseys, respectively; using dominance deviations resulted in smaller dominance and larger additive variance estimates. For non-yield traits, dominance variances were very small for both breeds. For yield traits, including additive and dominance effects fit the data better than including only additive effects; average correlations between estimated genetic effects and phenotypes showed that prediction accuracy increased when both effects rather than just additive effects were included. No corresponding gains in prediction ability were found for non-yield traits. Including cows with derived genotype probabilities from genotyped ancestors did not improve prediction accuracy. The largest additive effects were located on chromosome 14 near DGAT1 for yield traits for both

  15. 76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

    Science.gov (United States)

    2011-02-17

    ... Options'' tab. 2. By regular mail. You may mail written comments to the following address ONLY: Centers... provide for payment that is consistent with efficiency, economy, and quality of care. With the...

  16. Air Emissions of Selected Substances from Particular Sectors Including Metallurgy in Poland

    Directory of Open Access Journals (Sweden)

    Kargulewicz I.

    2017-03-01

    Full Text Available This article presents data on the anthropogenic air emissions of selected substances (CO2, SO2, total suspended particles (TSP, dioxins and furans (PCDD/F, Pb and Cd subject to reporting under the Climate Convention (UNFCCC or the Convention on Long-range Transboundary Air Pollution (UNECE CLRTAP. It also presents the national emissions of these substances in 2014 by the major source categories and defines the share of metal production in these emissions. Analysis is based on national emission inventory reports. Most important source of air emission in case of CO2 and SO2 is 1.A.1 Energy industries category. TSP and PCDD/F are emitted mainly from fuel combustion in small sources (i.a. households. Emission of heavy metals (Pb and Cd is connected mostly with 1.A.2. Manufacturing industries and construction category. Metallurgy is significant source of emission only for lead and cadmium from among all considered substances. The shares of particular sectors in the national emissions of given pollutants are important, in view of the possible reduction measures and the determination in which industries they could bring about tangible results.

  17. Comparison of behavioral profiles for anxiety-related comorbidities including ADHD and selective mutism in children.

    Science.gov (United States)

    Levin-Decanini, Tal; Connolly, Sucheta D; Simpson, David; Suarez, Liza; Jacob, Suma

    2013-09-01

    Elucidating differences in social-behavioral profiles of children with comorbid presentations, utilizing caregiver as well as teacher reports, will refine our understanding of how contextual symptoms vary across anxiety-related disorders. In our pediatric anxiety clinic, the most frequent diagnoses and comorbidities were mixed anxiety (MA; ≥ 1 anxiety disorder; N = 155), anxiety with comorbid attention-deficit hyperactivity disorder (MA/ADHD, N = 47) and selective mutism (SM, N = 48). Behavioral measures (CPRS, CTRS) were analyzed using multiple one-way multivariate analyses of covariance tests. Differences between the three diagnostic groups were examined using completed parent and teacher reports (N = 135, 46, and 48 for MA, MA/ADHD, and SM groups, respectively). Comparisons across the MA, MA/ADHD, and SM groups indicate a significant multivariate main effect of group for caregiver and teacher responses (P < 0.01). Caregivers reported that children with SM are similar in profile to those with MA, and both groups were significantly different from the MA/ADHD group. Teachers reported that children with SM had more problems with social behaviors than with the MA or MA/ADHD groups. Further comparison indicates a significant main effect of group (P < 0.001), such that children with SM have the greatest differences in behavior observed by teachers versus caregivers. Clinical profiles between MA/ADHD, MA, and SM groups varied, illustrating the importance of multi-rater assessment scales to capture subtle distinctions and to inform treatment planning given that comorbidities occur frequently in children who present with anxiety. © 2013 Wiley Periodicals, Inc.

  18. Characterization of Campylobacter phages including analysis of host range by selected Campylobacter Penner serotypes

    Directory of Open Access Journals (Sweden)

    Brown Stanley

    2007-10-01

    agent in the effort to reduce the incidence of campylobacteriosis in Denmark. This study provides the basis for future experiments in Campylobacter phages and knowledge for the selection of Campylobacter phages for biocontrol in broilers.

  19. Characterization of Campylobacter phages including analysis of host range by selected Campylobacter Penner serotypes.

    Science.gov (United States)

    Hansen, Vinni Mona; Rosenquist, Hanne; Baggesen, Dorte Lau; Brown, Stanley; Christensen, Bjarke Bak

    2007-10-18

    the incidence of campylobacteriosis in Denmark. This study provides the basis for future experiments in Campylobacter phages and knowledge for the selection of Campylobacter phages for biocontrol in broilers.

  20. Selective mutism: are primary care physicians missing the silence?

    Science.gov (United States)

    Schwartz, Richard H; Freedy, Alicia S; Sheridan, Michael J

    2006-01-01

    To survey parents of children with selective mutism (SM) in regard to (1) the role of the primary care physician in the diagnosis of SM; (2) the social and school consequences of SM; and (3) their opinion of the effectiveness of different treatment modalities, a 39-item written survey was mailed to 27 parents with at least one child diagnosed with SM on the basis of diagnostic and statistical manual IV-text revision (DSM IV-TR) criteria. Twenty-seven parents (100%), with a total of 33 children with SM, completed the survey. There were 24 girls and 9 boys. The mean age when parents had strong concerns about symptoms of SM was 3.8 years, but diagnosis did not occur until nearly a year later. Twenty-three (69.7%) of the children with SM were never diagnosed accurately or referred by their primary care physicians. SM caused important school/social problems for 17 (51.5%) of the children. Speech therapy was provided for 36.4% of children and was thought to have been helpful for 30% of them. Behavior modification was the treatment for 45.5% of children and perceived to be helpful for 66.7% of them. Selective serotonin re-uptake inhibitor pharmacotherapy was prescribed for 17 (51.5%) of the children and believed to be effective for 11 (65%) of them. Primary care physicians in this study rarely diagnosed accurately or referred children with SM in a timely fashion, even though symptoms of the condition were generally very apparent and parents had expressed concern. Behavioral modification, pharmacotherapy with SSRIs, and early intervention are viable treatment options. Early diagnosis is key to preventing long-term effects of this condition.

  1. An instrument for broadened risk assessment in antenatal health care including non-medical issues.

    NARCIS (Netherlands)

    A.A. Vos (Amber); M.J. van Veen (Mieke); E. Birnie (Erwin); S. Denktaş (Semiha); E.A.P. Steegers (Eric); G.J. Bonsel (Gouke)

    2015-01-01

    markdownabstractGrowing evidence on the risk contributing role of non-medical factors on pregnancy outcomes urged for a new approach in early antenatal risk selection. The evidence invites to more integration, in particular between the clinical working area and the public health domain. We developed

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

    Science.gov (United States)

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

    2014-09-17

    The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.

  3. Patient Experienced Continuity of Care in the Psychiatric Healthcare System—A Study Including Immigrants, Refugees and Ethnic Danes

    Directory of Open Access Journals (Sweden)

    Natasja Koitzsch Jensen

    2014-09-01

    Full Text Available Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes. Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. Conclusions: The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.

  4. From rhetoric to reality: including patient voices in supportive cancer care planning

    Science.gov (United States)

    Gold, Sara K. Tedford; Abelson, Julia; Charles, Cathy A.

    2005-01-01

    Abstract Objective  To explore the extent and manner of patient participation in the planning of regional supportive care networks throughout the province of Ontario. We consider the disconnect between the rhetoric and reality of patient involvement in network planning and co‐ordination. Context  In 1997, the Province of Ontario, Canada, established a new, regionalized cancer care system. By transferring responsibility to the regional level and to networks, the architects of the new provincial system hoped to broaden participation in decision making and to enhance the responsiveness of decisions to communities. Research approach  Through a qualitative, multiple case study approach we evaluated the processes of involving patients in network development. In‐depth, semi‐structured interviews and document analysis were complemented by observations of provincial meetings, regional council and network meetings. Results  The network development processes in the three case study regions reveal a significant gap between intentions to involve patients in health planning and their actual involvement. This gap can be explained by: (i) a lack of clear direction regarding networks and patient participation in these networks; (ii) the dominance of regional cancer centres in network planning activities; and, (iii) the emergence of competing provincial priorities. Discussion  These three trends expose the complexity of the notion of public participation and how it is embedded in social and political contexts. The failed attempt at involving patients in health planning efforts is the result of benign neglect of public participation intents and the social and political contexts in which public and patient participation is meant to occur. PMID:16098150

  5. Cost-Effectiveness of Including a Nurse Specialist in the Treatment of Urinary Incontinence in Primary Care in the Netherlands.

    Directory of Open Access Journals (Sweden)

    K M Holtzer-Goor

    Full Text Available Incontinence is an important health problem. Effectively treating incontinence could lead to important health gains in patients and caregivers. Management of incontinence is currently suboptimal, especially in elderly patients. To optimise the provision of incontinence care a global optimum continence service specification (OCSS was developed. The current study evaluates the costs and effects of implementing this OCSS for community-dwelling patients older than 65 years with four or more chronic diseases in the Netherlands.A decision analytic model was developed comparing the current care pathway for urinary incontinence in the Netherlands with the pathway as described in the OCSS. The new care strategy was operationalised as the appointment of a continence nurse specialist (NS located with the general practitioner (GP. This was assumed to increase case detection and to include initial assessment and treatment by the NS. The analysis used a societal perspective, including medical costs, containment products (out-of-pocket and paid by insurer, home care, informal care, and implementation costs.With the new care strategy a QALY gain of 0.005 per patient is achieved while saving €402 per patient over a 3 year period from a societal perspective. In interpreting these findings it is important to realise that many patients are undetected, even in the new care situation (36%, or receive care for containment only. In both of these groups no health gains were achieved.Implementing the OCSS in the Netherlands by locating a NS in the GP practice is likely to reduce incontinence, improve quality of life, and reduce costs. Furthermore, the study also highlighted that various areas of the continence care process lack data, which would be valuable to collect through the introduction of the NS in a study setting.

  6. Consequences of Inadequate Staffing Include Missed Care, Potential Failure to Rescue, and Job Stress and Dissatisfaction.

    Science.gov (United States)

    Simpson, Kathleen Rice; Lyndon, Audrey; Ruhl, Catherine

    2016-01-01

    To evaluate responses of registered nurse members of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) to a survey that sought their recommendations for staffing guidelines and their perceptions of the consequences of inadequate nurse staffing. The goal was to use these member data to inform the work of the AWHONN nurse staffing research team. Secondary analysis of responses to the 2010 AWHONN nurse staffing survey. Online. AWHONN members (N = 884). Review of data from an online survey of AWHONN members through the use of thematic analysis for descriptions of the consequences of inadequate nurse staffing during the childbirth process. Three main themes emerged as consequences of inadequate staffing or being short-staffed: Missed Care, Potential for Failure to Rescue, and Job-Related Stress and Dissatisfaction. These themes are consistent with those previously identified in the literature related to inadequate nurse staffing. Based on the responses from participants in the 2010 AWHONN nurse staffing survey, consequences of inadequate staffing can be quite serious and may put patients at risk for preventable harm. Copyright © 2016 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  7. Dashboard report on performance on select quality indicators to cancer care providers.

    Science.gov (United States)

    Stattin, Pär; Sandin, Fredrik; Sandbäck, Torsten; Damber, Jan-Erik; Franck Lissbrant, Ingela; Robinson, David; Bratt, Ola; Lambe, Mats

    2016-01-01

    Cancer quality registers are attracting increasing attention as important, but still underutilized sources of clinical data. To optimize the use of registers in quality assurance and improvement, data have to be rapidly collected, collated and presented as actionable, at-a-glance information to the reporting departments. This article presents a dashboard performance report on select quality indicators to cancer care providers. Ten quality indicators registered on an individual patient level in the National Prostate Cancer Register of Sweden and recommended by the National Prostate Cancer Guidelines were selected. Data reported to the National Prostate Cancer Register are uploaded within 24 h to the Information Network for Cancer Care platform. Launched in 2014, "What''s Going On, Prostate Cancer" provides rapid, at-a-glance performance feedback to care providers. The indicators include time to report to the National Prostate Cancer Register, waiting times, designated clinical nurse specialist, multidisciplinary conference, adherence to guidelines for diagnostic work-up and treatment, and documentation and outcome of treatment. For each indicator, three performance levels were defined. What's Going On, a dashboard performance report on 10 selected quality indicators to cancer care providers, provides an example of how data in cancer quality registers can be transformed into condensed, at-a-glance information to be used as actionable metrics for quality assurance and improvement.

  8. Does including informal care in economic evaluations matter? A systematic review of inclusion and impact of informal care in cost-effectiveness studies.

    Science.gov (United States)

    Krol, Marieke; Papenburg, Jocé; van Exel, Job

    2015-02-01

    Informal care makes an important contribution to societal welfare. However, it may involve substantial time costs and can have a considerable negative effect on the health and well-being of informal caregivers. These costs and effects of informal caregiving are often excluded in economic evaluations of healthcare interventions. The impact of this exclusion on the outcomes of these evaluations is largely unknown. This study aimed to explore the inclusion of informal care in economic evaluations and the potential impact of the costs and effects of informal caregiving on cost-effectiveness outcomes. A systematic review was conducted to identify economic evaluations of interventions in four distinct disease areas where informal care is potentially important: Alzheimer's disease, metastatic colorectal cancer, Parkinson's disease and rheumatoid arthritis. It was recorded how often economic evaluations included informal caregiving. Next, for the studies including informal care, the impact on cost-effectiveness outcomes was determined by removing informal care costs and effects of the cost-effectiveness calculations and recalculating the outcomes. The new cost-effectiveness outcomes were then compared with the original reported outcomes. The study identified 100 economic evaluations investigating interventions targeted at Alzheimer's disease (n = 25), metastatic colorectal cancer (n = 24), Parkinson's disease (n = 8) and rheumatoid arthritis (n = 43). Twenty-three of these evaluations (23 %) included costs and/or effects of informal caregiving: 64 % of the Alzheimer's disease studies, 0 % of the metastatic colorectal cancer studies, 13 % of Parkinson's disease studies and 14 % of rheumatoid arthritis studies. When informal care was included, this mostly concerned time costs. Studies rarely included both costs and effects. The effect of including or excluding informal care costs or effects on cost-effectiveness outcomes in most studies was modest, but in some studies the

  9. The value of including spirometry in health checks - a randomized controlled study in primary health care

    DEFF Research Database (Denmark)

    Ørts, Lene Maria; Ottesen, Anders Løkke; Bjerregaard, Anne-Louise

    Background Lung diseases are among the most frequent and most serious ailments in Denmark. Preventive health checks including spirometry can be used to detect lung diseases earlier. Over time the attendance at preventive health checks has decreased and at present the response rate is approximately...... 50%. Little is known about initiatives that can influence the attendance rate. Objectives To examine whether focused information on spirometry in the invitation material will influence the attendance in preventive health checks. Materiel/Methods Design: A randomized controlled study on information...... on spirometry embedded in “Check your health Prevention Program, CHPP” from 2015-16. CHPP is a house-hold cluster randomized controlled trial offering a preventive health check to 30-49 year olds in a Danish municipality during the years 2012 through to 2017 (n= 26,216), carried out in collaboration between...

  10. Implementation considerations when expanding health worker roles to include safe abortion care: a five-country case study synthesis

    Directory of Open Access Journals (Sweden)

    Claire Glenton

    2017-09-01

    Full Text Available Abstract Background Allowing a broader range of trained health workers to deliver services can be an important way of improving access to safe abortion care. However, the expansion of health worker roles may be challenging to implement. This study aimed to explore factors influencing the implementation of role expansion strategies for non-physician providers to include the delivery of abortion care. Methods We conducted a multi-country case study synthesis in Bangladesh, Ethiopia, Nepal, South Africa and Uruguay, where the roles of non-physician providers have been formally expanded to include the provision of abortion care. We searched for documentation from each country related to non-physician providers, abortion care services and role expansion through general internet searches, Google Scholar and PubMed, and gathered feedback from 12 key informants. We carried out a thematic analysis of the data, drawing on categories from the SURE Framework of factors affecting the implementation of policy options. Results Several factors appeared to affect the successful implementation of including non-physician providers to provide abortion care services. These included health workers’ knowledge about abortion legislation and services; and health workers’ willingness to provide abortion care. Health workers’ willingness appeared to be influenced by their personal views about abortion, the method of abortion and stage of pregnancy and their perceptions of their professional roles. While managers’ and co-workers’ attitudes towards the use of non-physician providers varied, the synthesis suggests that female clients focused less on the type of health worker and more on factors such as trust, privacy, cost, and closeness to home. Health systems factors also played a role, including workloads and incentives, training, supervision and support, supplies, referral systems, and monitoring and evaluation. Strategies used, with varying success, to address

  11. Implementation considerations when expanding health worker roles to include safe abortion care: a five-country case study synthesis.

    Science.gov (United States)

    Glenton, Claire; Sorhaindo, Annik M; Ganatra, Bela; Lewin, Simon

    2017-09-21

    Allowing a broader range of trained health workers to deliver services can be an important way of improving access to safe abortion care. However, the expansion of health worker roles may be challenging to implement. This study aimed to explore factors influencing the implementation of role expansion strategies for non-physician providers to include the delivery of abortion care. We conducted a multi-country case study synthesis in Bangladesh, Ethiopia, Nepal, South Africa and Uruguay, where the roles of non-physician providers have been formally expanded to include the provision of abortion care. We searched for documentation from each country related to non-physician providers, abortion care services and role expansion through general internet searches, Google Scholar and PubMed, and gathered feedback from 12 key informants. We carried out a thematic analysis of the data, drawing on categories from the SURE Framework of factors affecting the implementation of policy options. Several factors appeared to affect the successful implementation of including non-physician providers to provide abortion care services. These included health workers' knowledge about abortion legislation and services; and health workers' willingness to provide abortion care. Health workers' willingness appeared to be influenced by their personal views about abortion, the method of abortion and stage of pregnancy and their perceptions of their professional roles. While managers' and co-workers' attitudes towards the use of non-physician providers varied, the synthesis suggests that female clients focused less on the type of health worker and more on factors such as trust, privacy, cost, and closeness to home. Health systems factors also played a role, including workloads and incentives, training, supervision and support, supplies, referral systems, and monitoring and evaluation. Strategies used, with varying success, to address some of these issues in the study countries included values

  12. Readmissions for Selected Infections Due to Medical Care: Expanding the Definition of a Patient Safety Indicator

    National Research Council Canada - National Science Library

    Gallagher, Brian; Cen, Liyi; Hannan, Edward L

    2005-01-01

    Objective: Evaluate the Agency for Healthcare Research and Quality's Patient Safety Indicator that identifies patients with selected infections that result from medical care during hospital inpatient treatment...

  13. FACTORS THAT INFLUENCE THE SELECTION OF LEARNING OPPORTUNITIES FOR STUDENT NURSES IN PRIMARY HEALTH CARE

    Directory of Open Access Journals (Sweden)

    H. lita

    2002-11-01

    The study therefore focused on the following objective: To identify the factors that influence the selection of learning opportunities for primary health care in hospital units. A qualitative research design utilising focus group discussions were used. The population consisted of conveniently selected lecturers, student nurses and registered nurses. The same initial question was asked in each focus group to initiate the discussions. The data were analysed according to Tesch's method. The results indicated that there is positive commitment from the lecturers and registered nurses to be involved in selecting appropriate learning opportunities. The student nurses also demonstrated a willingness to learn and to be exposed to learning opportunities in primary health care. There were however certain constraints that emerged as themes, namely: • Managerial constraints • Educational constraints Under the theme "managerial constraints" categories such as workload, nursing staff shortages and communication problems were identified. Under the theme "educational constraints" categories such as a lack of guidance, and the correlation of theory and practice emerged. Recommendations based on this research report include improvement of in-service education on managerial and educational aspects to facilitate the primary health care approach in hospitals.

  14. Development of a Web-Based Quality Dashboard Including a Toolbox to Improve Pain Management in Dutch Intensive Care.

    Science.gov (United States)

    Roos-Blom, Marie-José; Gude, Wouter T; de Jonge, Evert; Spijkstra, Jan Jaap; van der Veer, Sabine N; Dongelmans, Dave A; de Keizer, Nicolette F

    2017-01-01

    Audit and feedback (A&F) is a common strategy to improve quality of care. Meta-analyses have indicated that A&F may be more effective in realizing desired change when baseline performance is low, it is delivered by a supervisor or colleague, it is provided frequently and in a timely manner, it is delivered in both verbal and written formats, and it includes specific targets and an action plan. However, there is little information to guide operationalization of these factors. Researchers have consequently called for A&F interventions featuring well-described and carefully justified components, with their theoretical rationale made explicit. This paper describes the rationale and development of a quality dashboard including an improvement toolbox for four previous developed pain indicators, guided by Control Theory.

  15. Nonrandomized studies are not always found even when selection criteria for health systems intervention reviews include them: a methodological study.

    Science.gov (United States)

    Glenton, Claire; Lewin, Simon; Mayhew, Alain; Scheel, Inger; Odgaard-Jensen, Jan

    2013-04-01

    Systematic reviews within the Cochrane Effective Practice and Organisation of Care Group (EPOC) can include both randomized and nonrandomized study designs. We explored how many EPOC reviews consider and identify nonrandomized studies, and whether the proportion of nonrandomized studies identified is linked to the review topic. We recorded the study designs considered in 65 EPOC reviews. For reviews that considered nonrandomized studies, we calculated the proportion of identified studies that were nonrandomized and explored whether there were differences in the proportion of nonrandomized studies according to the review topic. Fifty-one (78.5%) reviews considered nonrandomized studies. Forty-six of these reviews found nonrandomized studies, but the proportion varied a great deal (median, 33%; interquartile range, 25--50%). Reviews of health care delivery interventions had lower proportions of nonrandomized studies than those of financial and governance interventions. Most EPOC reviews consider nonrandomized studies, but the degree to which they find them varies. As nonrandomized studies are believed to be at higher risk of bias and their inclusion entails a considerable effort, review authors should consider whether the benefits justify the inclusion of these designs. Research should explore whether it is more useful to consider nonrandomized studies in reviews of some intervention types than others. Copyright © 2013 Elsevier Inc. All rights reserved.

  16. Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Beekman Aartjan TF

    2007-03-01

    Full Text Available Abstract Background Depressive disorder is currently one of the most burdensome disorders worldwide. Evidence-based treatments for depressive disorder are already available, but these are used insufficiently, and with less positive results than possible. Earlier research in the USA has shown good results in the treatment of depressive disorder based on a collaborative care approach with Problem Solving Treatment and an antidepressant treatment algorithm, and research in the UK has also shown good results with Problem Solving Treatment. These treatment strategies may also work very well in the Netherlands too, even though health care systems differ between countries. Methods/design This study is a two-armed randomised clinical trial, with randomization on patient-level. The aim of the trial is to evaluate the treatment of depressive disorder in primary care in the Netherlands by means of an adapted collaborative care framework, including contracting and adherence-improving strategies, combined with Problem Solving Treatment and antidepressant medication according to a treatment algorithm. Forty general practices will be randomised to either the intervention group or the control group. Included will be patients who are diagnosed with moderate to severe depression, based on DSM-IV criteria, and stratified according to comorbid chronic physical illness. Patients in the intervention group will receive treatment based on the collaborative care approach, and patients in the control group will receive care as usual. Baseline measurements and follow up measures (3, 6, 9 and 12 months are assessed using questionnaires and an interview. The primary outcome measure is severity of depressive symptoms, according to the PHQ9. Secondary outcome measures are remission as measured with the PHQ9 and the IDS-SR, and cost-effectiveness measured with the TiC-P, the EQ-5D and the SF-36. Discussion In this study, an American model to enhance care for patients with a

  17. Applicability of bioanalysis of multiple analytes in drug discovery and development: review of select case studies including assay development considerations.

    Science.gov (United States)

    Srinivas, Nuggehally R

    2006-05-01

    The development of sound bioanalytical method(s) is of paramount importance during the process of drug discovery and development culminating in a marketing approval. Although the bioanalytical procedure(s) originally developed during the discovery stage may not necessarily be fit to support the drug development scenario, they may be suitably modified and validated, as deemed necessary. Several reviews have appeared over the years describing analytical approaches including various techniques, detection systems, automation tools that are available for an effective separation, enhanced selectivity and sensitivity for quantitation of many analytes. The intention of this review is to cover various key areas where analytical method development becomes necessary during different stages of drug discovery research and development process. The key areas covered in this article with relevant case studies include: (a) simultaneous assay for parent compound and metabolites that are purported to display pharmacological activity; (b) bioanalytical procedures for determination of multiple drugs in combating a disease; (c) analytical measurement of chirality aspects in the pharmacokinetics, metabolism and biotransformation investigations; (d) drug monitoring for therapeutic benefits and/or occupational hazard; (e) analysis of drugs from complex and/or less frequently used matrices; (f) analytical determination during in vitro experiments (metabolism and permeability related) and in situ intestinal perfusion experiments; (g) determination of a major metabolite as a surrogate for the parent molecule; (h) analytical approaches for universal determination of CYP450 probe substrates and metabolites; (i) analytical applicability to prodrug evaluations-simultaneous determination of prodrug, parent and metabolites; (j) quantitative determination of parent compound and/or phase II metabolite(s) via direct or indirect approaches; (k) applicability in analysis of multiple compounds in select

  18. Factors associated with late antenatal care attendance in selected ...

    African Journals Online (AJOL)

    Background: Despite antenatal care services being provided free of charge or sometimes at a minimal cost in Zambia, only 19% of women attend antenatal care by their fourth month of pregnancy, as recommended by World Health Organization (WHO). An estimated 21% of pregnant women in urban and 18% in rural ...

  19. Genomic selection needs to be carefully assessed to meet specific requirements in livestock breeding programs

    Directory of Open Access Journals (Sweden)

    Elisabeth eJonas

    2015-02-01

    Full Text Available Genomic selection is a promising development in agriculture, aiming improved production by exploiting molecular genetic markers to design novel breeding programs and to develop new markers-based models for genetic evaluation. It opens opportunities for research, as novel algorithms and lab methodologies are developed. Genomic selection can be applied in many breeds and species. Further research on the implementation of genomic selection in breeding programs is highly desirable not only for the common good, but also the private sector (breeding companies. It has been projected that this approach will improve selection routines, especially in species with long reproduction cycles, late or sex-limited or expensive trait recording and for complex traits. The task of integrating genomic selection into existing breeding programs is, however, not straightforward. Despite successful integration into breeding programs for dairy cattle, it has yet to be shown how much emphasis can be given to the genomic information and how much additional phenotypic information is needed from new selection candidates. Genomic selection is already part of future planning in many breeding companies of pigs and beef cattle among others, but further research is needed to fully estimate how effective the use of genomic information will be for the prediction of the performance of future breeding stock. Genomic prediction of production in crossbreeding and across-breed schemes, costs and choice of individuals for genotyping are reasons for a reluctance to fully rely on genomic information for selection decisions. Breeding objectives are highly dependent on the industry and the additional gain when using genomic information has to be considered carefully. This review synthesizes some of the suggested approaches in selected livestock species including cattle, pig, chicken and fish. It outlines tasks to help understanding possible consequences when applying genomic information in

  20. Model Selection and Evaluation Based on Emerging Infectious Disease Data Sets including A/H1N1 and Ebola

    Directory of Open Access Journals (Sweden)

    Wendi Liu

    2015-01-01

    Full Text Available The aim of the present study is to apply simple ODE models in the area of modeling the spread of emerging infectious diseases and show the importance of model selection in estimating parameters, the basic reproduction number, turning point, and final size. To quantify the plausibility of each model, given the data and the set of four models including Logistic, Gompertz, Rosenzweg, and Richards models, the Bayes factors are calculated and the precise estimates of the best fitted model parameters and key epidemic characteristics have been obtained. In particular, for Ebola the basic reproduction numbers are 1.3522 (95% CI (1.3506, 1.3537, 1.2101 (95% CI (1.2084, 1.2119, 3.0234 (95% CI (2.6063, 3.4881, and 1.9018 (95% CI (1.8565, 1.9478, the turning points are November 7,November 17, October 2, and November 3, 2014, and the final sizes until December 2015 are 25794 (95% CI (25630, 25958, 3916 (95% CI (3865, 3967, 9886 (95% CI (9740, 10031, and 12633 (95% CI (12515, 12750 for West Africa, Guinea, Liberia, and Sierra Leone, respectively. The main results confirm that model selection is crucial in evaluating and predicting the important quantities describing the emerging infectious diseases, and arbitrarily picking a model without any consideration of alternatives is problematic.

  1. Closed-form solutions for linear regulator-design of mechanical systems including optimal weighting matrix selection

    Science.gov (United States)

    Hanks, Brantley R.; Skelton, Robert E.

    1991-01-01

    This paper addresses the restriction of Linear Quadratic Regulator (LQR) solutions to the algebraic Riccati Equation to design spaces which can be implemented as passive structural members and/or dampers. A general closed-form solution to the optimal free-decay control problem is presented which is tailored for structural-mechanical systems. The solution includes, as subsets, special cases such as the Rayleigh Dissipation Function and total energy. Weighting matrix selection is a constrained choice among several parameters to obtain desired physical relationships. The closed-form solution is also applicable to active control design for systems where perfect, collocated actuator-sensor pairs exist. Some examples of simple spring mass systems are shown to illustrate key points.

  2. Parental Child Care Selection Criteria and Program Quality in Metropolitan and Nonmetropolitan Communities.

    Science.gov (United States)

    Ispa, Jean M.; Thornburg, Kathy R.; Venter-Barkley, Janet

    1998-01-01

    A study of 127 families and 50 child care facilities in 17 Missouri communities found that criteria for selecting child care were similar for metropolitan and nonmetropolitan parents; parents were more concerned with quality child care and caregiver "warmth" than with practical considerations; but ratings on caregiver warmth did not…

  3. Simultaneous determination of multiclass preservatives including isothiazolinones and benzophenone-type UV filters in household and personal care products by micellar electrokinetic chromatography.

    Science.gov (United States)

    Lopez-Gazpio, Josu; Garcia-Arrona, Rosa; Millán, Esmeralda

    2015-04-01

    In this work, a simple and reliable micellar electrokinetic chromatography method for the separation and quantification of 14 preservatives, including isothiazolinones, and two benzophenone-type UV filters in household, cosmetic and personal care products was developed. The selected priority compounds are widely used as ingredients in many personal care products, and are included in the European Regulation concerning cosmetic products. The electrophoretic separation parameters were optimized by means of a modified chromatographic response function in combination with an experimental design, namely a central composite design. After optimization of experimental conditions, the BGE selected for the separation of the targets consisted of 60 mM SDS, 18 mM sodium tetraborate, pH 9.4 and 10% v/v methanol. The MEKC method was checked in terms of linearity, LODs and quantification, repeatability, intermediate precision, and accuracy, providing appropriate values (i.e. R(2) ≥ 0.992, repeatability RSD values ˂9%, and accuracy 90-115%). Applicability of the validated method was successfully assessed by quantifying preservatives and UV filters in commercial consumer products. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  4. Using aspen for artist stretcher frames: adding value through quality service, direct marketing, and careful material selection

    Science.gov (United States)

    Chris. Polson

    2001-01-01

    Aspen wood, when carefully selected and kiln dried, makes excellent stock for artist stretcher frames. Direct marketing techniques including the Internet and word of mouth give access to national markets, providing a more diverse and stable customer base for operations from a rural area. High-quality service, as shown by product performance and rapid order fulfillment...

  5. factors associated with late antenatal care attendance in selected

    African Journals Online (AJOL)

    Esem

    delivery and ensuring that they deliver in a suitably. 5 equipped facility . ntenatal care attendance and ..... Table 4: Predictors of Late ANC attendance in Mpongwe and Ndola-logistic regression. Predictors. Mpongwe. Ndola. AOR .... transport systems were also hindrance factors to. 21 maternity service utilization . Univariate ...

  6. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul Dlpm; Frith, Peter A; Zwerink, Marlies; Monninkhof, Evelyn M; van der Palen, Job; Effing, Tanja W

    2017-08-04

    Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary

  7. Stepwise intervention including 1-on-1 counseling is highly effective in increasing influenza vaccination among health care workers.

    Science.gov (United States)

    Jung, Younghee; Kwon, Mihye; Song, Jeongmi

    2017-06-01

    The influenza vaccination rate among health care workers (HCWs) remains suboptimal. We attempted to increase vaccine uptake in HCWs by nonmandatory measures, including 1-on-1 counseling. In 2015 we used a stepwise approach including (1) text messaging on the last day of the vaccination period, (2) extending the vaccination period by 3 days, (3) education for the low uptake group, and (4) 1-on-1 counseling for unvaccinated HCWs after the 3 interventions. There were 1,433 HCWs included. By the end of the initial 3 days, the uptake rate was 80.0% (1,146/1,433). During an extension for a further 3 days, 33 additional HCWs received the vaccine. One month after starting the vaccination, 90.1% (1,291/1,433) of the HCWs were vaccinated, but this included only 76.1% (210/276) of the doctors (lowest among HCWs). After 3 educational presentations targeted at the unvaccinated doctors, no additional individuals were vaccinated in the following 2 weeks. After 1-on-1 counseling for unvaccinated HCWs, the overall vaccination rate increased to 94.7% (1,357/1,433) in 2015, higher than in the previous year (82.5%, P vaccinated, therefore achieving 92.4% (255/276) compliance, higher than the 56.5% in the previous year (152/269, P vaccination rates among HCWs. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  8. Managing the health care solid waste in selected districts of Punjab, Pakistan

    International Nuclear Information System (INIS)

    Ullah, J.H.; Ahmad, K.

    2010-01-01

    Hospital and other health care facilities (HCFs) are known to generate lot of waste for which its management is a matter of considerable public health and environmental concern. The study was undertaken to describe the current practices, gaps and quantify the load of health care solid waste. Out of one hundred and fifty health care facilities (HCFs) in Punjab, the largest province of Pakistan, a sample of fifteen (HCFs) was taken from a few selected Districts, to include six large hospitals and nine without indoor facilities. Only 40% of studied institutions had some program to dispose-off the waste. Even these programs were deficient in many areas and could hardly be considered as scientific. One third of institutional personnel interviewed had proper awareness or existence of a training program. Only one institution had some concept of taking safety steps from infectious materials. The process of solid waste collection, storing, transporting and final disposal was highly inefficient in almost all the institutions. No regulatory body or system of waste was in place in any of the hospitals. There was no allocated budget in 27% of the hospitals for covering the cost of waste disposal. An average of 0.3 kg/bed/day of solid unsafe waste demands a systematic program of its disposal, failing which serious environmental hazards would develop for within and surroundings communities. (author)

  9. Point-of-care diagnostic tools : Selection, evaluation and implementation in resource-constrained settings

    NARCIS (Netherlands)

    Kosack, C.S.

    2017-01-01

    In recent year’s point-of-care diagnostic tools especially for the three main killer diseases HIV/AIDS, tuberculosis and malaria have been emerging on the market. This thesis examines the selection, evaluation and implementation of point-of-care diagnostic tools for use in resource-constrained

  10. Genomic selection in a pig population including information from slaughtered full sibs of boars within a sib-testing program.

    Science.gov (United States)

    Samorè, A B; Buttazzoni, L; Gallo, M; Russo, V; Fontanesi, L

    2015-05-01

    Genomic selection is becoming a common practise in dairy cattle, but only few works have studied its introduction in pig selection programs. Results described for this species are highly dependent on the considered traits and the specific population structure. This paper aims to simulate the impact of genomic selection in a pig population with a training cohort of performance-tested and slaughtered full sibs. This population is selected for performance, carcass and meat quality traits by full-sib testing of boars. Data were simulated using a forward-in-time simulation process that modeled around 60K single nucleotide polymorphisms and several quantitative trait loci distributed across the 18 porcine autosomes. Data were edited to obtain, for each cycle, 200 sires mated with 800 dams to produce 800 litters of 4 piglets each, two males and two females (needed for the sib test), for a total of 3200 newborns. At each cycle, a subset of 200 litters were sib tested, and 60 boars and 160 sows were selected to replace the same number of culled male and female parents. Simulated selection of boars based on performance test data of their full sibs (one castrated brother and two sisters per boar in 200 litters) lasted for 15 cycles. Genotyping and phenotyping of the three tested sibs (training population) and genotyping of the candidate boars (prediction population) were assumed. Breeding values were calculated for traits with two heritability levels (h 2=0.40, carcass traits, and h 2=0.10, meat quality parameters) on simulated pedigrees, phenotypes and genotypes. Genomic breeding values, estimated by various models (GBLUP from raw phenotype or using breeding values and single-step models), were compared with the classical BLUP Animal Model predictions in terms of predictive ability. Results obtained for traits with moderate heritability (h 2=0.40), similar to the heritability of traits commonly measured within a sib-testing program, did not show any benefit from the

  11. Variations in Carabidae assemblages across the farmland habitats in relation to selected environmental variables including soil properties

    Directory of Open Access Journals (Sweden)

    Beáta Baranová

    2018-03-01

    Full Text Available The variations in ground beetles (Coleoptera: Carabidae assemblages across the three types of farmland habitats, arable land, meadows and woody vegetation were studied in relation to vegetation cover structure, intensity of agrotechnical interventions and selected soil properties. Material was pitfall trapped in 2010 and 2011 on twelve sites of the agricultural landscape in the Prešov town and its near vicinity, Eastern Slovakia. A total of 14,763 ground beetle individuals were entrapped. Material collection resulted into 92 Carabidae species, with the following six species dominating: Poecilus cupreus, Pterostichus melanarius, Pseudoophonus rufipes, Brachinus crepitans, Anchomenus dorsalis and Poecilus versicolor. Studied habitats differed significantly in the number of entrapped individuals, activity abundance as well as representation of the carabids according to their habitat preferences and ability to fly. However, no significant distinction was observed in the diversity, evenness neither dominance. The most significant environmental variables affecting Carabidae assemblages species variability were soil moisture and herb layer 0-20 cm. Another best variables selected by the forward selection were intensity of agrotechnical interventions, humus content and shrub vegetation. The other from selected soil properties seem to have just secondary meaning for the adult carabids. Environmental variables have the strongest effect on the habitat specialists, whereas ground beetles without special requirements to the habitat quality seem to be affected by the studied environmental variables just little.

  12. The use of the waiting list in a fair selection of patients for nursing home care

    NARCIS (Netherlands)

    Meiland, F. J.; Danse, J. A.; Hoos, A. M.; Wendte, J. F.; Gunning-Schepers, L. J.

    1996-01-01

    When health care resources are scarce, waiting lists may be used as a distribution measure in order to enhance the fair allocation of resources through selection of patients. In this study, the structure and use of a waiting list for a fair selection of patients for nursing home admission was

  13. Selection Behavior in the Market for Private Complementary Long-term Care Insurance in Germany

    DEFF Research Database (Denmark)

    Bauer, Jan; Schiller, Jörg; Schreckenberger, Christopher

    In this paper, we analyze selection effects in the German market for private complementary longterm care insurance contracts (CompLTCI) within a static and dynamic framework. Using data on more than 98,000 individuals from a German insurance company, we provide evidence that advantageous selection...

  14. Employer Satisfaction With an Injured Employee's Health Care: How Does It Affect the Selection of an Occupational Health Care Provider?

    Science.gov (United States)

    Keleher, Myra P; Stanton, Marietta P

    2016-01-01

    The purpose of this article is to explore the most important factors that an employer utilizes in selecting an occupational health care provider for their employees injured on the job. The primary practice setting is the attending physician's office who is an occupational health care provider. The responding employers deemed "work restrictions given after each office visit" as their most important factor in selecting an occupational health care provider, with a score of 43. This was followed in order in the "very important" category by communication, appointment availability, employee return to work within nationally recognized guidelines, tied were medical provider professionalism and courtesy with diagnostics ordered timely, next was staff professionalism and courtesy, and tied with 20 responses in the "very important" category were wait time and accurate billing by the provider.The selection of an occupational health care provider in the realm of workers' compensation plays a monumental role in the life of a claim for the employer. Safe and timely return to work is in the best interest of the employer and their injured employee. For the employer, it can represent hard dollars saved in indemnity payments and insurance premiums when the employee can return to some form of work. For the injured employee, it can have a positive impact on their attitude of going back to work as they will feel they are a valued asset to their employer. The case managers, who are the "eyes and ears" for the employer in the field of workers' compensation, have a valuable role in a successful outcome of dollars saved and appropriate care rendered for the employees' on the job injury. The employers in the study were looking for case managers who could ensure their employees received quality care but that this care is cost-effective. The case manager can be instrumental in assisting the employer in developing and monitoring a "stay-at-work" program, thereby reducing the financial exposure

  15. Current and emerging occupational safety and health (OSH) issues in the healthcare sector, including home and community care

    NARCIS (Netherlands)

    Jong, T. de; Bos, E.; Pawlowska-Cyprysiak, K.; Hildt-Ciupinska, K.; Malinska, M.; Nicolescu, G.; Trifu, A.

    2014-01-01

    This report gives an overview of the current and emerging OSH issues for health- and social care workers and how these affect their safety and health at work and influence the quality of care they provide. It combines a literature review and the responses received to a questionnaire sent to OSH

  16. Adult Asylum Seekers from the Middle East Including Syria in Central Europe: What Are Their Health Care Problems?

    Directory of Open Access Journals (Sweden)

    Carmen Andrea Pfortmueller

    Full Text Available Forced displacement related to persecution and violent conflict has reached a new peak in recent years. The primary aim of this study is to provide an initial overview of the acute and chronic health care problems of asylum seekers from the Middle East, with special emphasis on asylum seekers from Syria.Our retrospective data analysis comprised adult patients presenting to our emergency department between 01.11.2011 and 30.06.2014 with the official resident status of an "asylum seeker" or "refugee" from the Middle East.In total, 880 patients were included in the study. Of these, 625 (71.0% were male and 255 (29.0% female. The median age was 34 (range 16-84. 222 (25.2% of our patients were from Syria. The most common reason for presentation was surgical (381, 43.3%, followed by medical (321, 36.5% and psychiatric (137, 15.6%. In patients with surgical presentations, trauma-related problems were most common (n = 196, 50.6%. Within the group of patients with medical presentation, acute infectious diseases were most common (n = 141, 43.9%, followed by neurological problems (n = 70, 21.8% and gastrointestinal problems (n = 47, 14.6%. There were no differences between Syrian and non-Syrian refugees concerning surgical or medical admissions. The most common chronic disorder of unclear significance was chronic gastrointestinal problems (n = 132, 15%, followed by chronic musculoskeletal problems (n = 108, 12.3% and chronic headaches (n = 78, 8.9%. Patients from Syria were significantly younger and more often suffered from a post-traumatic stress disorder than patients of other nationalities (p<0.0001, and p = 0.05, respectively.Overall a remarkable number of our very young group of patients suffered from psychiatric disorders and unspecified somatic symptoms. Asylum seekers should be carefully evaluated when presenting to a medical facility and physicians should be aware of the high incidence of unspecified somatic symptoms in this patient population

  17. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units: an open-label, clustered group-randomised, crossover study

    NARCIS (Netherlands)

    Smet, A.M. de; Kluytmans, J.A.; Blok, H.E.; Mascini, E.M.; Benus, R.F.; Bernards, A.T.; Kuijper, E.J.; Leverstein-van Hall, M.A.; Jansz, A.R.; Jongh, B.M. de; Asselt, G.J. van; Frenay, I.H.; Thijsen, S.F.; Conijn, S.N.; Kaan, J.A.; Arends, J.P.; Sturm, P.D.J.; Bootsma, M.C.; Bonten, M.J.

    2011-01-01

    BACKGROUND: Previously, we assessed selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) on survival and prevention of bacteraemia in patients in intensive-care units. In this analysis, we aimed to assess effectiveness of these interventions for

  18. Selective digestive tract decontamination and selective oropharyngeal decontamination and antibiotic resistance in patients in intensive-care units : an open-label, clustered group-randomised, crossover study

    NARCIS (Netherlands)

    de Smet, Anne Marie G. A.; Kluytmans, Jan A. J. W.; Blok, Hetty E. M.; Mascini, Ellen M.; Benus, Robin F. J.; Bernards, Alexandra T.; Kuijper, Ed J.; Leverstein-van Hall, Maurine A.; Jansz, Arjan R.; de Jongh, Bartelt M.; van Asselt, Gerard J.; Frenay, Ine H. M. E.; Thijsen, Steven F. T.; Conijn, Simon N. M.; Kaan, Jan A.; Arends, Jan P.; Sturm, Patrick D. J.; Bootsma, Martin C. J.; Bonten, Marc J. M.

    Background Previously, we assessed selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) on survival and prevention of bacteraemia in patients in intensive-care units. In this analysis, we aimed to assess effectiveness of these interventions for prevention

  19. Adult Asylum Seekers from the Middle East Including Syria in Central Europe: What Are Their Health Care Problems?

    Science.gov (United States)

    Pfortmueller, Carmen Andrea; Schwetlick, Miriam; Mueller, Thomas; Lehmann, Beat; Exadaktylos, Aristomenis Konstantinos

    2016-01-01

    Forced displacement related to persecution and violent conflict has reached a new peak in recent years. The primary aim of this study is to provide an initial overview of the acute and chronic health care problems of asylum seekers from the Middle East, with special emphasis on asylum seekers from Syria. Our retrospective data analysis comprised adult patients presenting to our emergency department between 01.11.2011 and 30.06.2014 with the official resident status of an "asylum seeker" or "refugee" from the Middle East. In total, 880 patients were included in the study. Of these, 625 (71.0%) were male and 255 (29.0%) female. The median age was 34 (range 16-84). 222 (25.2%) of our patients were from Syria. The most common reason for presentation was surgical (381, 43.3%), followed by medical (321, 36.5%) and psychiatric (137, 15.6%). In patients with surgical presentations, trauma-related problems were most common (n = 196, 50.6%). Within the group of patients with medical presentation, acute infectious diseases were most common (n = 141, 43.9%), followed by neurological problems (n = 70, 21.8%) and gastrointestinal problems (n = 47, 14.6%). There were no differences between Syrian and non-Syrian refugees concerning surgical or medical admissions. The most common chronic disorder of unclear significance was chronic gastrointestinal problems (n = 132, 15%), followed by chronic musculoskeletal problems (n = 108, 12.3%) and chronic headaches (n = 78, 8.9%). Patients from Syria were significantly younger and more often suffered from a post-traumatic stress disorder than patients of other nationalities (pSyria when compared to other nationalities of asylum seekers from the Middle East.

  20. Experimental study of the relative efficiency of nonlinear and restricted selection indices for ratios including quadratic and cubic terms.

    Science.gov (United States)

    Campo, J L; Jorquera, M J

    1994-01-12

    A nonlinear selection index (NL) method was compared with restricted linear index (RI) using two experiments of upward selection for the weight/(lenght)(n) ratio in Tribolium castaneum. The first experiment was designed to increase pupal weight/(pupal length)(2) , while the second experiment was intended to improve larval weight/(larval length)(3) . Larval and pupal traits were measured at 14 and 21 days after adult emergence, respectively. There were four generations of selection in each of three replicates, the proportion selected being 20 %. The selection criterion in the NL lines was (m(1) + Ĝ(1) )/(m(2) + Ĝ(2) )(n) , where m(1) and m(2) are the population means for the numerator and denominator traits, Ĝ(1) and Ĝ(2) are the estimated additive genetic values, and n is 2 (experiment 1) or 3 (experiment 2). The restricted linear index used as the selection criterion in the RI lines was calculated to increase the numerator trait and hold the denominator constant. Responses observed for the ratios differed significantly between lines (P generaciones de selección en cada una de tres repeticiones, siendo la proporción seleccionada el 20 %. El criterio de selección en las líneas NL fue (m(1) +Ĝ(1) /(m(2) +Ĝ(2) )(n) , donde m(1) y m(2) son las medias para los caracteres numerador y denominador, Ĝ(1) y Ĝ(2) son los valores aditivos estimados, y n es 2 (experimento 1) o 3 (experimento 2). El índice con restricción usado como criterio de selección en las líneas RI fue calculado para incrementar el numerador y mantener constante el denominador. Las respuestas observadas para el cociente diferían significativamente entre líneas (P < .05) en ambos experimentos, teniendo mayor respuesta las líneas NL. En el experimento 1, la respuesta observada en el numerador fue significativa en la línea NL, mientras que fue positiva y significativa para ambos caracteres en la línea RI; las líneas diferían significativamente para longitud de pupa (P < .01). La

  1. Knee disorders in primary care: design and patient selection of the HONEUR knee cohort

    Directory of Open Access Journals (Sweden)

    Koes Bart W

    2005-08-01

    Full Text Available Abstract Background Knee complaints are a frequent reason for consultation in general practice. These patients constitute a specific population compared to secondary care patients. However, information to base treatment decisions on is generally derived from specialistic settings. Our cohort study is aimed at collecting knowledge about prognosis and prognostic factors of knee complaints presented in a primary care setting. This paper describes the methods used for data collection, and discusses potential selectiveness of patient recruitment. Methods This is a descriptive prospective cohort study with one-year follow-up. 40 Dutch GPs recruited consecutive patients with incident knee complaints aged 12 years and above from October 2001 to October 2003. Patients were assessed with questionnaires and standardised physical examinations. Additional measurements of subgroups included MRI for recent knee traumas and device assessed function measurements for non-traumatic patients. After the inclusion period we retrospectively searched the computerized medical files of participating GPs to obtain a sample to determine possible selective recruitment. We assessed differences in proportions of gender, traumatic onset of injury and age groups between participants and non-participants using Odds Ratios (OR and 95% confidence intervals. Results We recruited 1068 patients. In a sample of 310 patients visiting the GP, we detected some selective recruitment, indicating an underrepresentation of patients aged 12 to 35 years (OR 1.70; 1.15–2.77, especially among men (OR 2.16; 1.12–4.18. The underrepresentation of patients with traumatic onset of injury was not statistically significant. Conclusion This cohort is unique in its size, setting, and its range of both age and type of knee complaints. We believe the detected selective recruitment is unlikely to introduce significant bias, as the cohort will be divided into subgroups according to age group or traumatic

  2. [Transparency and replicability of nursing intervention studies in long-term care: A selective literature review].

    Science.gov (United States)

    Gspörer, Irene; Schrems, Berta M

    2017-12-18

    The development and evaluation of interventions in long-term care is time-consuming and expensive due to their complexity. To ensure reproducibility and successful implementation, these interventions must be described and published in a comprehensible and qualitative manner. The aim of this study is to analyze intervention studies from the inpatient long-term care setting with regard to their completeness, reporting quality, transparency and thus reproducibility. The completeness and the reporting quality of the interventions described in the publications were examined in the context of a selective literature review by means of intervention studies from the long-term care setting (n=22). To this end, the Template for Intervention Description and Replication (TIDieR) checklist and the Criteria for Reporting the Development and Evaluation of Complex Interventions in Healthcare 2 (CReDECI2-DE) list were used. Transparency criteria included study registration and access to study protocols. The TIDieR checklist examination revealed that only three studies contained all the information necessary; the CReDECI2 test provided a complete description for only one study. Frequent shortcomings were observed concerning the information on modifications and titrations for the study participants and the location. Protocols were available for eight studies, 14 studies were registered. In terms of science, this means that the reproducibility of scientific findings is limited, which is why they cannot provide secure knowledge. As a result, the practical benefit to be derived from published studies that are accessible to decision-makers is limited as well. As far as publishers are concerned they should pay more attention to the completeness, registration and availability of materials. Copyright © 2017. Published by Elsevier GmbH.

  3. Influence of probiotics, included in peanut butter, on the fate of selected Salmonella and Listeria strains under simulated gastrointestinal conditions.

    Science.gov (United States)

    Klu, Y A K; Chen, J

    2016-04-01

    This study observed the behaviour of probiotics and selected bacterial pathogens co-inoculated into peanut butter during gastrointestinal simulation. Peanut butter homogenates co-inoculated with Salmonella/Listeria strains (5 log CFU ml(-1) ) and lyophilized or cultured probiotics (9 log CFU ml(-1) ) were exposed to simulated gastrointestinal conditions for 24 h at 37°C. Sample pH, titratable acidity and pathogen populations were determined. Agar diffusion assay was performed to assess the inhibitory effect of probiotic culture supernatants with either natural (3·80 (Lactobacillus), 3·78 (Bifidobacteirum) and 5·17 (Streptococcus/Lactococcus)) or neutralized (6·0) pH. Antibacterial effect of crude bacteriocin extracts were also evaluated against the pathogens. After 24 h, samples with probiotics had lower pH and higher titratable acidity than those without probiotics. The presence of probiotics caused a significant reduction (P pH diminished their antibacterial activities. Crude bacteriocin extracts had a strain-specific inhibitory effect only towards Listeria monocytogenes. Probiotics in 'peanut butter' survived simulated gastrointestinal conditions and inhibited the growth of Salmonella/Listeria. Peanut butter is a plausible carrier to deliver probiotics to improve the gastrointestinal health of children in developing countries. © 2016 The Society for Applied Microbiology.

  4. Development of a Web-Based Quality Dashboard Including a Toolbox to Improve Pain Management in Dutch Intensive Care

    NARCIS (Netherlands)

    Roos-Blom, Marie-José; Gude, Wouter T.; de Jonge, Evert; Spijkstra, Jan Jaap; van der Veer, Sabine N.; Dongelmans, Dave A.; de Keizer, Nicolette F.

    2017-01-01

    Audit and feedback (A&F) is a common strategy to improve quality of care. Meta-analyses have indicated that A&F may be more effective in realizing desired change when baseline performance is low, it is delivered by a supervisor or colleague, it is provided frequently and in a timely manner, it is

  5. Estimation of Genetic Variance Components Including Mutation and Epistasis using Bayesian Approach in a Selection Experiment on Body Weight in Mice

    DEFF Research Database (Denmark)

    Widyas, Nuzul; Jensen, Just; Nielsen, Vivi Hunnicke

    selected downwards and three lines were kept as controls. Bayesian statistical methods are used to estimate the genetic variance components. Mixed model analysis is modified including mutation effect following the methods by Wray (1990). DIC was used to compare the model. Models including mutation effect...

  6. Assessment of provider competence and quality of maternal/newborn care in selected Latin American and Caribbean countries

    Directory of Open Access Journals (Sweden)

    Joyce E Thompson

    2015-05-01

    Full Text Available OBJECTIVE: To obtain a snapshot of the maternal and newborn care provided by different types of maternal and child health providers in Latin America and the Caribbean (LAC to 1 better inform advocacy and programmatic strategies and interventions to improve the quality of those services in the region, and 2 determine the need for more rigorous study of the issues. METHODS: A rapid assessment of 83 health workers providing antepartum, intrapartum, and immediate postpartum and newborn care (within two hours of birth in eight LAC countries was conducted in November and December of 2011. Health workers were observed by two-person expert maternal/newborn clinician teams using pretested forms based on international quality-of-care standards. A total of 105 care encounters were observed, primarily in urban, public, referral-level settings. Providers of care included obstetricians, midwives, generalist physicians, medical residents, registered nurses, auxiliary nurses, and students of medicine, midwifery, and nursing. RESULTS: Hand washing, as an indicator of quality of antepartum care, was observed in only 41% of the observed encounters. Labor management often lacked certain elements of respectful maternity care across all provider groups. Several clinical tasks of high importance in the identification and prevention of common complications of antepartum, intrapartum, and immediate postpartum/newborn care were not documented as performed during the observation periods. Providers self-reported limited competence (ability to perform to a defined level of proficiency in manual removal of the placenta, bimanual compression of the uterus, and newborn resuscitation. CONCLUSIONS: The findings suggest that 1 the quality of maternal and newborn care and 2 the competence of maternal and child health providers in the diverse selection of LAC countries that were studied require substantial attention.

  7. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    Directory of Open Access Journals (Sweden)

    Marc Carreras

    2016-08-01

    Full Text Available Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care. Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain for the year 2012 (N = 92,498 individuals. A set of individual cost models as a function of sex, age and morbidity burden were adjusted and individual healthcare costs were calculated using a retrospective full-costing system. The individual morbidity burden was inferred using the Clinical Risk Groups (CRG patient classification system. Results: Depending on the characteristics of the data, and according to the algorithm criteria, the choice of model was a linear model on the log of costs or a generalized linear model with a log link. We checked for goodness of fit, accuracy, linear structure and heteroscedasticity for the models obtained. Conclusion: The proposed algorithm identified a set of suitable cost models for the distinct groups of services integrated care entails. The individual morbidity burden was found to be indispensable when allocating appropriate resources to targeted individuals.

  8. The impact of a medical undergraduate student-selected module in palliative care.

    Science.gov (United States)

    Sweeney, Catherine; Lynch, Gerardine; Khashan, Ali; Maher, Bridget; Murphy, Marie; O'Brien, Tony

    2014-03-01

    The need for undergraduate medical education in palliative care is widely recognised. An optional student-selected module 'Fundamentals of Palliative Medicine' was introduced in 2011 and offered to third-year medical students. The overall objective of the module was to develop students' knowledge, attitudes and skills in palliative care. To assess impact of the module in terms of qualitative and quantitative measures, and to improve the module design and content for future years. Students completed validated tools (Self Efficacy in Palliative Care and Thanatophobia Scale (TS)) premodule and postmodule. A Minute Paper was completed at the penultimate session with students identifying areas they had a good understanding of, and issues they still found unclear. Twenty-four of 155 eligible students chose the module. Significant differences were seen in premodule and postmodule Self Efficacy in Palliative Care scores (communication ppalliative care, and further palliative care learning needs. Several students commented that the module should be core curriculum. The module was a popular choice with students, was well received, and appears to have had a significant educational impact in terms of changing students' attitudes and perceived knowledge and skills in palliative care.

  9. Use of web services for computerized medical decision support, including infection control and antibiotic management, in the intensive care unit.

    Science.gov (United States)

    Steurbaut, Kristof; Van Hoecke, Sofie; Colpaert, Kirsten; Lamont, Kristof; Taveirne, Kristof; Depuydt, Pieter; Benoit, Dominique; Decruyenaere, Johan; De Turck, Filip

    2010-01-01

    The increasing complexity of procedures in the intensive care unit (ICU) requires complex software services, to reduce improper use of antibiotics and inappropriate therapies, and to offer earlier and more accurate detection of infections and antibiotic resistance. We investigated whether web-based software can facilitate the computerization of complex medical processes in the ICU. The COSARA application contains the following modules: Infection overview, Thorax, Microbiology, Antibiotic therapy overview, Admission cause with comorbidity and admission diagnosis, Infection linking and registration, and Feedback. After the implementation and test phase, the COSARA software was installed on a physician's office PC and then on the bedside PCs of the patients. Initial evaluation indicated that the services had been integrated easily into the daily clinical workflow of the medical staff. The use of a service oriented architecture with web service technology for the development of advanced decision support in the ICU offers several advantages over classical software design approaches.

  10. Patient-related factors and circumstances surrounding decisions to forego life-sustaining treatment, including intensive care unit admission refusal.

    Science.gov (United States)

    Reignier, Jean; Dumont, Romain; Katsahian, Sandrine; Martin-Lefevre, Laurent; Renard, Benoit; Fiancette, Maud; Lebert, Christine; Clementi, Eva; Bontemps, Frederic

    2008-07-01

    To assess decisions to forego life-sustaining treatment (LST) in patients too sick for intensive care unit (ICU) admission, comparatively to patients admitted to the ICU. Prospective observational cohort study. A medical-surgical ICU. Consecutive patients referred to the ICU during a one-yr period. None. Of 898 triaged patients, 147 were deemed too well to benefit from ICU admission. Decisions to forego LST were made in 148 of 666 (22.2%) admitted patients and in all 85 patients deemed too sick for ICU admission. Independent predictors of decisions to forego LST at ICU refusal rather than after ICU admission were: age; underlying disease; living in an institution; preexisting cognitive impairment; admission for medical reasons; and acute cardiac failure, acute central neurologic illness, or sepsis. Hospital mortality after decisions to forego LST was not significantly different in refused and admitted patients (77.5% vs. 86.5%; p = .1). Decisions to forego LST were made via telephone in 58.8% of refused patients and none of the admitted patients. Nurses caring for the patient had no direct contact with the ICU physicians for 62.3% of the decisions in refused patients, whereas meetings between nurses and physicians occurred in 70.3% of decisions to forego LST in the ICU. Patients or relatives were involved in 28.2% of decisions to forego LST at ICU refusal compared with 78.4% of decisions to forego LST in ICU patients (p refused patients (vs. none of admitted patients) and were associated with less involvement of nurses and relatives compared with decisions in admitted patients. Further work is needed to improve decisions to forego LST made under the distinctive circumstances of triage.

  11. Removal of Selected Pharmaceutical and Personal Care Products by the Green Alga Nannochloris sp.

    Science.gov (United States)

    Bai, X.; Acharya, K.

    2016-12-01

    Emerging contaminants have become an increasing concern in the environment due to their ubiquitous distribution and potential adverse effects on wildlife and humans. Municipal wastewater is a major source of pharmaceutical and personal care products (PPCPs) in the Las Vegas metropolitan area. The ecotoxic impacts of PPCPs on aquatic organisms include development of antimicrobial resistance, decreases in plankton diversity, and endocrine disruption. Freshwater algae can be responsible for the uptake and transfer of the contaminants because they are a major food source for most aquatic organisms. This research applied laboratory-based incubation studies to evaluate the removal efficiency and uptake mechanisms of the selected PPCPs (trimethoprim, sulfamethoxazole, and triclosan) by the green alga Nannochloris sp. The results showed that trimethoprim and sulfamethoxazole remained in the algal culture at 100% and 68%, respectively, after 14 days of incubation, and therefore were not significantly removed from the medium. However, the antimicrobial triclosan was significantly removed from the medium. Immediately after incubation began, 74% of triclosan dissipated and 100% of triclosan was removed after 7 days of incubation. Additionally, over 42% of triclosan was found associated with the algal cells throughout the incubation. The results demonstrate that the presence of Nannochloris sp. eliminated triclosan in the aquatic system, but could not significantly remove the antibiotics trimethoprim and sulfamethoxazole. This study provided crucial information that toxicity of triclosan in aquatic organisms is a critical concern because of its high uptake by phytoplankton. The resistance of trimethoprim and sulfamethoxazole to uptake by phytoplankton may threaten water quality.

  12. Ensuring a fair and equitable selection of students to serve society's health care needs.

    Science.gov (United States)

    Girotti, Jorge A; Park, Yoon Soo; Tekian, Ara

    2015-01-01

    This study aimed to evaluate a selection and programmatic intervention designated 'Conditional Admissions' (CA), which is intended to expand access to medical education for individuals from under-represented ethnic, racial and rural groups. Further aims were to establish principles of practice designed to increase access for under-represented groups based on an empirical comparison of programmatic changes made to CA in 2005, and to quantify the costs associated with its implementation. Data for all students admitted between 1999 and 2009 (n = 3227) were compiled; these included demographic data, undergraduate college performance grades, medical school performance indicators, and information on honours, residency placement and md degree completion. To examine the outcomes of the CA intervention, students were divided into two cohorts of those admitted through the CA initiative during 1999-2004 and 2005-2009, respectively, and analysed for differences. Costs associated with CA were also calculated. There were 274 students admitted through CA (8.5% of all admittances) during 1999-2009; of these, 81.4% were from under-represented ethnic or racial backgrounds and 18.6% were from rural backgrounds. These students had more hours of science coursework, lower science and cumulative grade point averages (GPAs), and lower mean Medical College Admission Test (MCAT) scores than non-CA students. However, first-time pass rates and mean scores on the US Medical Licensing Examination (USMLE) Step 1 and USMLE Step 2 Clinical Knowledge increased significantly in the CA cohort during 2005-2009. Additional costs incurred per student ranged between US$849 and US$3801. Interventions such as CA can significantly increase diversity in the physician workforce. Interventions must be based on careful assessment of academic preparedness, as well as on non-academic factors that contribute to ability to successfully manage the rigors of medical education. Furthermore, the selection and

  13. Genetic gain and economic values of selection strategies including semen traits in three- and four-way crossbreeding systems for swine production.

    Science.gov (United States)

    González-Peña, D; Knox, R V; MacNeil, M D; Rodriguez-Zas, S L

    2015-03-01

    Four semen traits: volume (VOL), concentration (CON), progressive motility of spermatozoa (MOT), and abnormal spermatozoa (ABN) provide complementary information on boar fertility. Assessment of the impact of selection for semen traits is hindered by limited information on economic parameters. Objectives of this study were to estimate economic values for semen traits and to evaluate the genetic gain when these traits are incorporated into traditional selection strategies in a 3-tier system of swine production. Three-way (maternal nucleus lines A and B and paternal nucleus line C) and 4-way (additional paternal nucleus line D) crossbreeding schemes were compared. A novel population structure that accommodated selection for semen traits was developed. Three selection strategies were simulated. Selection Strategy I (baseline) encompassed selection for maternal traits: number of pigs born alive (NBA), litter birth weight (LBW), adjusted 21-d litter weight (A21), and number of pigs at 21 d (N21); and paternal traits: number of days to 113.5 kg (D113), backfat (BF), ADG, feed efficiency (FE), and carcass lean % (LEAN). Selection Strategy II included Strategy I and the number of usable semen doses per collection (DOSES), a function of the 4 semen traits. Selection Strategy III included Strategy I and the 4 semen traits individually. The estimated economic values of VOL, CON, MOT, ABN, and DOSES for 7 to 1 collections/wk ranged from $0.21 to $1.44/mL, $0.12 to $0.83/10 spermatozoa/mm, $0.61 to $12.66/%, -$0.53 to -$10.88/%, and $2.01 to $41.43/%, respectively. The decrease in the relative economic values of semen traits and DOSES with higher number of collections per wk was sharper between 1 and 2.33 collections/wk than between 2.33 and 7 collections/wk. The higher economic value of MOT and ABN relative to VOL and CON could be linked to the genetic variances and covariances of these traits. Average genetic gains for the maternal traits were comparable across strategies

  14. The Nordic Maintenance Care Program – An interview study on the use of maintenance care in a selected group of Danish chiropractors

    Directory of Open Access Journals (Sweden)

    Leboeuf-Yde Charlotte

    2009-06-01

    Full Text Available Abstract Background Although maintenance care appears to be relatively commonly used among chiropractors, the indications for its use are incompletely understood. A questionnaire survey was recently carried out among Swedish chiropractors in order to identify their choice of various management strategies, including maintenance care. That study revealed a common pattern of choice of strategies. However, it would be necessary to verify these findings in another study population and to obtain some additional information best collected through an interview. Objectives The main aim of the present study was to attempt to reproduce the findings in the Swedish study and to obtain more information on the use of maintenance care. Method A group of 11 chiropractors were selected because they used maintenance care. They were interviewed using the questionnaire from the previous Swedish survey. The questionnaire consisted of a simple description of a hypothetical patient with low back pain and nine possible ways in which the case could develop ("scenarios". They could choose between six different management strategies for each scenario. In addition, the chiropractors were encouraged to provide their own definition of maintenance care in an open-ended question. Interviews were taped, transcribed and analyzed. For the open-ended question, statements were identified relating to six pre hoc defined topics on the inclusion criteria/rationale for maintenance care, the frequency of treatments, and the duration of the maintenance care program. Results The open-ended question revealed that in patients with low back pain, maintenance care appears to be offered to prevent new events. The rationale was to obtain optimal spinal function. There appears to be no common convention on the frequency of treatments and duration of the treatment program was not mentioned by any of the interviewees. Conclusion The results from the questionnaire in the Danish survey showed that

  15. The Effects of a Family Support Program Including Respite Care on Parenting Stress and Family Quality of Life Perceived by Primary Caregivers of Children with Disabilities in Korea

    Science.gov (United States)

    Sung, Minjung; Park, Jiyeon

    2012-01-01

    In this study, a family support program was carried out for primary caregivers of children with disabilities. The program included respite care, recreation programs, counseling, and social support coordination based on individual needs of each family. In order to verify the intervention effects, parenting stress and family quality of life were…

  16. ASID (HICSIG) position statement: infection control guidelines for patients with influenza-like illnesses, including pandemic (H1N1) influenza 2009, in Australian health care facilities.

    Science.gov (United States)

    Stuart, Rhonda L; Cheng, Allen C; Marshall, Caroline L; Ferguson, John K

    2009-10-19

    Standard and Droplet Precautions are considered adequate to control the transmission of influenza in most health care situations. Vaccination of health care staff, carers and vulnerable patients against seasonal and, eventually, pandemic influenza strains is an essential protective strategy. Management principles include: performance of hand hygiene before and after every patient contact or contact with the patient environment, in accord with the national 5 Moments for Hand Hygiene Standard; disinfection of the patient environment; early identification and isolation of patients with suspected or proven influenza; adoption of a greater minimum distance of patient separation (2 metres) than previously recommended; use of a surgical mask and eye protection for personal protection on entry to infectious areas or within 2 metres of an infectious patient; contact tracing for patient and health care staff and restriction of prophylactic antivirals mainly to those at high risk of severe disease; in high aerosol-risk settings, use of particulate mask, eye protection, impervious long-sleeved gown, and gloves donned in that sequence and removed in reverse sequence, avoiding self-contamination; exclusion of symptomatic staff from the workplace until criteria for non-infectious status are met; reserving negative-pressure ventilation rooms (if available) for intensive care patients, especially those receiving non-invasive ventilation; ensuring that infectious postpartum women wear surgical masks when caring for their newborn infants and practise strict hand hygiene; and implementation of special arrangements for potentially infected newborns who require nursery or intensive care.

  17. Non-adaptive territory selection by a bird with exceptionally long parental care

    Directory of Open Access Journals (Sweden)

    Radosław Włodarczyk

    2016-03-01

    Full Text Available High-quality territories are expected to provide greater fitness return for breeding individuals and, thus, are likely to have higher long-term occupation rate in comparison to low-quality territories. However, if environmental and ecological cues used for territory selection cannot reliably predict true territory quality, a mismatch between preferences and fitness may occur. We suggest that this kind of non-adaptive territory selection is more likely in species with long reproductive cycles, as a long time interval between territory establishment and young fledgling should reduce predictability of conditions during the critical stages of brood care. In this study, we investigated adaptiveness of territory selection in a migratory bird with exceptionally long parental care, the mute swan Cygnus olor, which requires over four months to complete the entire reproductive cycle from egg laying to young fledging. For this purpose, we collected information on the long-term (10–19 years occupancy of 222 swan breeding territories and correlated it with reproductive performance (n = 1,345 breeding attempts and body condition of breeding adults. We found that long-term occupancy positively correlated with the timing of breeding, suggesting that individuals settled earlier in the attractive, frequently occupied territories. By contrast, we found no relationship between territory occupancy and reproductive output (hatching and fledging success or adult body condition. The results indicate that at the time of territory selection swans might not be able to reliably assess territory quality, likely due to: (1 exceptionally long period of parental care, which reduces temporal correlation between the conditions at the time of territory selection and conditions during chick rearing; and (2 unpredictability of human-related activities that had a major impact on reproductive output of swan pairs in our population.

  18. Transformation management of primary health care services in two selected local authorities in Gauteng

    Directory of Open Access Journals (Sweden)

    W Sibaya

    2000-09-01

    Full Text Available The transformation of health services in South Africa today is governed by the political, policy and legislative frameworks. This article focuses on the transformation of a primary health care service within a local authority in Gauteng. The purpose with this article is to explore and describe the perceptions (expectations and fears of selected managers employed in this primary health care service. The results are utilised to compile a strategy (framework for transformation management and leadership within the primary health care service. A qualitative research design was utilised and the data was collected by means of individual interviews with selected managers in the service, followed by a content analysis. The expectations and fears of managers focus mainly on personnel matters, community participation/satisfaction, salaries and parity, inadequate stocks/supplies and medication, the deterioration of quality service delivery and the need for training and empowerment. These results are divided into structure, process and outcome dimensions and are embodied in the conceptual framework for the transformation and leadership strategy. It is recommended that standards for transformation management be formulated and that the quality of transformation management be evaluated accordingly.

  19. Game Theoretic Approach for Systematic Feature Selection; Application in False Alarm Detection in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Fatemeh Afghah

    2018-03-01

    Full Text Available Intensive Care Units (ICUs are equipped with many sophisticated sensors and monitoring devices to provide the highest quality of care for critically ill patients. However, these devices might generate false alarms that reduce standard of care and result in desensitization of caregivers to alarms. Therefore, reducing the number of false alarms is of great importance. Many approaches such as signal processing and machine learning, and designing more accurate sensors have been developed for this purpose. However, the significant intrinsic correlation among the extracted features from different sensors has been mostly overlooked. A majority of current data mining techniques fail to capture such correlation among the collected signals from different sensors that limits their alarm recognition capabilities. Here, we propose a novel information-theoretic predictive modeling technique based on the idea of coalition game theory to enhance the accuracy of false alarm detection in ICUs by accounting for the synergistic power of signal attributes in the feature selection stage. This approach brings together techniques from information theory and game theory to account for inter-features mutual information in determining the most correlated predictors with respect to false alarm by calculating Banzhaf power of each feature. The numerical results show that the proposed method can enhance classification accuracy and improve the area under the ROC (receiver operating characteristic curve compared to other feature selection techniques, when integrated in classifiers such as Bayes-Net that consider inter-features dependencies.

  20. Obstacles to implementing evidence-based practice in Belgium: a context-specific qualitative evidence synthesis including findings from different health care disciplines.

    Science.gov (United States)

    Hannes, K; Goedhuys, J; Aertgeerts, B

    2012-01-01

    A number of barriers to the implementation of evidence-based practice have already been inventoried. However, little attention has been given to their context-specific nature. This qualitative evidence synthesis examines commonalities in the obstacles perceived by different groups of health care practitioners working in the Belgian health care system and sets out to discuss potential strategies to bridge some of these barriers. We actively searched for primary studies addressing our topic of interest in international and national databases (1990 to May 2008), consulted experts and screened references of retrieved studies. We opted for the meta-aggregative approach, developed by the Joanna Briggs Institute, to analyse our findings. The findings indicate that (1) evidence might have a limited role in decision-making processes; (2) aspects other than quality of care steer the evidence-based practice agenda; (3) some health care providers benefit less from evidence-based practice than others and (4) there is a lack of competences to put the evidence-based principles in practice. Belgian policy makers might consider health care system characteristics from and strategies developed or suggested by others to respond to country-specific obstacles. Examples include but are not limited to; (a) providing incentives for patient-centred care coordination and patient communication, (b) supporting practitioners interested in applying research-related activities, (c) considering direct access systems and interprofessional learning to respond to the demand for autonomous decision-making from satellite professional groups, (d) systematically involving allied health professionals in important governmental advisory boards, (e) considering pharmaceutical companies perceived as 'the enemy' an ally in filling in research gaps, (f) embedding the evaluation of evidence-based knowledge and skills in examinations (g) moving from (in)formative learning to transformative learning and (h

  1. Sri Lanka's Health Unit Program: A Model of "Selective" Primary Health Care

    Directory of Open Access Journals (Sweden)

    Soma Hewa

    2011-12-01

    Full Text Available This paper argues that the health unit program developed in Sri Lanka in the early twentieth century was an earlier model of selective primary health care promoted by the Rockefeller Foundation in the 1980s in opposition to comprehensive primary health care advocated by the Alma-Ata Declaration of the World Health Organization. A key strategy of the health unit program was to identify the most common and serious infectious diseases in each health unit area and control them through improved sanitation, health education, immunization and treatment with the help of local communities. The health unit program was later introduced to other countries in South and Southeast Asia as part of the Rockefeller Foundation's global campaign to promote public health.

  2. The ethics of sex selection: a comparison of the attitudes and experiences of primary care physicians and physician providers of clinical sex selection services.

    Science.gov (United States)

    Puri, Sunita; Nachtigall, Robert D

    2010-05-01

    To compare the perspectives of primary care physicians (PCPs) and physician sex-selection technology providers (SSTPs) about the ethics of sex selection. Qualitative interview study. Academic, private, and HMO-based infertility and general medical practices. Forty PCPs and 15 SSTPs. Semistructured interviews. Comparisons of bioethical attitudes towards sex selection. Primary care physicians and SSTPs had distinctly different perceptions of the ethical concepts of autonomy, beneficence, and nonmaleficence as applied to sex selection. Sex-selection technology providers argued that sex selection was an expression of reproductive rights, was initiated and pursued by women, and was a sign of female empowerment that allowed couples to make well-informed family planning decisions, prevented unwanted pregnancies and abortions, and minimized the abuse of wives and/or neglect of children. In contrast, PCPs challenged the concept of "family balancing" and questioned whether women could truly express free choice under family and community pressure. In addition, PCPs voiced the concerns that sex selection technologies led to invasive medical interventions in the absence of therapeutic indications, contributed to gender stereotypes that could result in neglect of children of the lesser-desired sex, and were not a solution to domestic violence. Primary care physicians and SSTPs had markedly different ethical perspectives on the provision of sex selection services that were informed by their professional and personal attitudes and experiences. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  3. Health-Care Waste Treatment Technology Selection Using the Interval 2-Tuple Induced TOPSIS Method.

    Science.gov (United States)

    Lu, Chao; You, Jian-Xin; Liu, Hu-Chen; Li, Ping

    2016-06-04

    Health-care waste (HCW) management is a major challenge for municipalities, particularly in the cities of developing nations. Selecting the best treatment technology for HCW can be regarded as a complex multi-criteria decision making (MCDM) issue involving a number of alternatives and multiple evaluation criteria. In addition, decision makers tend to express their personal assessments via multi-granularity linguistic term sets because of different backgrounds and knowledge, some of which may be imprecise, uncertain and incomplete. Therefore, the main objective of this study is to propose a new hybrid decision making approach combining interval 2-tuple induced distance operators with the technique for order preference by similarity to an ideal solution (TOPSIS) for tackling HCW treatment technology selection problems with linguistic information. The proposed interval 2-tuple induced TOPSIS (ITI-TOPSIS) can not only model the uncertainty and diversity of the assessment information given by decision makers, but also reflect the complex attitudinal characters of decision makers and provide much more complete information for the selection of the optimum disposal alternative. Finally, an empirical example in Shanghai, China is provided to illustrate the proposed decision making method, and results show that the ITI-TOPSIS proposed in this paper can solve the problem of HCW treatment technology selection effectively.

  4. An Experimental Study of the Effects of Employer-Sponsored Child Care Services on Selected Employee Behaviors.

    Science.gov (United States)

    Dawson, Ann Gilman; And Others

    Described in this report is a study conducted to determine whether different kinds of employer-supported child care services had differing effects on the users of these services. Data were gathered on a year's attendance and turnover rates for 891 female employees who had used employer-provided child care. Subjects were randomly selected from 39…

  5. An Experimental Study of the Effects of Employer-Sponsored Child Care Services on Selected Employee Behaviors. Executive Summary.

    Science.gov (United States)

    Dawson, Ann Gilman; And Others

    This executive summary describes a study conducted to determine whether different kinds of employer-supported child care services had differing effects on service users. Turnover and attendance data on 891 randomly selected female employees were gathered from 39 companies and hospitals offering on-site or off-site child care, information and…

  6. Quality Improvement in Critical Care: Selection and Development of Quality Indicators

    Science.gov (United States)

    Martin, Claudio M.; Project, The Quality Improvement in Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts. PMID:27493476

  7. In vitro effects of selected contact lens care solutions on Acanthamoeba castellanii strains in Poland.

    Science.gov (United States)

    Padzik, Marcin; Chomicz, Lidia; Szaflik, Jacek P; Chruścikowska, Agnieszka; Perkowski, Konrad; Szaflik, Jerzy

    2014-11-01

    Free-living, cosmopolitan amoebae of the Acanthamoeba genus may be the causative agents of Acanthamoeba keratitis (AK) - a progressive, vision-threatening infection of the human cornea described particularly among contact lens wearers. Use of contact lens care solutions, effective against these organisms, is important in preventing AK infections. 3 different strains of Acanthamoeba castellanii of the T4 genotype (Neff strain and two others, isolated from patients with AK) were exposed to 4 selected multipurpose contact lens care solutions available in Poland: Ciba Vision AoSept Plus, Bausch & Lomb ReNu MultiPlus, Alcon Opti-Free, Ciba Vision Solo Care Aqua. No amoebicidal effect was observed. The strongest amoebostatic effect was visible after 24h of exposition to Opti-Free and ReNu solution and associated with percentage increase of rounded, motionless forms. This is significantly longer than minimum disinfection time recommended by manufacturers of all tested multipurpose solutions. Surprisingly, no clear induction of the encystation process was observed. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Solving a More Flexible Home Health Care Scheduling and Routing Problem with Joint Patient and Nursing Staff Selection

    Directory of Open Access Journals (Sweden)

    Jamal Abdul Nasir

    2018-01-01

    Full Text Available Development of an efficient and effective home health care (HHC service system is a quite recent and challenging task for the HHC firms. This paper aims to develop an HHC service system in the perspective of long-term economic sustainability as well as operational efficiency. A more flexible mixed-integer linear programming (MILP model is formulated by incorporating the dynamic arrival and departure of patients along with the selection of new patients and nursing staff. An integrated model is proposed that jointly addresses: (i patient selection; (ii nurse hiring; (iii nurse to patient assignment; and (iv scheduling and routing decisions in a daily HHC planning problem. The proposed model extends the HHC problem from conventional scheduling and routing issues to demand and capacity management aspects. It enables an HHC firm to solve the daily scheduling and routing problem considering existing patients and nursing staff in combination with the simultaneous selection of new patients and nurses, and optimizing the existing routes by including new patients and nurses. The model considers planning issues related to compatibility, time restrictions, contract durations, idle time and workload balance. Two heuristic methods are proposed to solve the model by exploiting the variable neighborhood search (VNS approach. Results obtained from the heuristic methods are compared with a CPLEX based solution. Numerical experiments performed on different data sets, show the efficiency and effectiveness of the solution methods to handle the considered problem.

  9. Effectiveness of a structured motivational intervention including smoking cessation advice and spirometry information in the primary care setting: the ESPITAP study

    Directory of Open Access Journals (Sweden)

    Martin-Lujan Francisco

    2011-11-01

    Full Text Available Abstract Background There is current controversy about the efficacy of smoking cessation interventions that are based on information obtained by spirometry. The objective of this study is to evaluate the effectiveness in the primary care setting of structured motivational intervention to achieve smoking cessation, compared with usual clinical practice. Methods Design Multicentre randomized clinical trial with an intervention and a control group. Setting 12 primary care centres in the province of Tarragona (Spain. Subjects of study 600 current smokers aged between 35 and 70 years with a cumulative habit of more than 10 packs of cigarettes per year, attended in primary care for any reason and who did not meet any of the exclusion criteria for the study, randomly assigned to structured intervention or standard clinical attention. Intervention Usual advice to quit smoking by a general practitioner as well as a 20-minute personalized visit to provide detailed information about spirometry results, during which FEV1, FVC, FEF 25-75% and PEF measurements were discussed and interpreted in terms of theoretical values. Additional information included the lung age index (defined as the average age of a non-smoker with the same FEV1 as the study participant, comparing this with the chronological age to illustrate the pulmonary deterioration that results from smoking. Measurements Spirometry during the initial visit. Structured interview questionnaire administered at the primary care centre at the initial visit and at 12-month follow-up. Telephone follow-up interview at 6 months. At 12-month follow-up, expired CO was measured in patients who claimed to have quit smoking. Main variables Smoking cessation at 12 months. Analysis Data will be analyzed on the basis of "intention to treat" and the unit of analysis will be the individual smoker. Expected results Among active smokers treated in primary care we anticipate significantly higher smoking cessation in the

  10. Effectiveness of a structured motivational intervention including smoking cessation advice and spirometry information in the primary care setting: the ESPITAP study.

    Science.gov (United States)

    Martin-Lujan, Francisco; Piñol-Moreso, Josep L I; Martin-Vergara, Nuria; Basora-Gallisa, Josep; Pascual-Palacios, Irene; Sagarra-Alamo, Ramon; Llopis, Estefania Aparicio; Basora-Gallisa, Maria T; Pedret-Llaberia, Roser

    2011-11-11

    There is current controversy about the efficacy of smoking cessation interventions that are based on information obtained by spirometry. The objective of this study is to evaluate the effectiveness in the primary care setting of structured motivational intervention to achieve smoking cessation, compared with usual clinical practice. Multicentre randomized clinical trial with an intervention and a control group. 12 primary care centres in the province of Tarragona (Spain). 600 current smokers aged between 35 and 70 years with a cumulative habit of more than 10 packs of cigarettes per year, attended in primary care for any reason and who did not meet any of the exclusion criteria for the study, randomly assigned to structured intervention or standard clinical attention. Usual advice to quit smoking by a general practitioner as well as a 20-minute personalized visit to provide detailed information about spirometry results, during which FEV1, FVC, FEF 25-75% and PEF measurements were discussed and interpreted in terms of theoretical values. Additional information included the lung age index (defined as the average age of a non-smoker with the same FEV1 as the study participant), comparing this with the chronological age to illustrate the pulmonary deterioration that results from smoking. Spirometry during the initial visit. Structured interview questionnaire administered at the primary care centre at the initial visit and at 12-month follow-up. Telephone follow-up interview at 6 months. At 12-month follow-up, expired CO was measured in patients who claimed to have quit smoking. Smoking cessation at 12 months. Data will be analyzed on the basis of "intention to treat" and the unit of analysis will be the individual smoker. Among active smokers treated in primary care we anticipate significantly higher smoking cessation in the intervention group than in the control group. Application of a motivational intervention based on structured information about spirometry results

  11. Risk factors for nosocomial infections in selected neonatal intensive care units in Colombia, South America.

    Science.gov (United States)

    Rojas, Mario A; Efird, Meica M; Lozano, Juan M; Bose, Carl L; Rojas, María X; Rondón, Martín A; Ruiz, Gloria; Piñeros, Juan G; Rojas, Catherine; Robayo, Guillermo; Hoyos, Angela; Gosendi, Maria H; Cruz, Hernan; O'Shea, Michael; Leon, Angela

    2005-08-01

    This study was designed to identify risk factors for nosocomial infections among infants admitted into eight neonatal intensive care units in Colombia. Knowledge of modifiable risk factors could be used to guide the design of interventions to prevent the problem. Data were collected prospectively from eight neonatal units. Nosocomial infection was defined as culture-proven infection diagnosed after 72 hours of hospitalization, resulting in treatment with antibiotics for >3 days. Associations were expressed as odds ratios. Logistic regression was used to adjust for potential confounders. From a total of 1504 eligible infants, 80 were treated for 127 episodes of nosocomial infection. Logistic regression analysis identified the combined exposure to postnatal steroids and H2-blockers, and use of oral gastric tubes for enteral nutrition as risk factors significantly associated with nosocomial infection. Nosocomial infections in Colombian neonatal intensive care units were associated with modifiable risk factors including use of postnatal steroids and H2-blockers.

  12. Analysis of antibiotics selection in patients undergoing appendectomy in a Chinese tertiary care hospital.

    Science.gov (United States)

    Xu, Shengyong; Yu, Xuezhong; Li, Yi; Shi, Donglei; Huang, Jingya; Gao, Qian; Zhang, Ting; Guo, Shigong

    2016-01-01

    To investigate the status of antibiotics use in acute appendicitis patients who undergo appendectomy in a Chinese tertiary care hospital. A retrospective analysis of 93 patients who underwent appendectomy from June 1, 2011 to May 30, 2012 and had recorded use of intravenous antibiotics. We defined simple appendicitis and suppurative appendicitis as mild appendicitis. Gangrenous appendicitis and perforated appendicitis were classified as advanced appendicitis. The occurrence of advanced appendicitis, postoperative complications and length of hospital stay were the three major end points for outcomes analysis. 100 % of the patients received antibiotics therapy before and after operation. 45 patients received Fluoroquinolones (48.4 %), 41 patients received Cephalosporins (44.1 %) and 7 patients received Carbapenems (7.5 %). We found no statistical difference between antibiotics selection and the occurrence of advanced appendicitis (P = 0.3337). Both the monovariate analysis and multivariate analysis showed no statistical difference between antibiotics selection and the postoperative complications (P > 0.05). The average stay of patients receiving Fluoroquinolones was 2.6 days shorter than patients who received Cephalosporins (P = 0.0085). It is a lack of a standardized guideline for antibiotics selection in our hospital. All the antibiotics prescription were empirical. We tended to choose high levels of antibiotics, pay insufficient attention to the anaerobic bacteria and have a long duration of antibiotics therapy. We also found that antibiotics selection bore no relationship with the occurrence of advanced appendicitis and postoperative complications. Fluoroquinolones may lead to a shorter hospital stay, but this result may also be affected by the fewer underlying diseases and lower severity of the patients.

  13. Impact of a Multidisciplinary Team Approach Including an Intensivist on the Outcomes of Critically Ill Patients in the Cardiac Care Unit.

    Science.gov (United States)

    Fanari, Zaher; Barekatain, Armin; Kerzner, Roger; Hammami, Sumaya; Weintraub, William S; Maheshwari, Vinay

    2016-12-01

    To investigate the impact of integrating a medical intensivist into a cardiac care unit (CCU) multidisciplinary team on the outcomes of CCU patients. We conducted a retrospective cohort study of 2239 CCU admissions between July 1, 2011, and July 1, 2013, which constituted patients admitted in the 12 months before and 12 months after the introduction of intensivists into the CCU multidisciplinary team. This team included a cardiologist, a medical intensivist, medical house staff, nurses, a pharmacist, a dietitian, and physical and respiratory therapists. The primary outcome was CCU mortality. Secondary outcomes included hospital mortality, CCU length of stay, hospital length of stay, and duration of mechanical ventilation. After the implementation of a multidisciplinary team approach, there was a significant decrease in both adjusted CCU mortality (3.5% vs 5.9%; P=.01) and hospital mortality (4.4% vs 11.1%; Pmultidisciplinary team approach in which an intensivist and a cardiologist comanage the critical care of CCU patients is feasible and may result in better patient outcomes. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  14. Consensus on quality indicators to assess the organisation of palliative cancer and dementia care applicable across national healthcare systems and selected by international experts.

    Science.gov (United States)

    van Riet Paap, Jasper; Vernooij-Dassen, Myrra; Dröes, Rose-Marie; Radbruch, Lukas; Vissers, Kris; Engels, Yvonne

    2014-09-17

    Large numbers of vulnerable patients are in need of palliative cancer and dementia care. However, a wide gap exists between the knowledge of best practices in palliative care and their use in everyday clinical practice. As part of a European policy improvement program, quality indicators (QIs) have been developed to monitor and improve the organisation of palliative care for patients with cancer and those with dementia in various settings in different European countries. A multidisciplinary, international panel of professionals participated in a modified RAND Delphi procedure to compose a set of palliative care QIs based on existing sets of QIs on the organisation of palliative care. Panellists participated in three written rounds, one feedback round and one meeting. The panel's median votes were used to identify the final set of QIs. The Delphi procedure resulted in 23 useful QIs. These QIs represent key elements of the organisation of good clinical practice, such as the availability of palliative care teams, the availability of special facilities to provide palliative care for patients and their relatives, and the presence of educational interventions for professionals. The final set also includes QIs that are related to the process of palliative care, such as documentation of pain and other symptoms, communication with patients in need of palliative care and their relatives, and end-of-life decisions. International experts selected a set of 23 QIs for the organisation of palliative care. Although we particularly focused on the organisation of cancer and dementia palliative care, most QIs are generic and are applicable for other types of diseases as well.

  15. Enterococcus faecalis colonisation and endocarditis in five intensive care patients as late sequelae of selective decontamination.

    Science.gov (United States)

    Sijpkens, Y W; Buurke, E J; Ulrich, C; van Asselt, G J

    1995-03-01

    To describe Enterococcus faecalis colonisation and endocarditis in 5 intensive care patients after treatment with selective decontamination (SDD). Intensive care unit (ICU) in a general hospital. The patients were admitted to the ICU because of adult respiratory distress syndrome, polytrauma (2 patients), abdominal aortic surgery and gastrointestinal surgery. Because these patients needed mechanical ventilation they received systemic cefotaxime and SDD (polymyxin E, amphotericin B and norfloxacin). Colonisation with E. faecalis was documented in all patients. Intravascular catheter-related infection with E. faecalis occurred in 4 patients. None of the patients received antibiotics active against, E. faecalis, because body temperature normalised after catheter removal. In the course of his ICU stay one patient died. Autopsy showed E. faecalis endocarditis. The other 4 patients recovered from their primary illness, but had to be readmitted after several months because of E. faecalis endocarditis. One of these patients died. One patient recovered of endocarditis, but one year later valve surgery was necessary. The other 2 patients needed acute valve replacement. The latter 3 patients survived. We observed 5 patients with E. faecalis endocarditis as a late and severe sequela of SDD during their ICU stay.

  16. Challenging nurse student selection policy: Using a lifeworld approach to explore the link between care experience and student values.

    Science.gov (United States)

    Scammell, Janet; Tait, Desiree; White, Sara; Tait, Michael

    2017-10-01

    This study uses a lifeworld perspective to explore beginning students' values about nursing. Internationally, increasing care demand, a focus on targets and evidence of dehumanized care cultures have resulted in scrutiny of practitioner values. In England, selection policy dictates that prospective nursing students demonstrate person-centred values and care work experience. However, there is limited recent evidence exploring values at programme commencement or the effect of care experience on values. Mixed method study. A total of 161 undergraduate nursing students were recruited in 2013 from one English university. Thematic content analysis and frequency distribution to reveal descriptive statistics were used. Statistical analysis indicated that most of the values identified in student responses were not significantly affected by paid care experience. Five themes were identified: How I want care to be; Making a difference; The value of learning; Perceived characteristics of a nurse; and Respecting our humanity. Students readily drew on their experience of living to identify person-centred values about nursing.

  17. Experiences of primary health care nurses in implementing integrated management of childhood illnesses strategy at selected clinics of Limpopo Province.

    Science.gov (United States)

    Vhuromu, E N; Davhana-Maselesele, M

    2009-09-01

    Treatment of the under five years is a national priority as an attempt in curbing deaths and deformities affecting children. Primary health care was implemented in the clinics in order to help in the treatment of illnesses affecting the community, including children. As a result of childhood illnesses; the World Health Organization (WHO) and United Nation Children's Fund (UNICEF) came up with Integrated Management of Childhood illnesses (IMCI) strategy to enhance treatment of such illnesses in developing countries. Primary health care nurses (PHCNS) in Limpopo Province were also trained to implement the strategy. This study is intended to explore and describe the experiences of PHCNS in implementing the IMCI strategy at selected clinics in Vhembe District in the Limpopo Province. A qualitative, explorative, descriptive and contextual design was used. In-depth interviews were conducted with PHCNS who are IMCI trained and have implemented the strategy for a period of not less than two years. Data analysis was done through using Tesch 's method of open coding for qualitative analysis. Findings revealed that PHCNS had difficulty in rendering IMCI services due to lack of resources and poor working conditions. Recommendations address the difficulties experienced by PHCNS when implementing the IMCI strategy.

  18. Select critically ill patients at risk of augmented renal clearance: experience in a Malaysian intensive care unit.

    Science.gov (United States)

    Adnan, S; Ratnam, S; Kumar, S; Paterson, D; Lipman, J; Roberts, J; Udy, A A

    2014-11-01

    Augmented renal clearance (ARC) refers to increased solute elimination by the kidneys. ARC has considerable implications for altered drug concentrations. The aims of this study were to describe the prevalence of ARC in a select cohort of patients admitted to a Malaysian intensive care unit (ICU) and to compare measured and calculated creatinine clearances in this group. Patients with an expected ICU stay of patients were included, with a median age of 34 years. Most study participants were male and admitted after trauma. Thirty-nine percent were found to have ARC. These patients were more commonly admitted in emergency (P=0.03), although no other covariants were identified as predicting ARC, likely due to the inclusion criteria and the study being under-powered. Significant imprecision was demonstrated when comparing calculated Cockcroft-Gault creatinine clearance (Crcl) and measured Crcl. Bias was larger in ARC patients, with Cockcroft-Gault Crcl being significantly lower than measured Crcl (P patients with 'normal' serum creatinine concentrations have varied Crcl. Many are at risk of ARC, which may necessitate individualised drug dosing. Furthermore, significant bias and imprecision between calculated and measured Crcl exists, suggesting clinicians should carefully consider which method they employ in assessing renal function.

  19. More Than Just Accuracy: A Novel Method to Incorporate Multiple Test Attributes in Evaluating Diagnostic Tests Including Point of Care Tests.

    Science.gov (United States)

    Thompson, Matthew; Weigl, Bernhard; Fitzpatrick, Annette; Ide, Nicole

    2016-01-01

    Current frameworks for evaluating diagnostic tests are constrained by a focus on diagnostic accuracy, and assume that all aspects of the testing process and test attributes are discrete and equally important. Determining the balance between the benefits and harms associated with new or existing tests has been overlooked. Yet, this is critically important information for stakeholders involved in developing, testing, and implementing tests. This is particularly important for point of care tests (POCTs) where tradeoffs exist between numerous aspects of the testing process and test attributes. We developed a new model that multiple stakeholders (e.g., clinicians, patients, researchers, test developers, industry, regulators, and health care funders) can use to visualize the multiple attributes of tests, the interactions that occur between these attributes, and their impacts on health outcomes. We use multiple examples to illustrate interactions between test attributes (test availability, test experience, and test results) and outcomes, including several POCTs. The model could be used to prioritize research and development efforts, and inform regulatory submissions for new diagnostics. It could potentially provide a way to incorporate the relative weights that various subgroups or clinical settings might place on different test attributes. Our model provides a novel way that multiple stakeholders can use to visualize test attributes, their interactions, and impacts on individual and population outcomes. We anticipate that this will facilitate more informed decision making around diagnostic tests.

  20. Evolution of egg dummies in Tanganyikan cichlid fishes: the roles of parental care and sexual selection.

    Science.gov (United States)

    Amcoff, M; Gonzalez-Voyer, A; Kolm, N

    2013-11-01

    Sexual selection has been suggested to be an important driver of speciation in cichlid fishes of the Great Lakes of Africa, and the presence of male egg dummies is proposed to have played a key role. Here, we investigate how mouthbrooding and egg dummies have evolved in Tanganyikan cichlids, the lineage which seeded the other African radiations, with a special emphasis on the egg dummies. Using modern phylogenetic comparative analyses and a phylogeny including 86% of the 200 described species, we provide formal evidence demonstrating correlated evolution between mouthbrooding and egg dummies in Tanganyikan cichlids. These results concur with existing evidence, suggesting that egg dummies have evolved through sensory exploitation. We also demonstrate that there is a strong evolutionary correlation between the presence of egg dummies and both pre- and post-copulatory sexual selection. Moreover, egg dummy evolution was contingent on the intensity of pre- and post-copulatory sexual selection in Tanganyikan cichlids. In sum, our results provide evidence supporting the hypothesis of egg dummies evolving through sensory exploitation and highlight the role of sexual selection in favouring the evolution and maintenance of this trait. © 2013 The Authors. Journal of Evolutionary Biology © 2013 European Society For Evolutionary Biology.

  1. Why you need to include human factors in clinical and empirical studies of in vitro point of care devices? Review and future perspectives.

    Science.gov (United States)

    Borsci, Simone; Buckle, Peter; Hanna, George B

    2016-01-01

    Use of in-vitro point of care devices - intended as tests performed out of laboratories and near patient - is increasing in clinical environments. International standards indicate that interaction assessment should not end after the product release, yet human factors methods are frequently not included in clinical and empirical studies of these devices. Whilst the literature confirms some advantages of bed-side tests compared to those in laboratories there is a lack of knowledge of the risks associated with their use. This article provides a review of approaches applied by clinical researchers to model the use of in-vitro testing. Results suggest that only a few studies have explored human factor approaches. Furthermore, when researchers investigated people-device interaction these were predominantly limited to qualitative and not standardised approaches. The methodological failings and limitations of these studies, identified by us, demonstrate the growing need to integrate human factors methods in the medical field.

  2. Inviting parents to take part in paediatric palliative care research: A mixed-methods examination of selection bias

    OpenAIRE

    Crocker, Joanna C; Beecham, Emma; Kelly, Paula; Dinsdale, Andrew P; Hemsley, June; Jones, Louise; Bluebond-Langner, Myra

    2015-01-01

    Background: Recruitment to paediatric palliative care research is challenging, with high rates of non-invitation of eligible families by clinicians. The impact on sample characteristics is unknown. Aim: To investigate, using mixed methods, non-invitation of eligible families and ensuing selection bias in an interview study about parents? experiences of advance care planning (ACP). Design: We examined differences between eligible families invited and not invited to participate by clinicians us...

  3. Stochastic dynamic simulation modeling including multitrait genetics to estimate genetic, technical, and financial consequences of dairy farm reproduction and selection strategies.

    Science.gov (United States)

    Kaniyamattam, K; Elzo, M A; Cole, J B; De Vries, A

    2016-10-01

    The objective of this study was to develop a daily stochastic dynamic dairy simulation model that included multitrait genetics and to evaluate the effects of reduced genetic models and various reproduction and selection strategies on the genetic, technical, and financial performance of a dairy herd. The 12 correlated genetic traits included in the 2014 lifetime net merit (NM$) index were modeled for each animal. For each animal, a true breeding value (TBV) for each trait was calculated as the average of the sire's and dam's TBV, plus a fraction of the inbreeding and Mendelian sampling variability. Similarly, an environmental component for each trait was calculated and was partitioned into a permanent and a daily (temporary) effect. The combined TBV and environmental effects were converted into the phenotypic performance of each animal. Hence, genetics and phenotypic performances were associated. Estimated breeding values (EBV) were also simulated. Genetic trends for each trait for the service sire were based on expected trends in US Holsteins. Surplus heifers were culled based on various ranking criteria to maintain a herd size of 1,000 milking cows. In the first 8 scenarios, culling of surplus heifers was either random or based on the EBV of NM$. Four different genetic models, depending on the presence or absence of genetic trends or genetic and environmental correlations, or both, were evaluated to measure the effect of excluding multitrait genetics on animal performance. In the last 5 scenarios, the full genetic model was used and culling of surplus heifers was either random or based on the EBV of NM$ or the EBV of milk. Sexed semen use and reliability of the EBV were also varied. Each scenario was simulated for 15yr into the future. Results showed that genetic models without all 12 genetic trends and genetic and environmental correlations provided biased estimates of the genetic, technical, and financial performance of the dairy herd. Average TBV of NM$ of all

  4. Characterization of the selection of medicines for the Brazilian primary health care.

    Science.gov (United States)

    Karnikowski, Margô Gomes de Oliveira; Galato, Dayani; Meiners, Micheline Marie Milward de Azevedo; Silva, Emília Vitória da; Gerlack, Letícia Farias; Bós, Ângelo José Gonçalves; Leite, Silvana Nair; Álvares, Juliana; Guibu, Ione Aquemi; Soeiro, Orlando Mario; Costa, Karen Sarmento; Costa, Ediná Alves; Guerra, Augusto Afonso; Acurcio, Francisco de Assis

    2017-11-13

    To characterize the process of selection of medicines for primary health care in the Brazilian regions. This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos - Serviços, 2015 (PNAUM - National Survey on Access, Use and Promotion of Rational Use of Medicines - Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05. The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands. As this is the first national survey of characterization of the process of selection of medicines within

  5. The status of IT service management in health care - ITIL® in selected European countries

    Directory of Open Access Journals (Sweden)

    Hoerbst Alexander

    2011-12-01

    Full Text Available Abstract Background Due to the strained financial situation in the healthcare sector, hospitals and other healthcare providers are facing an increasing pressure to improve their efficiency and to reduce costs. These trends challenge health care organizations to introduce innovative information technology (IT based supportive processes. To guarantee that IT supports the clinical processes perfectly, IT must be managed proactively. However, until now, there is only very few research on IT service management especially on ITIL® implementations in the health care context. Methods The current study aims at exploring knowledge about and acceptance of IT service management (especially ITIL® in hospitals in Austria and its neighboring regions Bavaria (Germany, Slovakia, South Tyrol (Italy and Switzerland. Therefore highly standardized interviews with the respective head of information technology (CIO, IT manager were conducted for selected hospitals from the different regions. In total 75 hospitals were interviewed. Data gathered was analyzed using descriptive statistics and where necessary methods of qualitative content analysis. Results In most regions, two-thirds or more of the participating IT managers claim to be familiar with the concepts of IT service management and of ITIL®. IT managers expect from ITIL® mostly better IT services, followed by an increased productivity and a reduction of IT cost. But only five hospitals said to have implemented at least parts of ITIL®, and eight hospitals stated to be planning to do this in the next two years. When it comes to ITIL®, Switzerland and Bavaria seem to be ahead of the other countries. There, the highest levels of knowledge, the highest number of implementations or plans of an implementation as well as the highest number of ITIL® certified staff members were observed. Conclusion The results collected through this study indicate that the idea of IT services and IT service management is still not

  6. The status of IT service management in health care - ITIL® in selected European countries.

    Science.gov (United States)

    Hoerbst, Alexander; Hackl, Werner O; Blomer, Roland; Ammenwerth, Elske

    2011-12-21

    Due to the strained financial situation in the healthcare sector, hospitals and other healthcare providers are facing an increasing pressure to improve their efficiency and to reduce costs. These trends challenge health care organizations to introduce innovative information technology (IT) based supportive processes. To guarantee that IT supports the clinical processes perfectly, IT must be managed proactively. However, until now, there is only very few research on IT service management especially on ITIL® implementations in the health care context. The current study aims at exploring knowledge about and acceptance of IT service management (especially ITIL®) in hospitals in Austria and its neighboring regions Bavaria (Germany), Slovakia, South Tyrol (Italy) and Switzerland. Therefore highly standardized interviews with the respective head of information technology (CIO, IT manager) were conducted for selected hospitals from the different regions. In total 75 hospitals were interviewed. Data gathered was analyzed using descriptive statistics and where necessary methods of qualitative content analysis. In most regions, two-thirds or more of the participating IT managers claim to be familiar with the concepts of IT service management and of ITIL®. IT managers expect from ITIL® mostly better IT services, followed by an increased productivity and a reduction of IT cost. But only five hospitals said to have implemented at least parts of ITIL®, and eight hospitals stated to be planning to do this in the next two years. When it comes to ITIL®, Switzerland and Bavaria seem to be ahead of the other countries. There, the highest levels of knowledge, the highest number of implementations or plans of an implementation as well as the highest number of ITIL® certified staff members were observed. The results collected through this study indicate that the idea of IT services and IT service management is still not widely recognized in hospitals in the countries and regions

  7. Epidemiology of nosocomial infections in selected neonatal intensive care units in Colombia, South America.

    Science.gov (United States)

    Efird, Meica M; Rojas, Mario A; Lozano, Juan M; Bose, Carl L; Rojas, María X; Rondón, Martín A; Ruiz, Gloria; Piñeros, Juan G; Rojas, Catherine; Robayo, Guillermo; Hoyos, Angela; Gosendi, Maria E; Cruz, Hernan; Leon, Angela

    2005-08-01

    The epidemiology of nosocomial infections (NI) in neonatal intensive care units in developing countries has been poorly studied. We conducted a prospective study in selected neonatal units in Colombia, SA, to describe the incidence rate, causative organisms, and interinstitutional differences. Data were collected prospectively from February 20 to August 30, 2001 from eight neonatal units. NI was defined as culture-proven infection diagnosed after 72 h of hospitalization, resulting in treatment with antibiotics for >3 days. Linear regression models were used to describe associations between institutional variables and NI rates. A total of 1504 infants were hospitalized for more than 72 h, and therefore, at risk for NI. Of all, 127 infections were reported among 80 patients (5.3%). The incidence density rate was 6.2 per 1000 patient-days. Bloodstream infections accounted for 78% of NIs. Gram-negative organisms predominated over gram-positive organisms (55 vs 38%) and were prevalent in infants < or =2000 g (54%). The most common pathogens were Staphylococcus epidermidis (26%) and Klebsiella pneumonia (12%). Gram-negative organisms predominate in Colombia among infants <2000 g. The emergence of gram-negative organisms and their associated risk factors requires further study.

  8. Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review.

    Science.gov (United States)

    Gillman, Anna; Winkler, Renata; Taylor, Nicholas F

    2017-06-01

    The Frazier Free Water Protocol was developed with the aim of providing patients with dysphagia an option to consume thin (i.e. unthickened) water in-between mealtimes. A systematic review was conducted of research published in peer-reviewed journals. An electronic search of the EMBASE, CINAHL and MEDLINE databases was completed up to July 2016. A total of 8 studies were identified for inclusion: 5 randomised controlled trials, 2 cohort studies with matched cases and 1 single group pre-post intervention prospective study. A total of 215 rehabilitation inpatients and 30 acute patients with oropharyngeal dysphagia who required thickened fluids or were to remain 'nil by mouth', as determined by bedside swallow assessment and/or videofluoroscopy/fiberoptic endoscopic evaluation of swallowing, were included. Meta-analyses of the data from the rehabilitation studies revealed (1) low-quality evidence that implementing the protocol did not result in increased odds of having lung complications and (2) low-quality evidence that fluid intake may increase. Patients' perceptions of swallow-related quality of life appeared to improve. This review has found that when the protocol is closely adhered to and patients are carefully selected using strict exclusion criteria, including an evaluation of their cognition and mobility, adult rehabilitation inpatients with dysphagia to thin fluids can be offered the choice of implementing the Free Water Protocol. Further research is required to determine if the Free Water Protocol can be implemented in settings other than inpatient rehabilitation.

  9. Factors associated with utilization of antenatal care services among tribal women: A study of selected States

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    Tulsi Adhikari

    2016-01-01

    Full Text Available Background & objectives: Despite various efforts by the Government of India, utilization of antenatal care (ANC services continues to be low among women from rural areas particularly those belonging to the Scheduled Tribes. The present study was undertaken to examine the factors associated with the utilization of ANC services among women in four States including Rajasthan, Odisha, Chhattisgarh and Madhya Pradesh which constitute a good share of tribal population of the country. Methods: Data from third round of District Level Household and Facility Survey, 2007-08 (DLHS-3 have been used. Bivariate and multivariate analyses (logistic regression model were used to study the association between the utilization of ANC services and the independent variables at individual, household and village levels along with the motivational factors (motivation by health workers and family members. Results: The utilization of ANC services among Scheduled Tribes women varied from about 4 per cent in Madhya Pradesh and Rajasthan to 10-14 per cent in Chhattisgarh and Odisha. Utilization was highest among those women with level of education 9th class and above (15-28% and those women who visited health facility for pregnancy confirmation test (9-27%. Across the States, women who visited health facility for pregnancy testing (adjusted odds ratio, AOR = 1.5-2.5; P<0.001 except in Madhya Pradesh; registration of pregnancy (AOR = 2.1-4.5; P<0.01 and sought treatment of pregnancy related problems (AOR = 1.5-1.8; P<0.06 except in Rajasthan, were more likely to avail complete ANC services than their counterparts. Interpretation & conclusions: The utilization of antenatal care among Scheduled Tribe women across four States was very poor. The reasons behind non-utilisation include both socio-economic and health system factors. For improving ANC utilization among tribes, these factors need to be addressed with special emphasis on woman′s educational attainment of high school

  10. Effects of selective decontamination of digestive tract on mortality and antibiotic resistance in the intensive-care unit

    NARCIS (Netherlands)

    de Jonge, Evert

    2005-01-01

    Purpose of review Since its introduction in 1984 several small trials have studied the infection prevention regimen of selective decontamination of the digestive tract (SDD) in intensive care patients. Although meta-analyses of these studies suggested that SDD could reduce mortality, it continued to

  11. Effect of selective decontamination on antimicrobial resistance in intensive care units: a systematic review and meta-analysis.

    Science.gov (United States)

    Daneman, Nick; Sarwar, Syed; Fowler, Robert A; Cuthbertson, Brian H

    2013-04-01

    Many meta-analyses have shown reductions in infection rates and mortality associated with the use of selective digestive decontamination (SDD) or selective oropharyngeal decontamination (SOD) in intensive care units (ICUs). These interventions have not been widely implemented because of concerns that their use could lead to the development of antimicrobial resistance in pathogens. We aimed to assess the effect of SDD and SOD on antimicrobial resistance rates in patients in ICUs. We did a systematic review of the effect of SDD and SOD on the rates of colonisation or infection with antimicrobial-resistant pathogens in patients who were critically ill. We searched for studies using Medline, Embase, and Cochrane databases, with no limits by language, date of publication, study design, or study quality. We included all studies of selective decontamination that involved prophylactic application of topical non-absorbable antimicrobials to the stomach or oropharynx of patients in ICUs, with or without additional systemic antimicrobials. We excluded studies of interventions that used only antiseptic or biocide agents such as chlorhexidine, unless antimicrobials were also included in the regimen. We used the Mantel-Haenszel model with random effects to calculate pooled odds ratios. We analysed 64 unique studies of SDD and SOD in ICUs, of which 47 were randomised controlled trials and 35 included data for the detection of antimicrobial resistance. When comparing data for patients in intervention groups (those who received SDD or SOD) versus data for those in control groups (who received no intervention), we identified no difference in the prevalence of colonisation or infection with Gram-positive antimicrobial-resistant pathogens of interest, including meticillin-resistant Staphylococcus aureus (odds ratio 1·46, 95% CI 0·90-2·37) and vancomycin-resistant enterococci (0·63, 0·39-1·02). Among Gram-negative bacilli, we detected no difference in aminoglycoside-resistance (0

  12. Assessment of selected quality fields of nursing care in neurosurgical wards: a prospective study of 530 people – multicenter studies

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    Ślusarz R

    2014-08-01

    Full Text Available Robert Ślusarz,1 Monika Biercewicz,2 Ewa Barczykowska,3 Beata Haor,4 Mariola Głowacka5 1Neurological and Neurosurgical Nursing Department, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 2Clinic of Geriatrics, 3Nursing Department, Collegium Medicum, Nicolaus Copernicus University, Torun, 4Faculty of Health Science, University of Humanities and Economics in Wloclawek, Wloclawek, 5Institute of Health Sciences, State School of Higher Professional Education in Plock, Plock, Poland Background: One of the elements influencing the assessment of nursing care quality is the assessment of the nurse’s functions that determine the nurse’s particular tasks. The aim of this work was to assess selected tasks involved in the nurse’s caring function, which influence nursing care quality on neurosurgical wards, on the basis of patients’ and nursing staff’s opinions.Materials and methods: The research was carried out on neurosurgical wards in Poland on a group of 455 patients and 75 nurses. In order to assess nursing care quality, an author’s original questionnaire (Questionnaire – Patient Satisfaction was used.Results: Statistically significant differences concerned particular groups (both patients and nurses in the assessment of selected issues: providing information about performed activities and operations (P=0.000 and P=0.040, respecting personal dignity and assuring discretion during the operations (P=0.000 and P=0.001, speed of response to patient’s requests (P=0.000 and P=0.000, time availability of nurses for the patient (P=0.000 and P=0.000, providing information about further self-care at home (P=0.032, P=0.008, and nurses’ attitude (kindness, courtesy, tenderness, care to patients (patient’s assessment only P=0.000.Conclusion: Selected tasks in the field of the caring function of nurses were assessed differently by particular groups. There were no statistically significant differences in the assessment of particular

  13. Some compositional and health indicators of milk quality of dairy cows with higher milk yield at including of selected corn species into feeding ration

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    Jan Pozdíšek

    2008-01-01

    Full Text Available Because of economical reasons the substitution of maize by feed corn as wheat (Sulamit and triticale (Kitaro was revolved in concentrate part of dairy cow feeding rations. The design of mentioned replacement in feeding rations was carried out according to results of previous research (Pozdíšek and Vaculová, 2008 for nutrition experiment. The aim of this paper was to evaluate the possible effects of corn replacement in cow feeding rations on milk composition and properties. The expressively different variants of corn were selected for experiment in comparison to maize (reference. Dairy cows were fed by total mixed ration on the basis of maize and clover silage and hay. Otherwise the identical day feeding rations among cow groups differed only in concentrate portions ((K, control group maize 1.5 kg, wheat (P1 2.0 kg and triticale (P2 2.0 kg (experimental groups. Group feeding rations 1 (K, 2 (P1 and 3 (P2 had: NEL/kg dry (DM matter (6.524, 6.512 and 6.491; NL % in DM (17.9, 18.2 and 17.9; fibre % in DM (15.96, 15.74 and 15.72; PDIN/PDIE (1.189, 1.189 and 1.191. The experiment took six weeks, there were included 8, 9 and 9 cows (n = 26 of Czech Fleckvieh breed. Feed groups were well balanced in terms of milk yield, days in milk and number of lactation. The tie stable and pipeline milking equipment were used in experiment. Animals were milked twice a day and sampled at morning milking in intervals about seven days approximately. Cows were relatively healthy in terms of occurrence of milk secretion disorders. Within groups the individual milk samples (in total 182 in experiment were aggregated into bulk samples (n = 21 = 3 groups × 7 sampling periods, which were analysed on 45 milk indicators, 18 of them were evaluated in this paper. The differences in milk yield were significantly advantageous for K group (15.32 > 14.07 (wheat or 13.86 kg (triticale at morning milking, while fat (3.27 < 3.47 or 3.44 % was lower (P < 0.05. Lactose was not

  14. The burden of selected cancers in the US: health behaviors and health care resource utilization

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    Iadeluca L

    2017-11-01

    Full Text Available Laura Iadeluca,1 Jack Mardekian,1 Pratibha Chander,2 Markay Hopps,1 Geoffrey T Makinson1 1Pfizer Inc., 2Atrium Staffing, New York, NY, USA Objective: To characterize the disease burden among survivors of those cancers having the highest incidence in the US.Methods: Adult (≥18 years survivors of the 11 most frequently diagnosed cancers were identified from publically available data sources, including the Surveillance Epidemiology and End Results 9 1973–2012, National Health Interview Survey 2013, and the Medical Expenditure Panel Survey 2011. Chi-square tests and one-way analyses of variance were utilized to assess differences between cancer survivors and non-cancer controls in behavioral characteristics, symptoms and functions, preventative screenings, and health care costs.Results: Hematologic malignancies, melanoma, and breast, prostate, lung, colon/rectal, bladder, kidney/renal, uterine, thyroid, and pancreatic cancers had the highest incidence rates. Breast cancer had the highest incidence among women (156.4 per 100,000 and prostate cancer among men (167.2 per 100,000. The presence of pain (P=0.0003, fatigue (P=0.0005, and sadness (P=0.0012 was consistently higher in cancer survivors 40–64 years old vs. non-cancer controls. Cancer survivors ≥65 years old had higher rates of any functional limitations (P=0.0039 and reported a lack of exercise (P<0.0001 compared with the non-cancer controls. However, obesity rates were similar between cancer survivors and non-cancer controls. Among cancer survivors, an estimated 13.5 million spent $169.4 billion a year on treatment, with the highest direct expenditures for breast cancer ($39 billion, prostate cancer ($37 billion, and hematologic malignancies ($25 billion. Prescription medications and office-based visits contributed equally as the cost drivers of direct medical spending for breast cancer, while inpatient hospitalization was the driver for prostate (52.8% and lung (38.6% cancers

  15. Risks for upper respiratory infections in infants during their first months in day care included environmental and child-related factors

    DEFF Research Database (Denmark)

    Laursen, Rikke Pilmann; Larnkjær, Anni; Ritz, Christian

    2018-01-01

    AIM: We examined the frequency and potential risk factors for respiratory infections, diarrhoea and absences in infants during their first months in day care. METHODS: This prospective cohort study comprised 269 Danish infants aged 8-14 months and was part of a study that examined how probiotics...... affected absences from day care due to respiratory and gastrointestinal infections. The risk factors examined were the household, child characteristics and type of day care facility. Parents registered upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), diarrhoea and day...

  16. A Comparative Study of the Situation of Bereavement Care for Children with Cancer in Iran with Selected Countries

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    Maryam Pakseresht

    2018-02-01

    Full Text Available Background Death of a child with cancer is one of the most painful events that results in traumatic reactions of bereavement. Care should be taken into account during the bereavement period. The present study aimed to develop bereavement care in Iran and comparing it with Jordan, England, Australia and Canada, which have achieved the desired situation in the above area. Materials and Methods In this comparative study, the necessary data was made to databases of reputable and sovereign centers of the countries and palliative care programs. After accessing the pioneering patterns of world-wide palliative care, Iran's palliative care program, which came from children's service centers and access to the databases of those centers, was also examined. Results In the developed countries of Canada, England and Australia, a wide range of bereavement care is provided in care facilities. for example following the death of a child, in Canada family members are covered by all the bereavement care, in Australia formal caregivers increase their relationship with parents and are available to listen to feelings and in England all family members are supported. Jordan provides significant services in this regard such as visits at the bereavement ceremony, however, it is provided limitedly only in one center in Iran. Conclusion In the developed countries, pediatric palliative care is well developed. But in some developing countries, including Iran, there are only a few of these services for dying children and their families. As a result, the traumatic results emerge in social and family life activities.

  17. Temporary Mechanical Circulatory Support in Cardiac Critical Care: A State of the Art Review and Algorithm for Device Selection.

    Science.gov (United States)

    Nagpal, A Dave; Singal, Rohit K; Arora, Rakesh C; Lamarche, Yoan

    2017-01-01

    With more than 60 years of continuous development and improvement, a variety of temporary mechanical circulatory support (MCS) devices and implantation strategies exist, each with unique advantages and disadvantages. A thorough understanding of each available device is essential for optimizing patient outcomes in a fiscally responsible manner. In this state of the art review we examine the entire range of commonly available peripheral and centrally cannulated temporary MCS devices, including intra-aortic balloon pumps, the Impella (Abiomed, Danvers, MA) family of microaxial pumps, the TandemHeart (CardiacAssist Inc, Pittsburg, PA) pump and percutaneous cannulas, centrally cannulated centrifugal pumps such as the CentriMag (Thoratec Corp, Pleasanton, CA/St Jude Medical, St Paul, MN/Abbott Laboratories, Abbott Park, IL) and Rotaflow (Maquet Holding BV & Co KG, Rastatt Germany), and extracorporeal membrane oxygenation. Several factors need detailed consideration when contemplating MCS in any given patient, mandating a balanced, algorithmic approach for these sick patients. In this review we describe our approach to MCS, and emphasize the need for multidisciplinary input to consider patient-related, logistical, and institutional factors. Evidence is summarized and referenced where available, but because of the lack of high-quality evidence, current best practice is described. Future directions for investigation are discussed, which will better define patient and device selection, and optimize MCS-specific patient care protocols. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  18. The views of health care professionals about selective decontamination of the digestive tract: an international, theoretically informed interview study.

    Science.gov (United States)

    Duncan, Eilidh M; Cuthbertson, Brian H; Prior, Maria E; Marshall, Andrea P; Wells, Elisabeth C; Todd, Laura E; Bolsover, Denise; Newlands, Rumana S; Webster, Fiona; Rose, Louise; Campbell, Marion K; Bellingan, Geoff; Seppelt, Ian M; Francis, Jill J

    2014-08-01

    Selective decontamination of the digestive tract (SDD) as a prophylactic intervention improves hospital-acquired infection and survival rates. Uptake of SDD is low and remains controversial. This study applied the theoretical domains framework to assess intensive care unit clinicians' views about SDD in regions with limited or no adoption of SDD. Participants were health professionals with "decisional authority" for the adoption of SDD. Semistructured interviews were conducted as the first round of a Delphi study. Views about SDD adoption, delivery, and further SDD research were explored. Directed content analysis of interview data identified subthemes, which informed item development for subsequent Delphi rounds. Linguistic features of interview data were also explored. One hundred forty-one participants provided interview data. Fifty-six subthemes were identified; 46 were common across regions. Beliefs about consequences were the most widely elaborated theme. Linguistic features of how participants discussed SDD included caution expressed when discussing the risks and benefits and words such as "worry," "anxiety," and "fear" when discussing potential antibiotic resistance associated with SDD. We identified salient beliefs, barriers, and facilitators to SDD adoption and delivery. What participants said about SDD and the way in which they said it demonstrated the degree of clinical caution, uncertainty, and concern that SDD evokes. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Training, supervision and quality of care in selected integrated community case management (iCCM) programmes: A scoping review of programmatic evidence.

    Science.gov (United States)

    Bosch-Capblanch, Xavier; Marceau, Claudine

    2014-12-01

    To describe the training, supervision and quality of care components of integrated Community Case Management (iCCM) programmes and to draw lessons learned from existing evaluations of those programmes. Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. The number of people reached by iCCM programmes varied from the tens of thousands to more than a million. All programmes aimed at improving access of vulnerable populations to health care, focusing on the main childhood illnesses, managed by Community Health Workers (CHW), often selected bycommunities. Training and supervision were widely implemented, in different ways and intensities, and often complemented with tools (eg, guides, job aids), supplies, equipment and incentives. Quality of care was measured using many outcomes (eg, access or appropriate treatment). Overall, there seemed to be positive effects for those strategies that involved policy change, organisational change, standardisation of clinical practices and alignment with other programmes. Positive effects were mostly achieved in large multi-component programmes. Mild or no effects have been described on mortality reduction amongst the few programmes for which data on this outcome was available to us. Promising strategies included teaming-up of CHW, micro-franchising or social franchising. On-site training and supervision of CHW have been shown to improve clinical practices. Effects on caregivers seemed positive, with increases in knowledge, care seeking behaviour, or caregivers' basic disease management. Evidence on iCCM is often of low quality, cannot relate specific interventions or the ways they are implemented with outcomes and lacks standardisation; this limits the capacity to identify promising strategies to improve quality of care. Large, multi-faceted, iCCM programmes, with strong components of training, supervision, which

  20. Inviting parents to take part in paediatric palliative care research: a mixed-methods examination of selection bias.

    Science.gov (United States)

    Crocker, Joanna C; Beecham, Emma; Kelly, Paula; Dinsdale, Andrew P; Hemsley, June; Jones, Louise; Bluebond-Langner, Myra

    2015-03-01

    Recruitment to paediatric palliative care research is challenging, with high rates of non-invitation of eligible families by clinicians. The impact on sample characteristics is unknown. To investigate, using mixed methods, non-invitation of eligible families and ensuing selection bias in an interview study about parents' experiences of advance care planning (ACP). We examined differences between eligible families invited and not invited to participate by clinicians using (1) field notes of discussions with clinicians during the invitation phase and (2) anonymised information from the service's clinical database. Families were eligible for the ACP study if their child was receiving care from a UK-based tertiary palliative care service (Group A; N = 519) or had died 6-10 months previously having received care from the service (Group B; N = 73). Rates of non-invitation to the ACP study were high. A total of 28 (5.4%) Group A families and 21 (28.8%) Group B families (p qualitatively with invitation in both groups. In Group A, out-of-hours contact with family was statistically associated with invitation (adjusted odds ratio 5.46 (95% confidence interval 2.13-14.00); p Qualitative findings also indicated that clinicians' perceptions of families' wellbeing, circumstances, characteristics, engagement with clinicians and anticipated reaction to invitation influenced invitation. We found evidence of selective invitation practices that could bias research findings. Non-invitation and selection bias should be considered, assessed and reported in palliative care studies. © The Author(s) 2014.

  1. Screening the Toxicity of Selected Personal Care Products Using Embryo Bioassays: 4-MBC, Propylparaben and Triclocarban

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    Tiago Torres

    2016-10-01

    Full Text Available Recently, several emerging pollutants, including Personal Care Products (PCPs, have been detected in aquatic ecosystems, in the ng/L or µg/L range. Available toxicological data is limited, and, for certain PCPs, evidence indicates a potential risk for the environment. Hence, there is an urgent need to gather ecotoxicological data on PCPs as a proxy to improve risk assessment. Here, the toxicity of three different PCPs (4-Methylbenzylidene Camphor (4-MBC, propylparaben and triclocarban was tested using embryo bioassays with Danio rerio (zebrafish and Paracentrotus lividus (sea urchin. The No Observed Effect Concentration (NOEC for triclocarban was 0.256 µg/L for sea urchin and 100 µg/L for zebrafish, whereas NOEC for 4-MBC was 0.32 µg/L for sea urchin and 50 µg/L for zebrafish. Both PCPs impacted embryo development at environmentally relevant concentrations. In comparison with triclocarban and 4-MBC, propylparaben was less toxic for both sea urchin (NOEC = 160 µg/L and zebrafish (NOEC = 1000 µg/L. Overall, this study further demonstrates the sensitivity of embryo bioassays as a high-throughput approach for testing the toxicity of emerging pollutants.

  2. Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors.

    Science.gov (United States)

    Tucker, Larry A.; Clegg, Alan G.

    2002-01-01

    Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…

  3. HIV-positive patients’ perceptions of care received at a selected antiretroviral therapy clinic in Vhembe district, South Africa

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    Tshifhiwa V. Ndou

    2016-04-01

    Full Text Available Background: Patients’ experiences are a reflection of what has happened during the care process and, therefore, provide information about the performance of health care professional workers. They refer to the process of care provision at the antiretroviral therapy (ART sites. Aim and setting: This article explored the perceptions of HIV-positive patients of care received at the Gateway Clinic of the regional hospital that provides antiretroviral treatment in the Vhembe district. Methods: A qualitative, explorative and descriptive design was used. A non-probability, convenient sampling method was used to select 20 HIV-positive patients who were above 18 years of age. In-depth individual interviews were used to collect data. Data were analysed through Tech’s open coding method. Results: One theme and two sub-themes emerged, namely positive experiences related to the environment and attitudes of health professionals, and negative experiences concerning the practices by health care providers. Conclusion: Patients’ perceptions of quality of, and satisfaction with, health care may affect health outcomes. Recommendations are made to consider, practice and strengthen the protocols, the standard operating procedures and the principles of infection control in the health facilities. Keywords: Human Immunodeficiecy Virus, Antiretroviral Treatment, HIV positive, Limpopo

  4. Chiropractic physicians: toward a select conceptual understanding of bureaucratic structures and functions in the health care institution.

    Science.gov (United States)

    Fredericks, Marcel; Kondellas, Bill; Hang, Lam; Fredericks, Janet; Ross, Michael Wv

    2011-12-01

    The purpose of this article is to present select concepts and theories of bureaucratic structures and functions so that chiropractic physicians and other health care professionals can use them in their respective practices. The society-culture-personality model can be applied as an organizational instrument for assisting chiropractors in the diagnosis and treatment of their patients irrespective of locality. Society-culture-personality and social meaningful interaction are examined in relationship to the structural and functional aspects of bureaucracy within the health care institution of a society. Implicit in the examination of the health care bureaucratic structures and functions of a society is the focus that chiropractic physicians and chiropractic students learn how to integrate, synthesize, and actualize values and virtues such as empathy, integrity, excellence, diversity, compassion, caring, and understanding with a deep commitment to self-reflection. It is essential that future and current chiropractic physicians be aware of the structural and functional aspects of an organization so that chiropractic and other health care professionals are able to deliver care that involves the ingredients of quality, affordability, availability, accessibility, and continuity for their patients.

  5. Chiropractic physicians: toward a select conceptual understanding of bureaucratic structures and functions in the health care institution

    Science.gov (United States)

    Fredericks, Marcel; Kondellas, Bill; Hang, Lam; Fredericks, Janet; Ross, Michael WV

    2011-01-01

    Objective The purpose of this article is to present select concepts and theories of bureaucratic structures and functions so that chiropractic physicians and other health care professionals can use them in their respective practices. The society-culture-personality model can be applied as an organizational instrument for assisting chiropractors in the diagnosis and treatment of their patients irrespective of locality. Discussion Society-culture-personality and social meaningful interaction are examined in relationship to the structural and functional aspects of bureaucracy within the health care institution of a society. Implicit in the examination of the health care bureaucratic structures and functions of a society is the focus that chiropractic physicians and chiropractic students learn how to integrate, synthesize, and actualize values and virtues such as empathy, integrity, excellence, diversity, compassion, caring, and understanding with a deep commitment to self-reflection. Conclusion It is essential that future and current chiropractic physicians be aware of the structural and functional aspects of an organization so that chiropractic and other health care professionals are able to deliver care that involves the ingredients of quality, affordability, availability, accessibility, and continuity for their patients. PMID:22693481

  6. The effect of community health nurse home visit on self-care self-efficacy of the elderly living in selected Falavarjan villages in Iran in 2010.

    Science.gov (United States)

    Hosseini, Habibollah; Torkani, Sara; Tavakol, Khosrow

    2013-01-01

    Perceived self-efficacy is a strong predictor for behavior. Considering the importance of health-promoting self-care behaviors in increasing quality of life in the elderly, this study was aimed at defining the effect of nurse home visits on self-care self-efficacy of the elderly in rural areas. This is a pre and post quasi-experimental study conducted on 33 older adults randomly selected from five villages in Falavarjan province in Iran. Intervention program was in the direction of self-care self-efficacy in four domains including nutrition, health practice, physical activity, and well-being in the form of five home visit programs and one group session by a nurse during 6 weeks, and included two different sections of education and nursing interventions administered based on needs assessment and determination of the tasks for the clients and their families. Theoretical framework of this study was supported by Bandura's self-efficacy, Orem's self-care theory, and Pender's revised health promotion model. The data were collected by self-care self-efficacy and demographic information questionnaire before and after the intervention. Data were analyzed by descriptive statistics and paired t-test. The mean elderly score in the four aforementioned domains increased after the home visit program. A significant difference was seen in the mean total scores of self-care self-efficacy and its subscales by paired t-test before and after intervention (P health promotion of the elderly, multifaceted low-cost interventions with the highest effect seem essential.

  7. [Assessment of the technology of care relations in the health services: perception of the elderly included in the family health strategy in Bambuí, Brazil].

    Science.gov (United States)

    Santos, Wagner Jorge dos; Giacomin, Karla Cristina; Firmo, Josélia Oliveira Araújo

    2014-08-01

    In the health field, technologies of care relations are in the scope of the worker-user encounter, implying intersubjectivity with the development of relationships between subjects, resulting in action. Evaluation studies synthesize knowledge produced on the consequences of using these technologies for society. This anthropological study aims to understand the perception of the elderly regarding the resolution capability and effectiveness of the acts produced in health care relationships in the context of the Family Health Strategy (ESF). The group studied consisted of 57 elderly residents in Bambui, State of Minas Gerais, Brazil. The model of signs, meanings and actions was used for collecting and analyzing data and the semi-structured interview was applied as a research technique. Elderly individuals assess resolution capability and effectiveness of the acts of care in the ESF as negative, with relation to the quality of user and professional interaction. The ESF is not effective and the desired change in the health care model has not occurred in practice. It repeats the centrality of the medical-drug-procedure model that treats the disease rather than the patient, perceiving old age as a disease and illness as being related to aging.

  8. Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol

    NARCIS (Netherlands)

    Archambault, P.M.; Turgeon, A.F.; Witteman, H.O.; Lauzier, F.; Moore, L.; Lamontagne, F.; Horsley, T.; Gagnon, M.P.; Droit, A.; Weiss, M.; Tremblay, S.; Lachaine, J.; Sage, N. Le; Emond, M.; Berthelot, S.; Plaisance, A.; Lapointe, J.; Razek, T.; Belt, T.H. van de; Brand, K; Berube, M.; Clement, J.; Iii, F.J. Grajales; Eysenbach, G.; Kuziemsky, C.; Friedman, D.; Lang, E.; Muscedere, J.; Rizoli, S.; Roberts, D.J.; Scales, D.C.; Sinuff, T.; Stelfox, H.T.; Gagnon, I.; Chabot, C.; Grenier, R.; Legare, F.

    2015-01-01

    BACKGROUND: Trauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the

  9. Psychotropic medication in a randomly selected group of citizens receiving residential or home care

    DEFF Research Database (Denmark)

    Futtrup, Tina Bergmann; Schultz, Hanne; Jensen, Margit Bak

    2014-01-01

    INTRODUCTION: Treatment with one or more psychotropic medications (PMs), especially in the elderly, is associated with risk, and the effects of treatment are poorly validated. The aim of this article was to describe the use of PM in a population of citizens receiving either residential care or home...... care with focus on the prevalence of drug use, the combination of different PMs and doses in relation to current recommendations. METHODS: The medication lists of 214 citizens receiving residential care (122) and home care (92) were collected together with information on age, gender and residential...... status. RESULTS: Two thirds of the citizens (64.5%) used one or more PMs (antipsychotics 15.9%, antidepressants 43.5%, anxiolytics/hypnotics 27.1% and anti-dementia drugs 16.4%). Citizens treated with antipsychotics were also prescribed antidepressants (52.9%), anxiolytics/hypnotics (35.3%) and anti...

  10. Knee disorders in primary care: design and patient selection of the HONEUR knee cohort.

    NARCIS (Netherlands)

    E.M. Heintjes (Edith); M.Y. Berger (Marjolein); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita)

    2005-01-01

    textabstractBACKGROUND: Knee complaints are a frequent reason for consultation in general practice. These patients constitute a specific population compared to secondary care patients. However, information to base treatment decisions on is generally derived from specialistic settings. Our cohort

  11. Prevalence study and risk factor analysis of selected bacterial, protozoal and viral, including vector-borne, pathogens in cats from Cyprus.

    Science.gov (United States)

    Attipa, Charalampos; Papasouliotis, Kostas; Solano-Gallego, Laia; Baneth, Gad; Nachum-Biala, Yaarit; Sarvani, Elpida; Knowles, Toby G; Mengi, Sena; Morris, David; Helps, Chris; Tasker, Séverine

    2017-03-13

    Feline infectious agent studies are lacking in Cyprus. The aims of this study were to determine the prevalence and risk factors for various feline infectious agents, including feline vector-borne pathogens (FVBP), in cats from Cyprus. A cross-sectional, descriptive, multicentre study was performed on 174 feline samples [138 owned and 36 shelter-feral, including both healthy (43) and non-healthy (131), cats] from private veterinary clinics from all six districts of Cyprus. Real-time quantitative polymerase chain reaction (qPCR) assays were used to detect Mycoplasma haemofelis (Mhf), "Candidatus Mycoplasma haemominutum" (CMhm) and "Candidatus Mycoplasma turicensis" (CMt). The population was tested for four FVBP including Bartonella henselae and Leishmania spp. using qPCR, while conventional PCR assays were used to detect Ehrlichia/Anaplasma spp. and Hepatozoon spp. Serological assays were performed to detect Leishmania infantum antibodies, feline leukaemia virus (FeLV) antigen and feline immunodeficiency virus (FIV) antibodies. Statistical analysis was performed to test associations and possible risk factors between variables and infectious agents. Ninety-six (55.2%) of the 174 cats were PCR-positive for at least one infectious agent. Forty-six cats (26.4%) were haemoplasma positive, including 13 (7.5%) for Mhf, 36 (20.7%) for CMhm and 12 (6.9%) for CMt. Sixty-six cats (37.9%) were positive for Hepatozoon spp., while 19 (10.9%) were positive for B. henselae, four (2.3%) for Leishmania spp. and one (0.6%) for Ehrlichia/Anaplasma spp. Sequencing revealed the presence of Hepatozoon felis, L. infantum and Anaplasma platys. Of the 164 cats that underwent retroviral serology, 10 (6.1%) were FeLV-positive and 31 (18.9%) were FIV-positive, while L. infantum serology was positive in 7 (4.4%) of the 160 cats tested. Multivariable logistic regression revealed significant associations for various infectious agents including L. infantum with each of Hepatozoon spp. and CMt

  12. Microbiological quality of selected ready-to-eat leaf vegetables, sprouts and non-pasteurized fresh fruit-vegetable juices including the presence of Cronobacter spp.

    Science.gov (United States)

    Berthold-Pluta, Anna; Garbowska, Monika; Stefańska, Ilona; Pluta, Antoni

    2017-08-01

    Bacteria of the genus Cronobacter are emerging food-borne pathogens. Foods contaminated with Cronobacter spp. may pose a risk to infants or adults with suppressed immunity. This study was aimed at determining the microbiological quality of ready-to-eat (RTE) plant-origin food products available on the Polish market with special emphasis on the prevalence of Cronobacter genus bacteria. Analyses were carried out on 60 samples of commercial RTE type plant-origin food products, including: leaf vegetables (20 samples), sprouts (20 samples) and non-pasteurized vegetable, fruit and fruit-vegetable juices (20 samples). All samples were determined for the total count of aerobic mesophilic bacteria (TAMB) and for the presence of Cronobacter spp. The isolates of Cronobacter spp. were subjected to genetic identification and differentiation by 16S rDNA sequencing, PCR-RFLP analysis and RAPD-PCR and evaluation of antibiotic susceptibility by the disk diffusion assay. The TAMB count in samples of lettuces, sprouts and non-pasteurized fruit, vegetable and fruit-vegetable juices was in the range of 5.6-7.6, 6.7-8.4 and 2.9-7.7 log CFU g -1 , respectively. The presence of Cronobacter spp. was detected in 21 (35%) samples of the products, including in 6 (30%) samples of leaf vegetables (rucola, lamb's lettuce, endive escarola and leaf vegetables mix) and in 15 (75%) samples of sprouts (alfalfa, broccoli, small radish, lentil, sunflower, leek and sprout mix). No presence of Cronobacter spp. was detected in the analyzed samples of non-pasteurized fruit, vegetable and fruit-vegetable juices. The 21 strains of Cronobacter spp. isolated from leaf vegetable and sprouts included: 13 strains of C. sakazakii, 4 strains of C. muytjensii, 2 strains of C. turicensis, one strain of C. malonaticus and one strain of C. condimenti. All isolated C. sakazakii, C. muytjensii, C. turicensis and C. malonaticus strains were sensitive to ampicillin, cefepime, chloramphenicol, gentamycin

  13. Rheumatoid factor testing in Spanish primary care: A population-based cohort study including 4.8 million subjects and almost half a million measurements.

    Science.gov (United States)

    Morsley, Klara; Miller, Anne; Luqmani, Raashid; Fina-Aviles, Francesc; Javaid, Muhammad Kassim; Edwards, Christopher J; Pinedo-Villanueva, Rafael; Medina, Manuel; Calero, Sebastian; Cooper, Cyrus; Arden, Nigel; Prieto-Alhambra, Daniel

    2018-02-26

    Rheumatoid factor (RF) testing is used in primary care in the diagnosis of rheumatoid arthritis (RA); however a positive RF may occur without RA. Incorrect use of RF testing may lead to increased costs and delayed diagnoses. The aim was to assess the performance of RF as a test for RA and to estimate the costs associated with its use in a primary care setting. A retrospective cohort study using the Information System for the Development of Research in Primary Care database (contains primary care records and laboratory results of >80% of the Catalonian population, Spain). Participants were patients ≥18 years with ≥1 RF test performed between 01/01/2006 and 31/12/2011, without a pre-existing diagnosis of RA. Outcome measures were an incident diagnosis of RA within 1 year of testing, and the cost of testing per case of RA. 495,434/4,796,498 (10.3%) patients were tested at least once. 107,362 (21.7%) of those tested were sero-positive of which 2768 (2.6%) were diagnosed with RA within 1 year as were 1141/388,072 (0.3%) sero-negative participants. The sensitivity of RF was 70.8% (95% CI 69.4-72.2), specificity 78.7% (78.6-78.8), and positive and negative predictive values 2.6% (2.5-2.7) and 99.7% (99.6-99.7) respectively. Approximately €3,963,472 was spent, with a cost of €1432 per true positive case. Although 10% of patients were tested for RF, most did not have RA. Limiting testing to patients with a higher pre-test probability would significantly reduce the cost of testing. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  14. Investigation of pyrrolizidine alkaloids including their respective N-oxides in selected food products available in Hong Kong by liquid chromatography electrospray ionisation mass spectrometry.

    Science.gov (United States)

    Chung, Stephen W C; Lam, Aaron C H

    2017-07-01

    This study determined the levels of pyrrolizidine alkaloids (PAs), including their respective N-oxides, in foodstuffs available in Hong Kong by liquid chromatography-electrospray ionisation tandem mass spectrometry. A total of 234 samples (48 food items) were collected randomly from a local market and analysed. About 50% of samples were found to contain detectable amount of PAs. Amongst the 48 food items, PAs were not detected in 11 food items, including barley flour, beef, cattle liver, pork, pig liver, chicken meat, chicken liver, milk, non-fermented tea, Melissa tea and linden tea. For those found to contain detectable PAs, the summed PA content ranged up to 11,000 µg kg -1 . The highest sum of PA content among the 37 food items calculated with lower bound was cumin seed, then followed by oregano, tarragon and herbs de Provence with ranges of 2.5-11,000, 1.5-5100, 8.0-3300 and 18-1300 µg kg -1 respectively. Among the samples, the highest sum of PA content was detected in a cumin seed sample (11,000 µg kg -1 ), followed by an oregano (5100 µg kg -1 ), a tarragon (3300 µg kg -1 ) and a herbs de Provence (1300 µg kg -1 ). In general, the results of this study agreed well with other published results in peer-reviewed journals, except that the total PAs in honey and specific tea infusion in this study were comparatively lower.

  15. Multi-walled carbon nanotubes with selected properties for dynamic filtration of pharmaceuticals and personal care products.

    Science.gov (United States)

    Wang, Yifei; Ma, Jing; Zhu, Jiaxin; Ye, Ning; Zhang, Xiaolei; Huang, Haiou

    2016-04-01

    In this study, multi-walled carbon nanotubes (MWCNT) with selected properties, including pristine MWCNT, hydroxylated MWCNT (H-MWCNT), thin-walled MWCNT with large inner diameter (L-MWCNT), aminated MWCNT, and high-purity MWCNT were investigated for dynamic removal of eight pharmaceuticals and personal care products (PPCP). The removal ratios of different PPCP by the pristine MWCNT followed a decreasing order of triclosan (0.93) > prometryn (0.71) > 4-acetylamino-antipyrine (0.67) > carbendazim (0.65) > caffeine (0.42) > ibuprofen (0.34) > acetaminophen (0.29) at 100 min of filtration. Similar or even higher PPCP removals were obtained for all PPCP as the influent concentration decreased, suggesting potential consistent PPCP removals at environmental PPCP concentrations. The removal ratio of acetaminophen was increased to 0.74 by using H-MWCNT. SRFA (Suwannee River fulvic acid) suppressed PPCP adsorption to MWCNT, to greater extents with increasing SRFA concentrations. The L-MWCNT, despite a large inner diameter of 52 ± 3 nm, did not provide better resistance to the competitive adsorption of SRFA than MWCNT with a small inner diameter of 10 ± 2 nm. Future research will be conducted to minimize the effect of SRFA and facilitate application of MWCNT to the treatment of PPCP-contaminated water. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Comparative hepatic microsomal biotransformation of selected PBDEs, including decabromodiphenyl ether, and decabromodiphenyl ethane flame retardants in Arctic marine-feeding mammals.

    Science.gov (United States)

    McKinney, Melissa A; Dietz, Rune; Sonne, Christian; De Guise, Sylvain; Skirnisson, Karl; Karlsson, Karl; Steingrímsson, Egill; Letcher, Robert J

    2011-07-01

    The present study assessed and compared the oxidative and reductive biotransformation of brominated flame retardants, including established polybrominated diphenyl ethers (PBDEs) and emerging decabromodiphenyl ethane (DBDPE) using an in vitro system based on liver microsomes from various arctic marine-feeding mammals: polar bear (Ursus maritimus), beluga whale (Delphinapterus leucas), and ringed seal (Pusa hispida), and in laboratory rat as a mammalian model species. Greater depletion of fully brominated BDE209 (14-25% of 30 pmol) and DBDPE (44-74% of 90 pmol) occurred in individuals from all species relative to depletion of lower brominated PBDEs (BDEs 99, 100, and 154; 0-3% of 30 pmol). No evidence of simply debrominated metabolites was observed. Investigation of phenolic metabolites in rat and polar bear revealed formation of two phenolic, likely multiply debrominated, DBDPE metabolites in polar bear and one phenolic BDE154 metabolite in polar bear and rat microsomes. For BDE209 and DBDPE, observed metabolite concentrations were low to nondetectable, despite substantial parent depletion. These findings suggested possible underestimation of the ecosystem burden of total-BDE209, as well as its transformation products, and a need for research to identify and characterize the persistence and toxicity of major BDE209 metabolites. Similar cause for concern may exist regarding DBDPE, given similarities of physicochemical and environmental behavior to BDE209, current evidence of biotransformation, and increasing use of DBDPE as a replacement for BDE209. Copyright © 2011 SETAC.

  17. A prospective observational description of frequency and timing of antenatal care attendance and coverage of selected interventions from sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia.

    Science.gov (United States)

    Bucher, Sherri; Marete, Irene; Tenge, Constance; Liechty, Edward A; Esamai, Fabian; Patel, Archana; Goudar, Shivaprasad S; Kodkany, Bhalchandra; Garces, Ana; Chomba, Elwyn; Althabe, Fernando; Barreuta, Mabel; Pasha, Omrana; Hibberd, Patricia; Derman, Richard J; Otieno, Kevin; Hambidge, K; Krebs, Nancy F; Carlo, Waldemar A; Chemweno, Carolyne; Goldenberg, Robert L; McClure, Elizabeth M; Moore, Janet L; Wallace, Dennis D; Saleem, Sarah; Koso-Thomas, Marion

    2015-01-01

    The Global Network for Women's and Children's Health Research is one of the largest international networks for testing and generating evidence-based recommendations for improvement of maternal-child health in resource-limited settings. Since 2009, Global Network sites in six low and middle-income countries have collected information on antenatal care practices, which are important as indicators of care and have implications for programs to improve maternal and child health. We sought to: (1) describe the quantity of antenatal care attendance over a four-year period; and (2) explore the quality of coverage for selected preventative, screening, and birth preparedness components. The Maternal Newborn Health Registry (MNHR) is a prospective, population-based birth and pregnancy outcomes registry in Global Network sites, including: Argentina, Guatemala, India (Belgaum and Nagpur), Kenya, Pakistan, and Zambia. MNHR data from these sites were prospectively collected from January 1, 2010 - December 31, 2013 and analyzed for indicators related to quantity and patterns of ANC and coverage of key elements of recommended focused antenatal care. Descriptive statistics were generated overall by global region (Africa, Asia, and Latin America), and for each individual site. Overall, 96% of women reported at least one antenatal care visit. Indian sites demonstrated the highest percentage of women who initiated antenatal care during the first trimester. Women from the Latin American and Indian sites reported the highest number of at least 4 visits. Overall, 88% of women received tetanus toxoid. Only about half of all women reported having been screened for syphilis (49%) or anemia (50%). Rates of HIV testing were above 95% in the Argentina, African, and Indian sites. The Pakistan site demonstrated relatively high rates for birth preparation, but for most other preventative and screening interventions, posted lower coverage rates as compared to other Global Network sites. Results

  18. Psychotropic medication in a randomly selected group of citizens receiving residential or home care

    DEFF Research Database (Denmark)

    Futtrup, Tina Bergmann; Helnæs, Ann Kathrine; Schultz, Hanne

    2014-01-01

    INTRODUCTION: Treatment with one or more psychotropic medications (PMs), especially in the elderly, is associated with risk, and the effects of treatment are poorly validated. The aim of this article was to describe the use of PM in a population of citizens receiving either residential care or home...

  19. Personal Care Product Use in Men and Urinary Concentrations of Select Phthalate Metabolites and Parabens

    DEFF Research Database (Denmark)

    Nassan, Feiby L; Coull, Brent A; Gaskins, Audrey J

    2017-01-01

    BACKGROUND: Personal care products (PCPs) are exposure sources to phthalates and parabens; however, their contribution to men's exposure is understudied. OBJECTIVES: We examined the association between PCP use and urinary concentrations of phthalate metabolites and parabens in men. METHODS......). The largest percent increase in monoethyl phthalate (MEP) was associated with use of cologne/perfume (83%, p-valuevalue

  20. Psychotropic medication in a randomly selected group of citizens receiving residential or home care

    DEFF Research Database (Denmark)

    Futtrup, Tina Bergmann; Schultz, Hanne; Jensen, Margit Bak

    2014-01-01

    INTRODUCTION: Treatment with one or more psychotropic medications (PMs), especially in the elderly, is associated with risk, and the effects of treatment are poorly validated. The aim of this article was to describe the use of PM in a population of citizens receiving either residential care or ho...

  1. Prescription for natural cures: a self-care guide for treating health problems with natural remedies including diet, nutrition, supplements, and other holistic methods

    National Research Council Canada - National Science Library

    Balch, James F; Stengler, Mark; Young-Balch, Robin

    2011-01-01

    .... You'll find easy-to-understand discussions of the symptoms and root causes of each health problem along with a proven, natural, customized prescription that may include supplements, herbal medicine...

  2. More Careful or Less Marriageable? Parental Divorce, Spouse Selection and Entry into Marriage

    Science.gov (United States)

    Erola, Jani; Harkonen, Juho; Dronkers, Jaap

    2012-01-01

    Despite the large literature on the long-term effects of parental divorce, few studies have analyzed the effects of parental divorce on spouse selection behavior. However, the characteristics of one's spouse can have important effects on economic well-being and on marital success. We use discrete-time, event-history data from Finnish population…

  3. [Selective digestive tract decontamination in intensive care medicine. Fundamentals and current evaluation].

    Science.gov (United States)

    Krueger, W A; Heininger, A; Unertl, K E

    2003-02-01

    Selective digestive tract decontamination (SDD) is a method where topical non-absorbable antibiotics are applied to the oropharynx and stomach which primarily is aimed at the prevention of ventilator-associated pneumonia. The rationale for SDD is that ventilator associated pneumonia usually originates from the patients'own oropharyngeal microflora. SDD is also used for the prevention of gut-derived infections in acute necrotizing pancreatitis and in liver transplantation. Despite numerous clinical trials and several meta-analyses, SDD is still a controversial topic. It is now commonly accepted that the incidence of pneumonia is reduced,however, the concept of using topical antibiotics has its inherent limitations and the best results have been obtained by combination with a short course of intravenous antibiotics. Several issues surrounding the notorious difficulties in establishing the diagnosis of ventilator-associated pneumonia especially in the presence of antibiotics are an on-going matter of debate.Furthermore, pneumonia is the leading cause of death from nosocomial infections and its prevention was not adequately followed by reduced mortality in most individual trials, however, a benefit was suggested by recalculation of data in meta-analyses. Patients are not well defined by their need for ICU admission and mechanical ventilation and the attributable mortality of infections depends more on the type and severity of the underlying diseases. Recently published trials substantially improved our understanding as to which patients may derive most benefit from SDD.Currently, it seems that an improved survival can be achieved in surgical and trauma patients with severe but salvageable diseases, which might be classified e.g.by calculation of APACHE-II scores on admission.However, the most important drawback of SDD is the development of resistance and an increased selection pressure towards Gram-positive pathogens, especially in institutions with endemic multi

  4. Parenteral nutrition including an omega-3 fatty-acid-containing lipid emulsion for intensive care patients in China: a pharmacoeconomic analysis

    Directory of Open Access Journals (Sweden)

    Feng Y

    2017-09-01

    Full Text Available Yufei Feng,1 Chao Li,1 Tian Zhang,1 Lorenzo Pradelli2 1Department of Pharmacy, Beijing Hospital, National Center of Gerontology, Beijing, People’s Republic of China; 2AdRes Health Economics and Outcomes Research, Piazza Carlo Emanuele II, Torino, Italy Background/objectives: Parenteral nutrition (PN incorporating omega-3 fatty-acid-enriched lipid emulsions has been shown to be cost effective in Western populations. A pharmacoeconomic evaluation was performed within the Chinese intensive care unit (ICU setting. This assessed whether the additional acquisition cost of PN with omega-3 fatty-acid-enriched lipid emulsion (SMOFlipid vs standard PN was offset by improved clinical outcomes that can reduce subsequent costs. Materials and methods: A pharmacoeconomic discrete event simulation model was developed, based on an update to efficacy data from a previous international meta-analysis, with China-specific clinical and economic input parameters. Sensitivity analyses were undertaken to assess the effects of uncertainty around input parameters. Results: The model predicted that PN with an omega-3 fatty-acid-enriched lipid emulsion was more effective and less costly than PN with standard lipid emulsions for Chinese ICU patients, as follows: reduced length of overall hospital length of stay (19.48 vs 21.35 days, respectively, reduced length of ICU stay (5.03 vs 6.18 days, respectively, and prevention of 35.6% of nosocomial infections leading to a lower total cost per patient (¥47 189 [US $6937] vs ¥54 783 [US $8053], respectively. Additional treatment costs were offset by savings in overall hospital and ICU stay cost, and antibiotic cost, resulting in a mean cost saving of ¥7594 (US $1116 per patient. Sensitivity analyses confirmed the robustness of these findings. Conclusions: PN enriched with an omega-3 fatty-acid-containing lipid emulsion vs standard PN may be effective in reducing length of hospital and ICU stay and infectious complications in

  5. Direct Primary Care in 2015: A Survey with Selected Comparisons to 2005 Survey Data.

    Science.gov (United States)

    Rowe, Kyle; Rowe, Whitney; Umbehr, Josh; Dong, Frank; Ablah, Elizabeth

    2017-02-01

    Direct primary care (DPC), a fee for membership type of practice, is an evolving innovative primary care delivery model. Little is known about current membership fees, insurance billing status, physician training, and patient panel size in DPC practices. This study aimed to obtain current data for these variables, as well as additional demographic and financial indicators, and relate the findings to the Healthy People 2020 goals. It was predicted that DPC practices would (1) submit fewer claims to insurance, (2) have decreased membership fees, (3) be primarily family medicine trained, and (4) have increased the projected patient panel size since 2005. An electronic survey was sent to DPC practices (n = 65) requesting location, membership fees, projected patient panel size, insurance billing status, training, and other demographic and financial indicators. Data were aggregated, reported anonymously, and compared to two prior characterizations of DPC practices done in 2005. Thirty-eight of 65 (59%) practices responded to the 2015 survey. The majority of respondents (84%) reported using an EMR, offering physician email access (82%), 24-hour access (76%), same day appointments (92%), and wholesale labs (74%). Few respondents offered inpatient care (16%), obstetrics (3%), or financial/insurance consultant services. Eighty-eight percent (88%) of practices reported annual individual adult membership rates between $500 and $1,499, decreased from 2005 where 81% reported greater than a $1,500 annual fee. The proportion of practices who submit bills to insurance decreased from 75% in 2005 to 11% in 2015. Fifty-six percent (56%) of practices reported projected patient panel size to be greater than 600, increased from 40% in 2005. Family medicine physicians represented 87% of respondents, markedly different from 2005 when 62 - 77% of DPC respondents were general internal medicine physicians. Most DPC practices no longer submit to insurance and are family medicine trained

  6. Collaboration improves outcomes: cross county, joint acute and primary care, working party to select a super absorbent dressing.

    Science.gov (United States)

    Fenwick, Kim; Florence, Lorraine; Godar, Sue; Guy, Heidi; Tilbe, Helen

    2012-11-01

    This abstract highlights the work undertaken by the Bedfordshire and Hertfordshire Tissue Viability Nurses Forum (BHTVNF) to select a super absorbent dressing for local formularies. A range of super absorbent dressings was selected to be included in the evaluation based on their accessibility via FP10 or NHS Supply chain. Dressings were evaluated in the hospital setting, community setting and leg ulcer clinics. Table top evaluations were also undertaken. Performance of dressings both clinically and via table top were considered along with costs. It was interesting to find out that hospital patients had different needs to community patients and as such three recommendations were made. The acute sector has added one super absorbent which is different from the community selected one. The community has also selected a lower performing super absorbent which the acute sector has not chosen. Published by Elsevier Ltd.

  7. Participation in prenatal screening tests and intentions concerning selective termination in Finnish maternity care

    DEFF Research Database (Denmark)

    Santalahti, P; Hemminki, E; Aro, A R

    1999-01-01

    AIMS: The study examined how prenatal screening tests are presented to women, factors associated with women's participation in screening, their experience of decision-making and intentions concerning pregnancy termination, and hospital data on rates of selective terminations. METHODS...... as a routine procedure. Most women (92%) underwent serum screening and most (86%) found the decision to participate or not easy. In almost every aspect of presentation and participation studied, serum and ultrasound screening differed from each other. 85% of respondents to ultrasound screening answered...... asking about selective terminations following detected fetal disorders were sent in 1993 to all public hospitals with obstetrics or gynaecology departments (response rate 100%). RESULTS: The serum screening test had usually been offered to women as a free choice, but for 22% of them it was presented...

  8. Participation in prenatal screening tests and intentions concerning selective termination in Finnish maternity care

    DEFF Research Database (Denmark)

    Santalahti, P; Hemminki, E; Aro, A R

    1999-01-01

    AIMS: The study examined how prenatal screening tests are presented to women, factors associated with women's participation in screening, their experience of decision-making and intentions concerning pregnancy termination, and hospital data on rates of selective terminations. METHODS...... asking about selective terminations following detected fetal disorders were sent in 1993 to all public hospitals with obstetrics or gynaecology departments (response rate 100%). RESULTS: The serum screening test had usually been offered to women as a free choice, but for 22% of them it was presented...... that it was offered as a routine procedure. Close acquaintance with a person with congenital disability was negatively associated with participation in serum screening and with the intention to terminate pregnancy in case of a detected disability. 27% of women in the serum screening survey and 22% in the ultrasound...

  9. Selective digestive or oropharyngeal decontamination and topical oropharyngeal chlorhexidine for prevention of death in general intensive care: systematic review and network meta-analysis.

    Science.gov (United States)

    Price, Richard; MacLennan, Graeme; Glen, John

    2014-03-31

    To determine the effect on mortality of selective digestive decontamination, selective oropharyngeal decontamination, and topical oropharyngeal chlorhexidine in adult patients in general intensive care units and to compare these interventions with each other in a network meta-analysis. Systematic review, conventional meta-analysis, and network meta-analysis. Medline, Embase, and CENTRAL were searched to December 2012. Previous meta-analyses, conference abstracts, and key journals were also searched. We used pairwise meta-analyses to estimate direct evidence from intervention-control trials and a network meta-analysis within a Bayesian framework to combine direct and indirect evidence. Prospective randomised controlled trials that recruited adult patients in general intensive care units and studied selective digestive decontamination, selective oropharyngeal decontamination, or oropharyngeal chlorhexidine compared with standard care or placebo. Selective digestive decontamination had a favourable effect on mortality, with a direct evidence odds ratio of 0.73 (95% confidence interval 0.64 to 0.84). The direct evidence odds ratio for selective oropharyngeal decontamination was 0.85 (0.74 to 0.97). Chlorhexidine was associated with increased mortality (odds ratio 1.25, 1.05 to 1.50). When each intervention was compared with the other, both selective digestive decontamination and selective oropharyngeal decontamination were superior to chlorhexidine. The difference between selective digestive decontamination and selective oropharyngeal decontamination was uncertain. Selective digestive decontamination has a favourable effect on mortality in adult patients in general intensive care units. In these patients, the effect of selective oropharyngeal decontamination is less certain. Both selective digestive decontamination and selective oropharyngeal decontamination are superior to chlorhexidine, and there is a possibility that chlorhexidine is associated with increased

  10. Hospice Care

    Science.gov (United States)

    ... State SELECT YOUR LANGUAGE Español (Spanish) 简体中文 (Traditional Chinese) 繁体中文 (Simplified Chinese) Tiếng Việt (Vietnamese) Healthy Living for Heart.org ... your care. Other team members may include a music therapist, physical therapist, speech therapist or occupational therapist. ...

  11. Improving the Quality of Child Care. Hearing of the Committee on Labor and Human Resources on Examining Proposals To Improve the Quality of Child Care in the United States, Including the Proposed Creating Improved Delivery of Child Care: Affordable, Reliable, and Educational Act of 1997. United States Senate, One Hundred Fifth Congress. First Session.

    Science.gov (United States)

    Congress of the U.S., Washington, DC. Senate Committee on Labor and Human Resources.

    These hearings transcripts present testimony on proposals to improve the quality of child care in the United States. Both oral and submitted written statements are included. Contributors are: Representative Peter Deutsch (Florida); Senator James M. Jeffords, committee chairman; Senator Mike Enzi (Wyoming); Senator Edward M. Kennedy…

  12. Psychotropic medication in a randomly selected group of citizens receiving residential or home care

    DEFF Research Database (Denmark)

    Futtrup, Tina Bergmann; Schultz, Hanne; Jensen, Margit Bak

    2014-01-01

    INTRODUCTION: Treatment with one or more psychotropic medications (PMs), especially in the elderly, is associated with risk, and the effects of treatment are poorly validated. The aim of this article was to describe the use of PM in a population of citizens receiving either residential care or home...... status. RESULTS: Two thirds of the citizens (64.5%) used one or more PMs (antipsychotics 15.9%, antidepressants 43.5%, anxiolytics/hypnotics 27.1% and anti-dementia drugs 16.4%). Citizens treated with antipsychotics were also prescribed antidepressants (52.9%), anxiolytics/hypnotics (35.3%) and anti-dementia...... drugs (20.9%). Citizens treated with anti-dementia drugs were also prescribed antipsychotics (20.0%) and antidepressants (54.3%). Doses over 20 mg and 10 mg of citalopram and escitalopram, respectively, were given to 28.0% of the citizens treated with these antidepressants. CONCLUSION: Compared...

  13. Better Measurement for Performance Improvement in Low- and Middle-Income Countries: The Primary Health Care Performance Initiative (PHCPI) Experience of Conceptual Framework Development and Indicator Selection.

    Science.gov (United States)

    Veillard, Jeremy; Cowling, Krycia; Bitton, Asaf; Ratcliffe, Hannah; Kimball, Meredith; Barkley, Shannon; Mercereau, Laure; Wong, Ethan; Taylor, Chelsea; Hirschhorn, Lisa R; Wang, Hong

    2017-12-01

    Policy Points: Strengthening accountability through better measurement and reporting is vital to ensure progress in improving quality primary health care (PHC) systems and achieving universal health coverage (UHC). The Primary Health Care Performance Initiative (PHCPI) provides national decision makers and global stakeholders with opportunities to benchmark and accelerate performance improvement through better performance measurement. Results from the initial PHC performance assessments in low- and middle-income countries (LMICs) are helping guide PHC reforms and investments and improve the PHCPI's instruments and indicators. Findings from future assessment activities will further amplify cross-country comparisons and peer learning to improve PHC. New indicators and sources of data are needed to better understand PHC system performance in LMICs. The Primary Health Care Performance Initiative (PHCPI), a collaboration between the Bill and Melinda Gates Foundation, The World Bank, and the World Health Organization, in partnership with Ariadne Labs and Results for Development, was launched in 2015 with the aim of catalyzing improvements in primary health care (PHC) systems in 135 low- and middle-income countries (LMICs), in order to accelerate progress toward universal health coverage. Through more comprehensive and actionable measurement of quality PHC, the PHCPI stimulates peer learning among LMICs and informs decision makers to guide PHC investments and reforms. Instruments for performance assessment and improvement are in development; to date, a conceptual framework and 2 sets of performance indicators have been released. The PHCPI team developed the conceptual framework through literature reviews and consultations with an advisory committee of international experts. We generated 2 sets of performance indicators selected from a literature review of relevant indicators, cross-referenced against indicators available from international sources, and evaluated through

  14. Selecting an interprofessional education model for a tertiary health care setting.

    Science.gov (United States)

    Menard, Prudy; Varpio, Lara

    2014-07-01

    The World Health Organization describes interprofessional education (IPE) and collaboration as necessary components of all health professionals' education - in curriculum and in practice. However, no standard framework exists to guide healthcare settings in developing or selecting an IPE model that meets the learning needs of licensed practitioners in practice and that suits the unique needs of their setting. Initially, a broad review of the grey literature (organizational websites, government documents and published books) and healthcare databases was undertaken for existing IPE models. Subsequently, database searches of published papers using Scopus, Scholars Portal and Medline was undertaken. Through this search process five IPE models were identified in the literature. This paper attempts to: briefly outline the five different models of IPE that are presently offered in the literature; and illustrate how a healthcare setting can select the IPE model within their context using Reeves' seven key trends in developing IPE. In presenting these results, the paper contributes to the interprofessional literature by offering an overview of possible IPE models that can be used to inform the implementation or modification of interprofessional practices in a tertiary healthcare setting.

  15. Nest site selection and nutritional provision through excreta: a form of parental care in a tropical endogeic earthworm.

    Science.gov (United States)

    Ortiz-Ceballos, Angel I; Pérez-Staples, Diana; Pérez-Rodríguez, Paulino

    2016-01-01

    Nest construction is a common form of parental care in soil organisms. However, it is unknown whether the tropical earthworm Pontoscolex corethrurus produces nests in soils with low nutritional quality habitats. Here we studied the reproductive behaviour and nest site selection of P. corethrurus, and tested the hypothesis whether P. corethrurus produces more cocoons in habitats with low nutritional quality. In bidimensional terrariums we evaluated the combined effect of the nutritional quality of habitat: (Poor Quality Habitat = PQH, Medium Quality Habitat = MQH, High Quality Habitat = HQH) and soil depth (Shallow, Intermediate, Deep) in a factorial 3(2) design. The number and biomass of cocoons, progeny and the production of internal and external excreta were evaluated. The quality habitat and depth of soil and their interaction had a significant effect on nest site construction and the deposition of internal excreta. Pontoscolex corethrurus built a higher amount of nests in the PQH-Intermediate and MQH-Intermediate treatments while more internal excreta were found in the HQH-Intermediate treatment. Offspring biomass was positively associated with internal excreta in the PQH (soil only) and MQH (soil + grass) treatments, suggesting that this could be a form of parental care. Since P. corethrurus produces more cocoons in low and medium quality habitats, while produces more internal excreta at high quality habitats, there does not seem to be an association between number of offspring and parental care. We suggest P. corethrurus could have two reproductive strategies that act as diversified bet-hedging (do not put all cocoons in one basket) behavior in unpredictable environment, and thus build a higher amount of nests in low and medium quality habitats; and another where they produce more internal excreta as a form of parental care in high quality habitats. Parental care in the form of internal excreta may be particularly important in poor and medium quality habitats

  16. Nest site selection and nutritional provision through excreta: a form of parental care in a tropical endogeic earthworm

    Directory of Open Access Journals (Sweden)

    Angel I. Ortiz-Ceballos

    2016-05-01

    Full Text Available Nest construction is a common form of parental care in soil organisms. However, it is unknown whether the tropical earthworm Pontoscolex corethrurus produces nests in soils with low nutritional quality habitats. Here we studied the reproductive behaviour and nest site selection of P. corethrurus, and tested the hypothesis whether P. corethrurus produces more cocoons in habitats with low nutritional quality. In bidimensional terrariums we evaluated the combined effect of the nutritional quality of habitat: (Poor Quality Habitat = PQH, Medium Quality Habitat = MQH, High Quality Habitat = HQH and soil depth (Shallow, Intermediate, Deep in a factorial 32 design. The number and biomass of cocoons, progeny and the production of internal and external excreta were evaluated. The quality habitat and depth of soil and their interaction had a significant effect on nest site construction and the deposition of internal excreta. Pontoscolex corethrurus built a higher amount of nests in the PQH-Intermediate and MQH-Intermediate treatments while more internal excreta were found in the HQH-Intermediate treatment. Offspring biomass was positively associated with internal excreta in the PQH (soil only and MQH (soil + grass treatments, suggesting that this could be a form of parental care. Since P. corethrurus produces more cocoons in low and medium quality habitats, while produces more internal excreta at high quality habitats, there does not seem to be an association between number of offspring and parental care. We suggest P. corethrurus could have two reproductive strategies that act as diversified bet-hedging (do not put all cocoons in one basket behavior in unpredictable environment, and thus build a higher amount of nests in low and medium quality habitats; and another where they produce more internal excreta as a form of parental care in high quality habitats. Parental care in the form of internal excreta may be particularly important in poor and medium

  17. Success/Failure Prediction of Noninvasive Mechanical Ventilation in Intensive Care Units. Using Multiclassifiers and Feature Selection Methods.

    Science.gov (United States)

    Martín-González, Félix; González-Robledo, Javier; Sánchez-Hernández, Fernando; Moreno-García, María N

    2016-05-17

    This paper addresses the problem of decision-making in relation to the administration of noninvasive mechanical ventilation (NIMV) in intensive care units. Data mining methods were employed to find out the factors influencing the success/failure of NIMV and to predict its results in future patients. These artificial intelligence-based methods have not been applied in this field in spite of the good results obtained in other medical areas. Feature selection methods provided the most influential variables in the success/failure of NIMV, such as NIMV hours, PaCO2 at the start, PaO2 / FiO2 ratio at the start, hematocrit at the start or PaO2 / FiO2 ratio after two hours. These methods were also used in the preprocessing step with the aim of improving the results of the classifiers. The algorithms provided the best results when the dataset used as input was the one containing the attributes selected with the CFS method. Data mining methods can be successfully applied to determine the most influential factors in the success/failure of NIMV and also to predict NIMV results in future patients. The results provided by classifiers can be improved by preprocessing the data with feature selection techniques.

  18. Application of interval 2-tuple linguistic MULTIMOORA method for health-care waste treatment technology evaluation and selection.

    Science.gov (United States)

    Liu, Hu-Chen; You, Jian-Xin; Lu, Chao; Shan, Meng-Meng

    2014-11-01

    The management of health-care waste (HCW) is a major challenge for municipalities, particularly in the cities of developing countries. Selection of the best treatment technology for HCW can be viewed as a complicated multi-criteria decision making (MCDM) problem which requires consideration of a number of alternatives and conflicting evaluation criteria. Additionally, decision makers often use different linguistic term sets to express their assessments because of their different backgrounds and preferences, some of which may be imprecise, uncertain and incomplete. In response, this paper proposes a modified MULTIMOORA method based on interval 2-tuple linguistic variables (named ITL-MULTIMOORA) for evaluating and selecting HCW treatment technologies. In particular, both subjective and objective importance coefficients of criteria are taken into consideration in the developed approach in order to conduct a more effective analysis. Finally, an empirical case study in Shanghai, the most crowded metropolis of China, is presented to demonstrate the proposed method, and results show that the proposed ITL-MULTIMOORA can solve the HCW treatment technology selection problem effectively under uncertain and incomplete information environment. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Are We Appropriately Selecting Therapy For Patients With Cervical Cancer? Longitudinal Patterns-of-Care Analysis for Stage IB-IIB Cervical Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Carlson, Julie A., E-mail: Julie.A2.Carlson@ucdenver.edu [Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado (United States); Rusthoven, Chad [Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado (United States); DeWitt, Peter E. [Colorado Biostatistics Consortium, Aurora, Colorado (United States); Davidson, Susan A. [Department of Obstetrics/Gynecology, Division of Gynecologic Oncology, University of Colorado Denver, Aurora, Colorado (United States); Schefter, Tracey E.; Fisher, Christine M. [Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado (United States)

    2014-11-15

    Purpose: We performed a patterns-of-care analysis evaluating the effects of newer technology and recent research findings on treatment decisions over 26 years to determine whether patients with cervical cancer are being appropriately selected for treatment to optimize the therapeutic ratio. Methods and Materials: A retrospective analysis was conducted using the Surveillance, Epidemiology and End Results (SEER) program from 1983 to 2009. We identified 10,933 women with stage IB-IIB cervical carcinoma. Results: Of the 10,933 subjects identified, 40.1% received surgery, 26.8% received radiation (RT), and 33.1% received surgery plus RT. RT use increased after 2000 compared to prior to 2000, with a corresponding decrease in surgery and surgery plus RT. Among patients with risk factors including tumor size >4 cm, positive parametria, and positive lymph nodes, declining use of surgery plus RT was observed. However, 23% of patients with tumors >4 cm, 20% of patients with positive parametria, and 55% of node-positive patients continued to receive surgery plus RT as of 2009. Factors associated with increased use of surgery plus RT included patient age <50 and node-positive status. Conclusions: In this largest patterns-of-care analysis to date for patients with locally advanced cervical cancer, we found a substantial proportion of patients continue to undergo surgery followed by radiation, despite randomized data supporting the use of definitive radiation therapy, with lower morbidity than surgery and radiation.

  20. Evolving Meaning: The Roles of Kin Selection, Allomothering and Paternal Care in Language Evolution

    Science.gov (United States)

    Fitch, W. Tecumseh

    Many contemporary scholars agree that future theories of language evolution need to take a componential approach to language that breaks human language into separate mechanistic components such as vocal imitation, syntactic abilities, and propositional semantics. In this chapter, I discuss the evolution of the last component - the abilities and proclivities underlying honest, complex, propositional meanings. This is both a critical component of language, and one whose evolution is the hardest to explain, precisely because of its apparent uniqueness. Nonetheless, I argue, the comparative approach has important insights to offer in this domain. I briefly discuss the hypothesis that kin selection played an important, but neglected, role in driving the evolution of rich semantic communication. I then review several bodies of comparative data not addressed in previous discussions.

  1. Forecasting need and demand for home health care: a selective review.

    Science.gov (United States)

    Sharma, R K

    1980-01-01

    THREE MODELS FOR FORECASTING HOME HEALTH CARE (HHC) NEEDS ARE ANALYZED: HSA/SP model (Health Systems Agency of Southwestern Pennsylvania); Florida model (Florida State Department of Health and Rehabilitative Services); and Rhode Island model (Rhode Island Department of Community Affairs). A utilization approach to forecasting is also presented.In the HSA/SP and Florida models, need for HHC is based on a certain proportion of (a) hospital admissions and (b) patients entering HHC from other sources. The major advantage of these models is that they are relatively easy to use and explain; their major weaknesses are an imprecise definition of need and an incomplete model specification.The Rhode Island approach defines need for HHC in terms of the health status of the population as measured by chronic activity limitations. The major strengths of this approach are its explicit assumptions and its emphasis on consumer needs. The major drawback is that it requires considerable local area data.The utilization approach is based on extrapolation from observed utilization experience of the target population. Its main limitation is that it is based on current market imperfections; its major advantage is that it exposes existing deficiencies in HHC.The author concludes that each approach should be tested empirically in order to refine it, and that need and demand approaches be used jointly in the planning process.

  2. Algae-mediated removal of selected pharmaceutical and personal care products (PPCPs) from Lake Mead water.

    Science.gov (United States)

    Bai, Xuelian; Acharya, Kumud

    2017-03-01

    The persistence and fate of pharmaceutical and personal care products (PPCPs) in the Lake Mead ecosystem are particularly important considering the potential ecological risks and human health impacts. This study evaluated the removal of five common PPCPs (i.e., trimethoprim, sulfamethoxazole, carbamazepine, ciprofloxacin, and triclosan) from Lake Mead water mediated by the green alga Nannochloris sp. The results from the incubation studies showed that trimethoprim and carbamazepine were highly resistant to uptake in the algal cultural medium and were measured at approximately 90%-100% of the applied dose after 14days of incubation. Sulfamethoxazole was found relatively persistent, with >60% of the applied dose remaining in the water after 14days, and its removal was mainly caused by algae-mediated photolysis. However, ciprofloxacin and triclosan dissipated significantly and nearly 100% of the compounds were removed from the water after 7days of incubation under 24h of light. Ciprofloxacin and triclosan were highly susceptible to light, and their estimated half-lives were 12.7hours for ciprofloxacin and 31.2hours for triclosan. Algae-mediated sorption contributed to 11% of the removal of trimethoprim and sulfamethoxazole, 13% of the removal of carbamazepine, and 27% of the removal of triclosan from the lake water. This research showed that 1) trimethoprim, sulfamethoxazole, and carbamazepine are quite persistent in aquatic environments and may potentially affect human health via drinking water intake; 2) photolysis is the dominant pathway to remove ciprofloxacin from aquatic ecosystems, which indicates that ciprofloxacin may have lower ecological risks compared with other PPCPs; and 3) triclosan can undergo photolysis as well as algae-mediated uptake and it may potentially affect the food web because of its high toxicity to aquatic species. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. [Selection of indicators for continuous monitoring of the impact of programs optimizing antimicrobial use in Primary Care].

    Science.gov (United States)

    Fernández-Urrusuno, Rocío; Flores-Dorado, Macarena; Moreno-Campoy, Eva; Montero-Balosa, M Carmen

    2015-05-01

    To determine core indicators for monitoring quality prescribing in Primary Care based on the evidence, and to assess the feasibility of these indicators for monitoring the use of antibiotics. A literature review was carried out on quality indicators for antimicrobial prescribing through an electronic search limited to the period 2001-2012. It was completed with an "ad hoc" search on the websites of public national and international health services. Finally, indicators were chosen by consensus by a multidisciplinary group of professionals dedicated to managing infections from several areas. The feasibility and applicability of these indicators was verified through the reporting and use of data in the prescription database. Twenty two indicators were found. The consensus group selected 16 indicators. Eleven of them measure the specific antimicrobial selection, and 5 are consumption rates. The indicators were successfully applied to the prescription database, being able to make comparisons between different geographical areas and to observe trends in prescriptions. The definition of a basic set of indicators to monitor antibiotic use adapted to local conditions is required. The results of these indicators can be used for feedback to professionals and for evaluating the impact of programs aimed at improving antimicrobial use. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  4. A Descriptive Analysis of Changes in Selected Drug Groups Available to Primary Care Physicians in Israel From 2000 to 2013.

    Science.gov (United States)

    Treister-Goltzman, Yulia; Peleg, Roni

    Several medical and economic factors affect the process of development and introduction of new drugs and the disappearance of various medical agents from the drug market. There are no data in the existing literature on quantitative and qualitative changes in the drug market. We assessed changes in the drug market in Israel over 14 years, focusing on drug groups that, in our subjective opinion, are mainly used in primary care medicine: pain medications, lipid lowering agents, drugs for diabetes, and antihypertensives. We assessed volume of drugs and changes and trends in terms of therapeutic efficacy and safety in selected drugs in each of the groups over the study time period. We used the Medic Compendium for the analyses. Medic contains a listing of drugs that are approved and available for use in Israel. It is updated every 2 months. In 2000, there were 253 available drugs in the study groups that contained 124 active agents. In contrast, in 2013, there were 278 available drugs that contained 130 active agents. Over the study years, there was an increase in the number of drugs that are effective, "user friendly," and have a high safety profile. Our study provides the first data on quantitative and qualitative changes that have taken place in selected groups of drugs. Although the availability of the drugs in different countries is determined by multiple factors, we assumed that there are other countries with a similar situation in terms of their drug markets.

  5. Comparative gut microbiota and resistome profiling of intensive care patients receiving selective digestive tract decontamination and healthy subjects.

    Science.gov (United States)

    Buelow, Elena; Bello González, Teresita D J; Fuentes, Susana; de Steenhuijsen Piters, Wouter A A; Lahti, Leo; Bayjanov, Jumamurat R; Majoor, Eline A M; Braat, Johanna C; van Mourik, Maaike S M; Oostdijk, Evelien A N; Willems, Rob J L; Bonten, Marc J M; van Passel, Mark W J; Smidt, Hauke; van Schaik, Willem

    2017-08-14

    The gut microbiota is a reservoir of opportunistic pathogens that can cause life-threatening infections in critically ill patients during their stay in an intensive care unit (ICU). To suppress gut colonization with opportunistic pathogens, a prophylactic antibiotic regimen, termed "selective decontamination of the digestive tract" (SDD), is used in some countries where it improves clinical outcome in ICU patients. Yet, the impact of ICU hospitalization and SDD on the gut microbiota remains largely unknown. Here, we characterize the composition of the gut microbiota and its antimicrobial resistance genes ("the resistome") of ICU patients during SDD and of healthy subjects. From ten patients that were acutely admitted to the ICU, 30 fecal samples were collected during ICU stay. Additionally, feces were collected from five of these patients after transfer to a medium-care ward and cessation of SDD. Feces from ten healthy subjects were collected twice, with a 1-year interval. Gut microbiota and resistome composition were determined using 16S rRNA gene phylogenetic profiling and nanolitre-scale quantitative PCRs. The microbiota of the ICU patients differed from the microbiota of healthy subjects and was characterized by lower microbial diversity, decreased levels of Escherichia coli and of anaerobic Gram-positive, butyrate-producing bacteria of the Clostridium clusters IV and XIVa, and an increased abundance of Bacteroidetes and enterococci. Four resistance genes (aac(6')-Ii, ermC, qacA, tetQ), providing resistance to aminoglycosides, macrolides, disinfectants, and tetracyclines, respectively, were significantly more abundant among ICU patients than in healthy subjects, while a chloramphenicol resistance gene (catA) and a tetracycline resistance gene (tetW) were more abundant in healthy subjects. The gut microbiota of SDD-treated ICU patients deviated strongly from the gut microbiota of healthy subjects. The negative effects on the resistome were limited to selection

  6. “On the Margins and Not the Mainstream:” Case Selection for the Implementation of Community based Primary Health Care in Canada and New Zealand

    Directory of Open Access Journals (Sweden)

    Kerry Kuluski

    2017-06-01

    Full Text Available Healthcare system reforms are pushing beyond primary care to more holistic, integrated models of community based primary health care (CBPHC to better meet the needs of the population. Across the world CBPHC is at varying stages of development and few standard models exist. In order to scale up and spread successful models of care it is important to study what works and why. The first step is to select ‘appropriate’ cases to study. In this commentary we reflect on our journey in the selection of CBPHC models for older adults, revealing the limited utility of sourcing the empirical literature; the difficulty in identifying “successful” models to study when outcomes of importance differ across stakeholders; the value of drawing on clinical and organisational networks and experts; and the association between policy context and ease of case selection. Such insights have important implications for case study methodology in health services and policy research.

  7. Selecting process quality indicators for the integrated care of vulnerable older adults affected by cognitive impairment or dementia

    Directory of Open Access Journals (Sweden)

    Lebel Paule

    2007-11-01

    Full Text Available Abstract Background This study aimed at evaluating face and content validity, feasibility and reliability of process quality indicators developed previously in the United States or other countries. The indicators can be used to evaluate care and services for vulnerable older adults affected by cognitive impairment or dementia within an integrated service system in Quebec, Canada. Methods A total of 33 clinical experts from three major urban centres in Quebec formed a panel representing two medical specialties (family medicine, geriatrics and seven health or social services specialties (nursing, occupational therapy, psychology, neuropsychology, pharmacy, nutrition, social work, from primary or secondary levels of care, including long-term care. A modified version of the RAND®/University of California at Los Angeles (UCLA appropriateness method, a two-round Delphi panel, was used to assess face and content validity of process quality indicators. The appropriateness of indicators was evaluated according to a agreement of the panel with three criteria, defined as a median rating of 7–9 on a nine-point rating scale, and b agreement among panellists, judged by the statistical measure of the interpercentile range adjusted for symmetry. Feasibility of quality assessment and reliability of appropriate indicators were then evaluated within a pilot study on 29 patients affected by cognitive impairment or dementia. For measurable indicators the inter-observer reliability was calculated with the Kappa statistic. Results Initially, 82 indicators for care of vulnerable older adults with cognitive impairment or dementia were submitted to the panellists. Of those, 72 (88% were accepted after two rounds. Among 29 patients for whom medical files of the preceding two years were evaluated, 63 (88% of these indicators were considered applicable at least once, for at least one patient. Only 22 indicators were considered applicable at least once for ten or more out

  8. Selecting new health technologies for evaluation:Can clinical experts predict which new anticancer drugswill impact Danish health care?

    DEFF Research Database (Denmark)

    Douw, Karla; Vondeling, Hindrik

    2007-01-01

    Several countries have systems in place to support the managed entry of new health technologies. The big challenge for these so-called horizon-scanning systems is to select those technologies that require decision support by means of an early evaluation. Clinical experts are considered a valuable...... source of information on new health technologies, but research on the relevance of their input is scarce. In 2000, we asked six Danish expert oncologists to predict whether a sample of 19 new anticancer drugs would impact Danish health care over the next 5 years. In 2005, we assessed the accuracy...... of these predictions in a delayed type cross-sectional study. The specificity of the Danish experts' prediction was 1 (95% confidence interval 0.74-1.00) and the sensitivity was 0.63 (0.31-0.86). The negative predictive value was 0.79 (0.52-0.92) and the positive predictive value was 1 (0.57-1.00). This indicates...

  9. Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia-spectrum and bipolar I disorders: Four-year follow-up of the ACCESS II study.

    Science.gov (United States)

    Schöttle, Daniel; Schimmelmann, Benno G; Ruppelt, Friederike; Bussopulos, Alexandra; Frieling, Marietta; Nika, Evangelia; Nawara, Luise Antonia; Golks, Dietmar; Kerstan, Andrea; Lange, Matthias; Schödlbauer, Michael; Daubmann, Anne; Wegscheider, Karl; Rohenkohl, Anja; Sarikaya, Gizem; Sengutta, Mary; Luedecke, Daniel; Wittmann, Linus; Ohm, Gunda; Meigel-Schleiff, Christina; Gallinat, Jürgen; Wiedemann, Klaus; Bock, Thomas; Karow, Anne; Lambert, Martin

    2018-01-01

    The ACCESS-model offers integrated care including assertive community treatment to patients with psychotic disorders. ACCESS proved more effective compared to standard care (ACCESS-I study) and was successfully implemented into clinical routine (ACCESS-II study). In this article, we report the 4-year outcomes of the ACCESS-II study. Between May 2007 and December 2013, 115 patients received continuous ACCESS-care. We hypothesized that the low 2-year disengagement and hospitalization rates and significant improvements in psychopathology, functioning, and quality of life could be sustained over 4 years. Over 4 years, only 10 patients disengaged from ACCESS. Another 23 left for practical reasons and were successfully transferred to other services. Hospitalization rates remained low (13.0% in year 3; 9.1% in year 4). Involuntary admissions decreased from 35% in the 2 years prior to ACCESS to 8% over 4 years in ACCESS. Outpatient contacts remained stably high at 2.0-2.4 per week. We detected significant improvements in psychopathology (effect size d = 0.79), illness severity (d = 1.29), level of functioning (d = 0.77), quality of life (d = 0.47) and stably high client satisfaction (d = 0.02) over 4 years. Most positive effects were observed within the first 2 years with the exception of illness severity, which further improved from year 2 to 4. Within continuous intensive 4-year ACCESS-care, sustained improvements in psychopathology, functioning, quality of life, low service disengagement and re-hospitalization rates, as well as low rates of involuntary treatment, were observed in contrast to other studies, which reported a decline in these parameters once a specific treatment model was stopped. Yet, stronger evidence to prove these results is required. Clinical Trial Registration Number: NCT01888627.

  10. A patient and community-centered approach selecting endpoints for a randomized trial of a novel advance care planning tool

    Directory of Open Access Journals (Sweden)

    Bridges JFP

    2018-02-01

    Full Text Available John FP Bridges,1,2 Norah L Crossnohere,2 Anne L Schuster,1 Judith A Miller,3 Carolyn Pastorini,3,† Rebecca A Aslakson2,4,5 1Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 2Department of Health, Behavior, and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 3Patient-Centered Outcomes Research Institute (PCORI Project, Baltimore, MD, 4Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, 5Armstrong Institute for Patient Safety and Quality, The Johns Hopkins School of Medicine, Baltimore, MD, USA †Carolyn Pastorini passed away on August 24, 2015 Background: Despite a movement toward patient-centered outcomes, best practices on how to gather and refine patients’ perspectives on research endpoints are limited. Advanced care planning (ACP is inherently patient centered and would benefit from patient prioritization of endpoints for ACP-related tools and studies.Objective: This investigation sought to prioritize patient-centered endpoints for the content and evaluation of an ACP video being developed for patients undergoing major surgery. We also sought to highlight an approach using complementary engagement and research strategies to document priorities and preferences of patients and other stakeholders.Materials and methods: Endpoints identified from a previously published environmental scan were operationalized following rating by a caregiver co-investigator, refinement by a patient co-investigator, review by a stakeholder committee, and validation by patients and family members. Finalized endpoints were taken to a state fair where members of the public who indicated that they or a loved one had undergone major surgery prioritized their most relevant endpoints and provided comments.Results: Of the initial 50 ACP endpoints identified from the review, 12 endpoints were selected for public

  11. Traditional open-bay versus single-family room neonatal intensive care unit: a comparison of selected nutrition outcomes

    Directory of Open Access Journals (Sweden)

    Christina Erickson

    2011-03-01

    Full Text Available Christina Erickson1, Kendra Kattelmann1, Jessica Remington1, Cuirong Ren2, Carol C Helseth3, Dennis C Stevens31Department of Health and Nutritional Sciences, 2Department of Plant Science, South Dakota State University, Brookings, SD, USA; 3Sanford Children's Hospital, Sioux Falls, SD, USABackground: In contrast to the traditional open-bay–type design of the neonatal intensive care unit (tNICU, infants in developmentally appropriate NICU (dNICU are housed in individual rooms with greater control of light and noise. Previous reports have documented positive influence of the dNICU in cardiorespiratory status, physiologic stability, and weight gain of the infants. The objective of this study was to explore selected nutrition outcomes of infants in the dNICU versus tNICU.Method: A prospective cohort study was conducted on infants with birth weight of 1500 g or less cared for in dNICU (n = 42 or tNICU (n = 31. Differences between days to reach full parenteral nutrition, full enteral nutrition, or full bottling were determined using analysis of covariance controlling for gestational age, birth weight, and clinical risk index for babies (CRIB acuity score.Results: There were no differences between the two groups in days to reach full parenteral and bottle feeding. The infants in the dNICU took fewer days to reach full enteral nutrition (20.8 days, 95% confidence intervals [CI]: 17, 24.6 (dNICU vs 23.3 days, 95% CI: 17.1, 29.6 (tNICU, P = 0.04 than those in the tNICU.Conclusions: Although the two groups of infants only differed in the days to reach full enteral feeding, it is important to remember that the lack of difference may be clinically significant. Clinically, the infants in the dNICU were younger (gestational age and sicker (CRIB acuity score than the infants in the tNICU. Consequently, the results of this study support the change to dNICU, as the private room model provides a supportive environment for growth as evidenced by similar

  12. Selection of medical diagnostic codes for analysis of electronic patient records. Application to stroke in a primary care database.

    Directory of Open Access Journals (Sweden)

    Martin C Gulliford

    2009-09-01

    Full Text Available Electronic patient records from primary care databases are increasingly used in public health and health services research but methods used to identify cases with disease are not well described. This study aimed to evaluate the relevance of different codes for the identification of acute stroke in a primary care database, and to evaluate trends in the use of different codes over time.Data were obtained from the General Practice Research Database from 1997 to 2006. All subjects had a minimum of 24 months of up-to-standard record before the first recorded stroke diagnosis. Initially, we identified stroke cases using a supplemented version of the set of codes for prevalent stroke used by the Office for National Statistics in Key health statistics from general practice 1998 (ONS codes. The ONS codes were then independently reviewed by four raters and a restricted set of 121 codes for 'acute stroke' was identified but the kappa statistic was low at 0.23.Initial extraction of data using the ONS codes gave 48,239 cases of stroke from 1997 to 2006. Application of the restricted set of codes reduced this to 39,424 cases. There were 2,288 cases whose index medical codes were for 'stroke annual review' and 3,112 for 'stroke monitoring'. The frequency of stroke review and monitoring codes as index codes increased from 9 per year in 1997 to 1,612 in 2004, 1,530 in 2005 and 1,424 in 2006. The one year mortality of cases with the restricted set of codes was 29.1% but for 'stroke annual review,' 4.6% and for 'stroke monitoring codes', 5.7%.In the analysis of electronic patient records, different medical codes for a single condition may have varying clinical and prognostic significance; utilisation of different medical codes may change over time; researchers with differing clinical or epidemiological experience may have differing interpretations of the relevance of particular codes. There is a need for greater transparency in the selection of sets of codes for

  13. Occurrence of organic wastewater contaminants, pharmaceuticals, and personal care products in selected water supplies, Cape Cod, Massachusetts, June 2004

    Science.gov (United States)

    Zimmerman, Marc J.

    2005-01-01

    In June 2004, the U.S. Geological Survey, in cooperation with the Barnstable County Department of Health and Environment, sampled water from 14 wastewater sources and drinking-water supplies on Cape Cod, Massachusetts, for the presence of organic wastewater contaminants, pharmaceuticals, and personal care products. The geographic distribution of sampling locations does not represent the distribution of drinking-water supplies on Cape Cod. The environmental presence of the analyte compounds is mostly unregulated; many of the compounds are suspected of having adverse ecological and human health effects. Of the 85 different organic analyte compounds, 43 were detected, with 13 detected in low concentrations (less than 1 microgram per liter) from drinking-water supplies thought to be affected by wastewater because of previously detected high nitrate concentrations. (Phenol and d-limonene, detected in equipment blanks at unacceptably high concentrations, are not included in counts of detections in this report.) Compounds detected in the drinking-water supplies included the solvent, tetrachloroethylene; the analgesic, acetaminophen; the antibiotic, sulfamethoxazole; and the antidepressant, carbamazapine. Nitrate nitrogen, an indicator of wastewater, was detected in water supplies in concentrations ranging from 0.2 to 8.8 milligrams per liter.

  14. Heavy metal content of selected personal care products (PCPs available in Ibadan, Nigeria and their toxic effects

    Directory of Open Access Journals (Sweden)

    Sunday Samuel Omenka

    Full Text Available There is a growing concern on heavy metals in consumer products due to their potential human health risks and environmental effects. In this study, the levels of zinc, cadmium, lead and nickel were assessed in 3 different classes of personal care products commonly used in Ibadan, Nigeria. Samples were analysed for heavy metals using Atomic Absorption Spectrophotometer (AAS after acid digestion. Estimated daily intake (EDI of the metals and Health Risk Index (HRI were calculated to assess the human health risks associated with the use of these PCPs. The concentrations (mg/kg of zinc ranged from 3.75 to 19.3, 1.88 to 112,000 and 19.8 to 217 respectively in creams, powders and eyeliners. Cadmium ranged from ND—0.50, ND—36.3 and ND—0.50 mg/kg while lead ranged from ND—6.25, ND—468 and 3.73–27.5 mg/kg and nickel ranged from ND—6.25, 0.13–107 and 2.75–22.7 mg/kg respectively. There were high concentrations of Cd, Pb and Ni in some of the samples when compared with the available permissible limits in cosmetics (Cd: 0.3 ppm, Pb: 10 ppm and Ni: 0.6 ppm while there is no permissible limit for Zn in cosmetics currently available. Prolonged use of PCPs may pose human health and environmental risks due to toxic metal loading through dermal contact and accumulation over a period of time. Hence, the need for necessary government agencies to regulate and enforce toxic metals in consumer products including cosmetics produced and imported into Nigeria to safeguard public health and the environment, which is the final sink. Keywords: Heavy metals, Personal care products, Health effects, Dermal contact, Exposure

  15. Emission of artificial sweeteners, select pharmaceuticals, and personal care products through sewage sludge from wastewater treatment plants in Korea.

    Science.gov (United States)

    Subedi, Bikram; Lee, Sunggyu; Moon, Hyo-Bang; Kannan, Kurunthachalam

    2014-07-01

    Concern over the occurrence of artificial sweeteners (ASWs) as well as pharmaceuticals and personal care products (PPCPs) in the environment is growing, due to their high use and potential adverse effects on non-target organisms. The data for this study are drawn from a nationwide survey of ASWs in sewage sludge from 40 representative wastewater treatment plants (WWTPs) that receive domestic (WWTPD), industrial (WWTPI), or mixed (domestic plus industrial; WWTPM) wastewaters in Korea. Five ASWs (concentrations ranged from 7.08 to 5220 ng/g dry weight [dw]) and ten PPCPs (4.95-6930 ng/g dw) were determined in sludge. Aspartame (concentrations ranged from 28.4 to 5220 ng/g dw) was determined for the first time in sewage sludge. The median concentrations of ASWs and PPCPs in sludge from domestic WWTPs were 0.8-2.5 and 1.0-3.4 times, respectively, the concentrations found in WWTPs that receive combined domestic and industrial wastewaters. Among the five ASWs analyzed, the median environmental emission rates of aspartame through domestic WWTPs (both sludge and effluent discharges combined) were calculated to be 417 μg/capita/day, followed by sucralose (117 μg/capita/day), acesulfame (90 μg/capita/day), and saccharin (66μg/capita/day). The per-capita emission rates of select PPCPs, such as antimicrobials (triclocarban: 158 μg/capita/day) and analgesics (acetaminophen: 59 μg/capita/day), were an order of magnitude higher than those calculated for antimycotic (miconazole) and anthelmintic (thiabendazole) drugs analyzed in this study. Multiple linear regression analysis of measured concentrations of ASWs and PPCPs in sludge revealed that several WWTP parameters, such as treatment capacity, population-served, sludge production rate, and hydraulic retention time could influence the concentrations found in sludge. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh

    Directory of Open Access Journals (Sweden)

    Hoque Dewan ME

    2012-12-01

    Full Text Available Abstract Background Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh. Methods Using adapted World Health Organization (WHO hospital assessment tools and standards, an assessment of 18 randomly selected district (n=6 and sub-district (n=12 hospitals was undertaken. Teams of trained assessors used direct case observation, record review, interviews, and Management Information System (MIS data to assess the quality of clinical case management and monitoring; infrastructure, processes and hospital administration; essential hospital and laboratory supports, drugs and equipment. Results Findings demonstrate that the overall quality of care provided in these hospitals was poor. No hospital had a functioning triage system to prioritise those children most in need of immediate care. Laboratory supports and essential equipment were deficient. Only one hospital had all of the essential drugs for paediatric care. Less than a third of hospitals had a back-up power supply, and just under half had functioning arrangements for safe-drinking water. Clinical case management was found to be sub-optimal for prevalent illnesses, as was the quality of neonatal care. Conclusion Action is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care.

  17. Knowledge and Practices Relating to Acute Pesticide Poisoning Among Health Care Providers in Selected Regions of Tanzania

    Directory of Open Access Journals (Sweden)

    Elikana Lekei

    2017-02-01

    Full Text Available Background: Acute pesticide poisoning (APP is commonly underdiagnosed in Tanzania. Studies in developing countries suggest that a lack of diagnostic skills among health care providers (HCPs undermines surveillance for APP. This study aimed at characterizing experience and skills of Tanzanian HCPs regarding APP diagnosis and management. Methodology: The population included HCPs responsible for managing APP in Kilimanjaro and Arusha regions (n = 91. The resulting sample included 66 respondents (response rate: 73%. The data were collected in 2005 using a standardized questionnaire. Results: Half of all respondents (50% reported handling at least 1 APP case with 15% reporting handling more than 5 cases in the past. Reported experience of handling an APP case was marginally higher in respondents who reported ⩾4 years of work experience in the health sector compared with those with <4 years of work experience (odds ratio = 1.32; 95% confidence interval = 0.9-1.5. Most of the respondents had high knowledge of exposure routes, reporting awareness of oral (98.5%, inhalational (93.9%, and dermal (77% routes. The study revealed low awareness of pesticide classification by chemical groups (29% or World Health Organization hazard (0% and weak knowledge on pesticide label instructions (55%. Organophosphates accounted for 35% of the pesticide products reported by respondents as being responsible for poisoning. Some treatment options were incorrectly reported as first aid options, and some reported first aid options were wrong or inappropriate. Conclusions: The study revealed that HCPs in northern Tanzania lack adequate skills to diagnose and manage APP. For effective surveillance of APP, there is a need to include training on hazards, classification, diagnosis, and health effects in the training programmes for all HCPs in Tanzania.

  18. Prevalence of R5 strains in multi-treated HIV subjects and impact of new regimens including maraviroc in a selected group of patients with CCR5-tropic HIV-1 infection.

    Science.gov (United States)

    Bon, Isabella; Clò, Alberto; Borderi, Marco; Colangeli, Vincenzo; Calza, Leonardo; Morini, Silvia; Miserocchi, Anna; Cricca, Monica; Gibellini, Davide; Re, Maria Carla

    2013-10-01

    Maraviroc currently represents an important antiretroviral drug for multi-experienced and viremic HIV patients. This study focused on two main points: (1) determining the prevalence of R5 and X4 HIV strains in antiretroviral-experienced patients using two main tests currently in use to determine viral tropism, and (2) the follow-up to 3 years of a limited number of patients who started a new antiretroviral protocol including maraviroc. A group of 56 HIV patients, previously multi-treated, were first analyzed by genotyping assay and Trofile™ to establish their eligibility for maraviroc treatment. In addition, 25 subjects selected to follow a new therapeutic protocol including a CCR5 antagonist were monitored by HIV RNA viral load and CD4+ cell count. The determination of viral tropism showed a large percentage of patients with an R5 profile (72% by genotyping assay and 74% by Trofile). The follow-up of most (21 out 25) patients who started the new antiretroviral protocol showed an undetectable viral load throughout the observation period, accompanied by a major improvement in CD4 cell count (cells/mm(3)) (baseline: median CD4 cell count 365, interquartile range (IQR) 204-511; 12 months: median value 501, IQR 349-677, p=0.042; 24 months: median value 503, IQR 386-678, p=0.026; 36 months: median value 601, IQR 517-717, p=0.001). Among the four non-responder subjects, two showed a lack of drug compliance and two switched from R5 to X4. Although our patient cohort was small, the results showed a high prevalence of R5 viral strains in multi-experienced patients. As well as showing the advantages of genotyping, which can be performed in plasma samples with low viral load replication, the follow-up of HIV patients selected for an alternative drug protocol, including a CCR5 antagonist, showed a persistent undetectable viral replication and a good recovery of CD4 cell count in most treated HIV patients. Copyright © 2013 International Society for Infectious Diseases

  19. DECOMPOSING THE SOCIOECONOMIC INEQUALITY IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN SELECTED COUNTRIES OF SOUTH ASIA AND SUB-SAHARAN AFRICA.

    Science.gov (United States)

    Goli, Srinivas; Nawal, Dipty; Rammohan, Anu; Sekher, T V; Singh, Deepshikha

    2017-10-30

    The gap in access to maternal health care services is a challenge of an unequal world. In 2015, each day about 830 women died due to complications of pregnancy and childbirth. Almost all of these deaths occurred in low-resource settings, and most could have been prevented. This study quantified the contributions of the socioeconomic determinants of inequality to the utilization of maternal health care services in four countries in diverse geographical and cultural settings: Bangladesh, Ethiopia, Nepal and Zimbabwe. Data from the 2010-11 Demographic and Health Surveys of the four countries were used, and methods developed by Wagstaff and colleagues for decomposing socioeconomic inequalities in health were applied. The results showed that although the Concentration Index (CI) was negative for the selected indicators, meaning maternal health care was poorer among lower socioeconomic status groups, the level of CI varied across the different countries for the same outcome indicator: CI of -0.1147, -0.1146, -0.2859 and -0.0638 for inequalities in maternal health care varied across the selected countries. The findings are significant for a global understanding of the various determinants of maternal health care use in high-maternal-mortality settings in different geographical and socio-cultural contexts.

  20. Executive summary--nutritional care of HIV-infected adolescents and adults, including pregnant and lactating women: what do we know, what can we do, and where do we go from here?

    Science.gov (United States)

    Raiten, Daniel J; Mulligan, Kathleen; Papathakis, Peggy; Wanke, Christine

    2011-12-01

    The HIV pandemic continues to place an unbearable burden on the international community, with disease prevalence remaining highest in resource-limited settings in Africa, Asia, and the Americas. HIV is most often imposed on conditions of food insecurity and consequent malnutrition, poor sanitation, and chronic exposure to a myriad of infectious (eg, malaria, tuberculosis, and diarrheal) and noncommunicable (eg, obesity, diabetes, cancer, and cardiovascular) diseases. Women and children continue to bear the greatest burden. Two essential tenets underpin our approach to HIV: 1) antiretroviral drugs (ARVs) are essential to prolong lives and to halt the spread of HIV and AIDS and 2) food and sound nutrition are essential to human health. The challenge is to apply sound principles of clinical care and nutrition science to the safe and efficacious implementation of ARVs and for long-term care for people living with HIV and AIDS. The WHO has played a leading role in developing guidelines to support this goal with the generation of general recommendations regarding nutritional needs of people living with HIV and AIDS and specific guidelines for the nutritional care of HIV-infected infants and children (y of age). These proceedings represent a summary of the work accomplished at a workshop sponsored by the NIH to review the existing evidence to support changes in the recommendations regarding nutrient requirements for people living with HIV and AIDS; to support development of new WHO guidelines for adolescents and adults, including for pregnant and lactating women; and to identify a research agenda to address outstanding knowledge gaps.

  1. Including as a Care-ful Journey: A Parent's Perspective

    Science.gov (United States)

    Scorgie, Kate; Wilgosh, Lorraine

    2009-01-01

    The authors argue for the need of a cyclical, rather than a linear, model of family coping and life management when a child has a disability. Longitudinal support for such a cyclical model of family life management is presented, with recognition that parental control of outcome lessens as the young person ages, because the adult world is not…

  2. Trends in the utilization of dental outpatient services affected by the expansion of health care benefits in South Korea to include scaling: a 6-year interrupted time-series study.

    Science.gov (United States)

    Park, Hee-Jung; Lee, Jun Hyup; Park, Sujin; Kim, Tae-Il

    2018-02-01

    This study utilized a strong quasi-experimental design to test the hypothesis that the implementation of a policy to expand dental care services resulted in an increase in the usage of dental outpatient services. A total of 45,650,000 subjects with diagnoses of gingivitis or advanced periodontitis who received dental scaling were selected and examined, utilizing National Health Insurance claims data from July 2010 through November 2015. We performed a segmented regression analysis of the interrupted time-series to analyze the time-series trend in dental costs before and after the policy implementation, and assessed immediate changes in dental costs. After the policy change was implemented, a statistically significant 18% increase occurred in the observed total dental cost per patient, after adjustment for age, sex, and residence area. In addition, the dental costs of outpatient gingivitis treatment increased immediately by almost 47%, compared with a 15% increase in treatment costs for advanced periodontitis outpatients. This policy effect appears to be sustainable. The introduction of the new policy positively impacted the immediate and long-term outpatient utilization of dental scaling treatment in South Korea. While the policy was intended to entice patients to prevent periodontal disease, thus benefiting the insurance system, our results showed that the policy also increased treatment accessibility for potential periodontal disease patients and may improve long-term periodontal health in the South Korean population.

  3. Retooling for an aging America: building the healthcare workforce. A white paper regarding implementation of recommendation 4.2 of this Institute of Medicine Report of April 14, 2008, that "All licensure, certification and maintenance of certification for healthcare professionals should include demonstration of competence in care of older adults as a criterion.".

    Science.gov (United States)

    2011-08-01

    In Chicago, Illinois, on May 7, 2009, a group of 53 medical educators representing many U.S. certification boards, residency review committees, and medical societies met to review and approve a white paper intended to promote Recommendation 4.2 of the Institute of Medicine report of April 14, 2008, "Retooling for an Aging America: Building the Healthcare Workforce." This recommendation is one of 14 and states: "All licensure, certification and maintenance of certification for healthcare professionals should include demonstration of competence in care of older adults as a criterion." Background information given included the growing numbers of older adults, review of a 15-year initiative by a section of the American Geriatrics Society (AGS) to include geriatric education in all surgical and some related medical specialties, a recent announcement of 26 elder care competencies to be expected of graduating medical students from association of American Medical Colleges (AAMC) affiliated schools, and the American Board of Medical Specialties (ABMS) approach to 'Reinforcing Geriatric Competencies through Licensure and Certification Examinations." Nine points involved in the implementation of this recommendation received discussion, and approaches to realization were presented. In conclusion, this white paper, which those listed as being in attendance approved, proposes hat all ABMS member boards whose diplomates participate in the care of older adults select the floor competencies enumerated by the AAMC that apply to their specialty and add or subtract those completed during their trainees' initial (intern) year and then define those needed in subsequent years of residency and ultimate practice. This would fulfill the requirements of Recommendation 4.2 above.

  4. [People with Intellectual and Multiple Disabilities in the Acute-In-Patient Care - Selected Results of a Qualitative Exploratory Study].

    Science.gov (United States)

    Hasseler, M

    2015-10-01

    National and international publications indicate a higher importance of people with disabilities in health and nursing care. From the international literature it can be seen that for this target group the hospital care is to be regarded as deficient in many ways. This project intends to study on a qualitative exploratory basis experiences of employees of outpatient and residential care facilities for people with mental and multiple disabilities and family members of the target group concerning their experiences in health and nursing care. 21 guided interviews with employees of outpatient and in-patient residential facilities for people with mental and multiple disabilities and family members of the target group were conducted. 21 interviews could be evaluated according to Grounded Theory with the software program MAXQDA. The results show above all that in the perception and from the experience of the interviewees mainly a "lack" exists in the care of the target group, e. g., in time, staff, resources, qualification, cooperation and so forth. Employees of outpatient and inpatient residential facilities for people with mental and multiple disabilities and family members must contribute to a high degree to the care in hospitals, so that nursing and health measures are performed. The results point to an inadequate care of people with disabilities in hospitals. It is necessary to reflect critically on the medical and nursing care and to develop adequate measures, concepts, interventions and policies. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Legal size limit implies strong fisheries selection on sexually selected traits in a temperate wrasse providing male-only parental care

    Directory of Open Access Journals (Sweden)

    Kim Aleksander Tallaksen Halvorsen

    2015-12-01

    Full Text Available Corkwing wrasse (Symphodus melops is a temperate wrasse displaying both sex and male dimorphism and is targeted in a size selective commercial fishery which has increased dramatically since 2008. Wrasses are supplied alive to salmon farms as cleaner fish to combat infestations of Salmon lice. In previous studies, growth and maturation has been found to differ among male morphs and sexes and these groups might therefore be targeted unevenly by the size selective fishery. In the present study, we address this by comparing size regulations and fishing practice with data on sex specific growth and maturation from Western and Southern Norway, two regions varying in density and life histories. Two years of field data on density and length measures was used together with a subsample of otoliths to determine sex specific growth patterns. In the region with high density, nesting males were found to grow faster and mature later than sneaker males and females. Here, most nesting males will reach the minimum size as juveniles, one and two years before females and sneakers respectively. In contrast, sexual dimorphism was much less pronounced in the low density region, and relaxed male-male competition over nesting sites seems a likely explanation for this pattern. Intensive harvesting with selective removal of the larger nesting males could potentially lead to short term effect such as sperm limitation and reduced offspring survival and thus affect the productivity of juveniles. In addition, the current fishing regime may select for reduced growth rates and earlier maturation and oppose sexual selection.

  6. Costs of health care across primary care models in Ontario.

    Science.gov (United States)

    Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

    2017-08-01

    The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the

  7. Protocol for a randomised controlled trial evaluating the effects of providing essential medicines at no charge: the Carefully seLected and Easily Accessible at No Charge Medicines (CLEAN Meds) trial.

    Science.gov (United States)

    Persaud, Nav; Lee, Taehoon; Ahmad, Haroon; Li, Winny; Taglione, Michael Sergio; Rajakulasingam, Yathavan; Umali, Norman; Boozary, Andrew; Glazier, Richard H; Gomes, Tara; Hwang, Stephen W; Jüni, Peter; Law, Michael; Mamdani, Muhammad M; Manns, Braden; Martin, Danielle; Morgan, Steve; Oh, Paul; Pinto, Andrew David; Shah, Baiju R; Sullivan, Frank M; Thorpe, Kevin E; Tu, Karen; Laupacis, Andreas

    2017-06-12

    Cost-related non-adherence to medicines is common in low-income, middle-income and high-income countries such as Canada. Medicine non-adherence is associated with poor health outcomes and increased mortality. This randomised trial will test the impact of a carefully selected list of essential medicines at no charge (compared with usual medicine access) in primary care patients reporting cost-related non-adherence. This is an open-label, parallel two-arm, superiority, individually randomised controlled trial conducted in three primary care sites (one urban, two rural) in Ontario, Canada, that was codesigned by a community guidance panel. Adult patients (≥18 years) who report cost-related non-adherence to medicines are eligible to participate in the study. Participants will be randomised to receive free and convenient access to a carefully selected list of 125 essential medicines (based on the WHO's Model List of Essential Medicines) or usual means of medicine access. Care for patients in both groups will otherwise be unchanged. The primary outcome of this trial is adherence to appropriately prescribed medicines. Secondary outcomes include medicine adherence, appropriate prescribing, blood pressure, haemoglobin A1c, low-density lipoprotein cholesterol, patient-oriented outcomes and healthcare costs. All participants will be followed for at least 12 months. Ethics approval was obtained in all three participating sites. Results of the main trial and secondary outcomes will be submitted for publication in a peer-reviewed journal and discussed with members of the public and decision makers. NCT02744963. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Hepatic transplantation outcomes for carefully selected cirrhotic patients with hepatocellular carcinoma: experience at a small- to medium-volume centre.

    LENUS (Irish Health Repository)

    Qasim, A

    2012-02-01

    BACKGROUND: Hepatic transplantation outcomes for cirrhotic patients with hepatocellular carcinoma (HCC) at a small- to medium-volume centre are not fully known due to relative novelty of patient selection criteria. AIM: To determine hepatic transplantation outcomes for HCC at a small- to medium-volume centre. Patients and methods Hepatocellular carcinoma patients were listed for transplantation according to the International Guideline and further categorized as those fulfilling or exceeding Milan or University of San Francisco (UCSF) criteria on explanted liver morphology. Outcomes including mortality, retransplantation, and tumour recurrence rate were analysed. RESULTS: Twenty-six patients had HCC and on explanted liver morphology, Milan and UCSF criteria met 15 and 18 patients, respectively. Patients and graft survival at 3 months, 1 and 5 years were 100, 96, 84, and 88, 84, 77%, respectively. Outcomes favoured Milan criteria but did not reach statistical significance. CONCLUSIONS: Hepatic transplantation for HCC at a small-to medium-volume transplant centre had comparable survival outcomes to high-volume centres.

  9. Antibiotic-Induced Within-Host Resistance Development of Gram-Negative Bacteria in Patients Receiving Selective Decontamination or Standard Care.

    Science.gov (United States)

    Noteboom, Yvonne; Ong, David S Y; Oostdijk, Evelien A; Schultz, Marcus J; de Jonge, Evert; Purmer, Ilse; Bergmans, Dennis; Fijen, Jan Willem; Kesecioglu, Jozef; Bonten, Marc J M

    2015-12-01

    To quantify antibiotic-associated within-host antibiotic resistance acquisition rates in Pseudomonas aeruginosa, Klebsiella species, and Enterobacter species from lower respiratory tract samples of ICU patients receiving selective digestive decontamination, selective oropharyngeal decontamination, or standard care. Prospective cohort. This study was nested within a cluster-randomized crossover study of selective digestive decontamination and selective oropharyngeal decontamination in 16 ICUs in The Netherlands. Eligible patients were those colonized in the respiratory tract with P. aeruginosa, Klebsiella species, or Enterobacter species susceptible to one of the marker antibiotics and with at least two subsequent microbiological culture results from respiratory tract samples available. None. Antibiotic resistance acquisition rates were defined as the number of conversions from susceptible to resistant for a specific antibiotic per 100 patient-days or 100 days of antibiotic exposure within an individual patient. The hazard of antibiotic use for resistance development in P. aeruginosa was based on time-dependent Cox regression analysis. Findings of this study cohort were compared with those of a previous cohort of patients not receiving selective digestive decontamination/selective oropharyngeal decontamination. Numbers of eligible patients were 277 for P. aeruginosa, 174 for Klebsiella species, and 106 for Enterobacter species. Resistance acquisition rates per 100 patient-days ranged from 0.2 (for colistin and ceftazidime in P. aeruginosa and for carbapenems in Klebsiella species) to 3.0 (for piperacillin-tazobactam in P. aeruginosa and Enterobacter species). For P. aeruginosa, the acquisition rates per 100 days of antibiotic exposure ranged from 1.4 for colistin to 4.9 for piperacillin-tazobactam. Acquisition rates were comparable for patients receiving selective digestive decontamination/selective oropharyngeal decontamination and those receiving standard care

  10. Heavy metal content of selected personal care products (PCPs) available in Ibadan, Nigeria and their toxic effects.

    Science.gov (United States)

    Omenka, Sunday Samuel; Adeyi, Adebola Abosede

    2016-01-01

    There is a growing concern on heavy metals in consumer products due to their potential human health risks and environmental effects. In this study, the levels of zinc, cadmium, lead and nickel were assessed in 3 different classes of personal care products commonly used in Ibadan, Nigeria. Samples were analysed for heavy metals using Atomic Absorption Spectrophotometer (AAS) after acid digestion. Estimated daily intake (EDI) of the metals and Health Risk Index (HRI) were calculated to assess the human health risks associated with the use of these PCPs. The concentrations (mg/kg) of zinc ranged from 3.75 to 19.3, 1.88 to 112,000 and 19.8 to 217 respectively in creams, powders and eyeliners. Cadmium ranged from ND-0.50, ND-36.3 and ND-0.50 mg/kg while lead ranged from ND-6.25, ND-468 and 3.73-27.5 mg/kg and nickel ranged from ND-6.25, 0.13-107 and 2.75-22.7 mg/kg respectively. There were high concentrations of Cd, Pb and Ni in some of the samples when compared with the available permissible limits in cosmetics (Cd: 0.3 ppm, Pb: 10 ppm and Ni: 0.6 ppm while there is no permissible limit for Zn in cosmetics currently available). Prolonged use of PCPs may pose human health and environmental risks due to toxic metal loading through dermal contact and accumulation over a period of time. Hence, the need for necessary government agencies to regulate and enforce toxic metals in consumer products including cosmetics produced and imported into Nigeria to safeguard public health and the environment, which is the final sink.

  11. Applying quantitative bias analysis to estimate the plausible effects of selection bias in a cluster randomised controlled trial: secondary analysis of the Primary care Osteoarthritis Screening Trial (POST).

    Science.gov (United States)

    Barnett, L A; Lewis, M; Mallen, C D; Peat, G

    2017-12-04

    Selection bias is a concern when designing cluster randomised controlled trials (c-RCT). Despite addressing potential issues at the design stage, bias cannot always be eradicated from a trial design. The application of bias analysis presents an important step forward in evaluating whether trial findings are credible. The aim of this paper is to give an example of the technique to quantify potential selection bias in c-RCTs. This analysis uses data from the Primary care Osteoarthritis Screening Trial (POST). The primary aim of this trial was to test whether screening for anxiety and depression, and providing appropriate care for patients consulting their GP with osteoarthritis would improve clinical outcomes. Quantitative bias analysis is a seldom-used technique that can quantify types of bias present in studies. Due to lack of information on the selection probability, probabilistic bias analysis with a range of triangular distributions was also used, applied at all three follow-up time points; 3, 6, and 12 months post consultation. A simple bias analysis was also applied to the study. Worse pain outcomes were observed among intervention participants than control participants (crude odds ratio at 3, 6, and 12 months: 1.30 (95% CI 1.01, 1.67), 1.39 (1.07, 1.80), and 1.17 (95% CI 0.90, 1.53), respectively). Probabilistic bias analysis suggested that the observed effect became statistically non-significant if the selection probability ratio was between 1.2 and 1.4. Selection probability ratios of > 1.8 were needed to mask a statistically significant benefit of the intervention. The use of probabilistic bias analysis in this c-RCT suggested that worse outcomes observed in the intervention arm could plausibly be attributed to selection bias. A very large degree of selection of bias was needed to mask a beneficial effect of intervention making this interpretation less plausible.

  12. Procalcitonin for selecting the antibiotic regimen in outpatients with low-risk community-acquired pneumonia using a rapid point-of-care testing: A single-arm clinical trial.

    Directory of Open Access Journals (Sweden)

    Mar Masiá

    Full Text Available We aimed to assess the role of procalcitonin (PCT to guide the initial selection of the antibiotic regimen for low-risk community-acquired pneumonia (CAP.A single-arm clinical trial was conducted including outpatients with CAP and Pneumonia Severity Index risk classes I-II. Antimicrobial selection was based on the results of PCT measured with a rapid point-of-care testing. According to serum PCT levels, patients were assigned to two treatment strategies: oral azithromycin if PCT was <0.5 ng/ml, or levofloxacin if levels were ≥0.5 ng/ml. Primary outcome was clinical cure rate. Short-term and long-term outcomes were assessed. Results were compared with those of a historical standard-of-care control-group treated in our centre.Of 253 subjects included, 216 (85.4% were assigned to azithromycin. Pneumococcal infection was diagnosed in 26 (12% and 21 (56.8% patients allocated to azithromycin and levofloxacin groups, respectively. No patients in the azithromycin group developed bacteraemia. Atypical organisms were more common in patients given azithromycin (18.5% vs 8.1%, respectively. The majority (93% of patients with atypical pneumonia had low PCT levels. Clinical cure rates were 95.8% in the azithromycin group, 94.6% in the levofloxacin group, and 94.4% in the historical control group. No 30-day mortality or recurrences were observed, and the 3-year rates of recurrence and mortality were very low in both groups. Adverse events occurrence was also infrequent.A PCT-guided strategy with a rapid point-of-care testing safely allowed selecting empirical narrow-spectrum antibiotics in outpatients with CAP.The study is registered with ClinicalTrials.gov, number NCT02600806.

  13. Palliative Care

    Science.gov (United States)

    Palliative care is treatment of the discomfort, symptoms, and stress of serious illness. It provides relief from distressing symptoms ... of the medical treatments you're receiving. Hospice care, care at the end of life, always includes ...

  14. Procalcitonin for selecting the antibiotic regimen in outpatients with low-risk community-acquired pneumonia using a rapid point-of-care testing: A single-arm clinical trial

    Science.gov (United States)

    Masiá, Mar; Padilla, Sergio; Ortiz de la Tabla, Victoria; González, Matilde; Bas, Cristina; Gutiérrez, Félix

    2017-01-01

    Objective We aimed to assess the role of procalcitonin (PCT) to guide the initial selection of the antibiotic regimen for low-risk community-acquired pneumonia (CAP). Methods A single-arm clinical trial was conducted including outpatients with CAP and Pneumonia Severity Index risk classes I-II. Antimicrobial selection was based on the results of PCT measured with a rapid point-of-care testing. According to serum PCT levels, patients were assigned to two treatment strategies: oral azithromycin if PCT was Atypical organisms were more common in patients given azithromycin (18.5% vs 8.1%, respectively). The majority (93%) of patients with atypical pneumonia had low PCT levels. Clinical cure rates were 95.8% in the azithromycin group, 94.6% in the levofloxacin group, and 94.4% in the historical control group. No 30-day mortality or recurrences were observed, and the 3-year rates of recurrence and mortality were very low in both groups. Adverse events occurrence was also infrequent. Conclusion A PCT-guided strategy with a rapid point-of-care testing safely allowed selecting empirical narrow-spectrum antibiotics in outpatients with CAP. Trial registration The study is registered with ClinicalTrials.gov, number NCT02600806 PMID:28426811

  15. Clinician‐selected Electronic Information Resources do not Guarantee Accuracy in Answering Primary Care Physicians’ Information Needs. A review of: McKibbon, K. Ann, and Douglas B. Fridsma. “Effectiveness of Clinician‐selected Electronic Information Resources for Answering Primary Care Physicians’ Information Needs.” Journal of the American Medical Informatics Association 13.6 (2006: 653‐9.

    Directory of Open Access Journals (Sweden)

    Martha Ingrid Preddie

    2008-03-01

    Full Text Available Objective – To determine if electronic information resources selected by primary care physicians improve their ability to answer simulated clinical questions.Design – An observational study utilizing hour‐long interviews and think‐aloud protocols.Setting – The offices and clinics of primary care physicians in Canada and the United States.Subjects – Twenty‐five primary care physicians of whom 4 were women, 17 were from Canada, 22 were family physicians,and 24 were board certified.Methods – Participants provided responses to 23 multiple‐choice questions. Each physician then chose two questions and looked for the answers utilizing information resources of their own choice. The search processes, chosen resources and search times were noted. These were analyzed along with data on the accuracy of the answers and certainties related to the answer to each clinical question prior to the search.Main results – Twenty‐three physicians sought answers to 46 simulated clinical questions. Utilizing only electronic information resources, physicians spent a mean of 13.0 (SD 5.5 minutes searching for answers to the questions, an average of 7.3(SD 4.0 minutes for the first question and 5.8 (SD 2.2 minutes to answer the second question. On average, 1.8 resources were utilized per question. Resources that summarized information, such as the Cochrane Database of Systematic Reviews, UpToDate and Clinical Evidence, were favored 39.2% of the time, MEDLINE (Ovid and PubMed 35.7%, and Internet resources including Google 22.6%. Almost 50% of the search and retrieval strategies were keyword‐based, while MeSH, subheadings and limiting were used less frequently. On average, before searching physicians answered 10 of 23 (43.5% questions accurately. For questions that were searched using clinician‐selected electronic resources, 18 (39.1% of the 46 answers were accurate before searching, while 19 (42.1% were accurate after searching. The difference of

  16. Physician Rating Websites: What Aspects Are Important to Identify a Good Doctor, and Are Patients Capable of Assessing Them? A Mixed-Methods Approach Including Physicians' and Health Care Consumers' Perspectives.

    Science.gov (United States)

    Rothenfluh, Fabia; Schulz, Peter J

    2017-05-01

    Physician rating websites (PRWs) offer health care consumers the opportunity to evaluate their doctor anonymously. However, physicians' professional training and experience create a vast knowledge gap in medical matters between physicians and patients. This raises ethical concerns about the relevance and significance of health care consumers' evaluation of physicians' performance. To identify the aspects physician rating websites should offer for evaluation, this study investigated the aspects of physicians and their practice relevant for identifying a good doctor, and whether health care consumers are capable of evaluating these aspects. In a first step, a Delphi study with physicians from 4 specializations was conducted, testing various indicators to identify a good physician. These indicators were theoretically derived from Donabedian, who classifies quality in health care into pillars of structure, process, and outcome. In a second step, a cross-sectional survey with health care consumers in Switzerland (N=211) was launched based on the indicators developed in the Delphi study. Participants were asked to rate the importance of these indicators to identify a good physician and whether they would feel capable to evaluate those aspects after the first visit to a physician. All indicators were ordered into a 4×4 grid based on evaluation and importance, as judged by the physicians and health care consumers. Agreement between the physicians and health care consumers was calculated applying Holsti's method. In the majority of aspects, physicians and health care consumers agreed on what facets of care were important and not important to identify a good physician and whether patients were able to evaluate them, yielding a level of agreement of 74.3%. The two parties agreed that the infrastructure, staff, organization, and interpersonal skills are both important for a good physician and can be evaluated by health care consumers. Technical skills of a doctor and outcomes

  17. Selectivity of the highly preorganized tetradentate ligand 2,9-di(pyrid-2-yl)-1,10-phenanthroline for metal ions in aqueous solution, including lanthanide(III) ions and the uranyl(VI) cation.

    Science.gov (United States)

    Carolan, Ashley N; Cockrell, Gregory M; Williams, Neil J; Zhang, Gang; VanDerveer, Donald G; Lee, Hee-Seung; Thummel, Randolph P; Hancock, Robert D

    2013-01-07

    Some metal ion complexing properties of DPP (2,9-Di(pyrid-2-yl)-1,10-phenanthroline) are reported with a variety of Ln(III) (Lanthanide(III)) ions and alkali earth metal ions, as well as the uranyl(VI) cation. The intense π-π* transitions in the absorption spectra of aqueous solutions of 10(-5) M DPP were monitored as a function of pH and metal ion concentration to determine formation constants of the alkali-earth metal ions and Ln(III) (Ln = lanthanide) ions. It was found that log K(1)(DPP) for the Ln(III) ions has a peak at Ln(III) = Sm(III) in a plot of log K(1) versus 1/r(+) (r(+) = ionic radius for 8-coordination). For Ln(III) ions larger than Sm(III), there is a steady rise in log K(1) from La(III) to Sm(III), while for Ln(III) ions smaller than Sm(III), log K(1) decreases slightly to the smallest Ln(III) ion, Lu(III). This pattern of variation of log K(1) with varying size of Ln(III) ion was analyzed using MM (molecular mechanics) and DFT (density functional theory) calculations. Values of strain energy (∑U) were calculated for the [Ln(DPP)(H(2)O)(5)](3+) and [Ln(qpy)(H(2)O)(5)](3+) (qpy = quaterpyrdine) complexes of all the Ln(III) ions. The ideal M-N bond lengths used for the Ln(III) ions were the average of those found in the CSD (Cambridge Structural Database) for the complexes of each of the Ln(III) ions with polypyridyl ligands. Similarly, the ideal M-O bond lengths were those for complexes of the Ln(III) ions with coordinated aqua ligands in the CSD. The MM calculations suggested that in a plot of ∑U versus ideal M-N length, a minimum in ∑U occurred at Pm(III), adjacent in the series to Sm(III). The significance of this result is that (1) MM calculations suggest that a similar metal ion size preference will occur for all polypyridyl-type ligands, including those containing triazine groups, that are being developed as solvent extractants in the separation of Am(III) and Ln(III) ions in the treatment of nuclear waste, and (2) Am(III) is very

  18. PERCEPTION ABOUT BOTTLE FEEDING AMONG MOTHERS IN SELECTED HEALTH CARE SETTINGS IN ABA SOUTH LGA, ABIA STATE, NIGERIA

    OpenAIRE

    Achema.G.; Chigbo.R

    2011-01-01

    The study determined the perception of bottle feeding among mothers attending child welfare clinic in selected health centers in Aba South LGA. It also ascertained the knowledge of mothers about the breast feeding and factors responsible for chosen bottle feeding. A descriptive research design was adopted for the study where a total survey of 45 mothers who were selected systematically from the centers were interviewed as a method of data collection. The findings of the study showed that 93% ...

  19. Occurrence of transmitted HIV-1 drug resistance among Drug-naïve pregnant women in selected HIV-care centres in Ghana.

    Science.gov (United States)

    Martin-Odoom, Alexander; Adiku, Theophilus; Delgado, Elena; Lartey, Margaret; Ampofo, William K

    2017-03-01

    Access to antiretroviral therapy in Ghana has been scaled up across the country over the last decade. This study sought to determine the occurrence of transmitted HIV-1 drug resistance in pregnant HIV-1 positive women yet to initiate antiretroviral therapy at selected HIV Care Centres in Ghana. Plasma specimens from twenty-six (26) HIV seropositive pregnant women who were less than 28weeks pregnant with their first pregnancy and ART naïve were collected from selected HIV care centres in three (3) regions in Ghana. Genotypic testing was done for the reverse transcriptase gene and the sequences generated were analyzed for HIV-1 drug resistance mutations using the Stanford University HIV Drug Resistance Database. Resistance mutations associated with the reverse transcriptase gene were detected in 4 (15.4%) of the participants. At least one major drug resistance mutation in the reverse transcriptase gene was found in 3 (11.5%) of the women. The detection of transmitted HIV-1 drug resistance in this drug-naïve group in two regional HIV care sites is an indication of the need for renewed action in monitoring the emergence of transmitted HIV-1 drug resistance in Ghana. None declared.

  20. Under one roof : A review and selective meta-analysis on the outcomes of residential child and youth care

    NARCIS (Netherlands)

    Knorth, Erik J.; Harder, Annemiek T.; Zandberg, Tjalling; Kendrick, Andrew J.

    Residential child and youth care is a radical intervention that in many countries is perceived as a 'last resort' solution that should be avoided if at all possible - not least because of scepticism about its effectiveness. Against this, there is the view that a residential placement can contribute

  1. Prevalence, diagnostics and management of musculoskeletal disorders in primary health care in Sweden – an investigation of 2000 randomly selected patient records

    Science.gov (United States)

    Fahlström, Martin; Djupsjöbacka, Mats

    2016-01-01

    Abstract Rationale, aims and objectives The aims of this study is to investigate the prevalence of patients seeking care due to different musculoskeletal disorders (MSDs) at primary health care centres (PHCs), to chart different factors such as symptoms, diagnosis and actions prescribed for patients that visited the PHCs due to MSD and to make comparisons regarding differences due to gender, age and rural or urban PHC. Methods Patient records (2000) for patients in working age were randomly selected equally distributed on one rural and one urban PHC. A 3‐year period was reviewed retrospectively. For all patient records' background data, cause to the visit and diagnosis were registered. For visits due to MSD, type and location of symptoms and actions to resolve the patients problems were registered. Data was analysed using cross tabulation, multidimensional chi‐squared. Results The prevalence of MSD was high; almost 60% of all patients were seeking care due to MSD. Upper and lower limb problems were most common. Symptoms were most prevalent in the young and middle age groups. The patients got a variety of different diagnoses, and between 13 and 35% of the patients did not receive a MSD diagnose despite having MSD symptoms. There was a great variation in how the cases were handled. Conclusions The present study points out some weaknesses regarding diagnostics and management of MSD in primary care. PMID:27538347

  2. Prevalence, diagnostics and management of musculoskeletal disorders in primary health care in Sweden - an investigation of 2000 randomly selected patient records.

    Science.gov (United States)

    Wiitavaara, Birgitta; Fahlström, Martin; Djupsjöbacka, Mats

    2017-04-01

    The aims of this study is to investigate the prevalence of patients seeking care due to different musculoskeletal disorders (MSDs) at primary health care centres (PHCs), to chart different factors such as symptoms, diagnosis and actions prescribed for patients that visited the PHCs due to MSD and to make comparisons regarding differences due to gender, age and rural or urban PHC. Patient records (2000) for patients in working age were randomly selected equally distributed on one rural and one urban PHC. A 3-year period was reviewed retrospectively. For all patient records' background data, cause to the visit and diagnosis were registered. For visits due to MSD, type and location of symptoms and actions to resolve the patients problems were registered. Data was analysed using cross tabulation, multidimensional chi-squared. The prevalence of MSD was high; almost 60% of all patients were seeking care due to MSD. Upper and lower limb problems were most common. Symptoms were most prevalent in the young and middle age groups. The patients got a variety of different diagnoses, and between 13 and 35% of the patients did not receive a MSD diagnose despite having MSD symptoms. There was a great variation in how the cases were handled. The present study points out some weaknesses regarding diagnostics and management of MSD in primary care. © 2016 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

  3. Selecting an appropriate strategy to make quality 7.1 % chlorhexidine digluconate accessible for umbilical cord care.

    Science.gov (United States)

    Metzler, Mutsumi; Coffey, Patricia S

    2016-01-01

    Achieving increased access to medicines in low- and middle-income countries is a complex issue that requires a holistic approach. Choosing an appropriate manufacturing strategy that can ensure a sustainable supply of these medicines is an essential component of that approach. The Chlorhexidine Working Group, a consortium of more than 25 international organizations, donors, and manufacturers led by PATH, has been working to increase access to 7.1 % chlorhexidine digluconate for umbilical cord care in low- and middle-income countries to reduce neonatal mortality due to infection. The working group initially considered two strategies for manufacture of this commodity: (1) production and global distribution by a multinational company; and (2) production and regional distribution by locally owned companies or subsidiaries of multinational companies based in low- and middle-income countries. Local production may be beneficial to public health and economic development in these countries, yet capability and capacity of pharmaceutical manufacturers, regulatory and legal provisions, and market factors must be carefully assessed and addressed to ensure that local production is the correct strategy and that it contributes to improved access to the medicine. To date, this effort to implement a local production strategy has resulted in successful registration of 7.1 % chlorhexidine digluconate for umbilical cord care by manufacturers in Bangladesh, Kenya, Nepal, and Nigeria. Additionally, the product is now available in domestic and export markets.

  4. The health system burden of chronic disease care: an estimation of provider costs of selected chronic diseases in Uganda.

    Science.gov (United States)

    Settumba, Stella Nalukwago; Sweeney, Sedona; Seeley, Janet; Biraro, Samuel; Mutungi, Gerald; Munderi, Paula; Grosskurth, Heiner; Vassall, Anna

    2015-06-01

    To explore the chronic disease services in Uganda: their level of utilisation, the total service costs and unit costs per visit. Full financial and economic cost data were collected from 12 facilities in two districts, from the provider's perspective. A combination of ingredients-based and step-down allocation costing approaches was used. The diseases under study were diabetes, hypertension, chronic obstructive pulmonary disease (COPD), epilepsy and HIV infection. Data were collected through a review of facility records, direct observation and structured interviews with health workers. Provision of chronic care services was concentrated at higher-level facilities. Excluding drugs, the total costs for NCD care fell below 2% of total facility costs. Unit costs per visit varied widely, both across different levels of the health system, and between facilities of the same level. This variability was driven by differences in clinical and drug prescribing practices. Most patients reported directly to higher-level facilities, bypassing nearby peripheral facilities. NCD services in Uganda are underfunded particularly at peripheral facilities. There is a need to estimate the budget impact of improving NCD care and to standardise treatment guidelines. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  5. Selected Abstracts of the 6th International Congress of UENPS; Valencia (Spain); November 23rd-25th 2016; Session “Neonatology and NICU clinical care and practices”

    OpenAIRE

    --- Various Authors

    2016-01-01

    Selected Abstracts of the 6th International Congress of UENPS; Valencia (Spain); November 23rd-25th 2016; Session “Neonatology and NICU clinical care and practices”ABS 1. BILATERAL CLAVICLE FRACTURE: A RARE CAUSE OF PERSISTENT CRYING • P. Cruz, P. Mendes, M. Anselmo, L. GonçalvesABS 2. NEONATAL TRANSPORT DURATION AND SHORT-TERM OUTCOME IN VERY-LOW-GESTATIONAL-AGE NEONATES • A. Matic, M. Gavrilovic LatinovicABS 3. PEMPHIGOID GESTATIONIS – A RARE CASE IN TWIN PREGNANCY • L. Gonçalves, E. Scorte...

  6. Learning to stay in school: Selection, retention and identity processes in a Danish vocational educational training programme of basic health and care

    Directory of Open Access Journals (Sweden)

    Jakob Ditlev Bøje

    2014-04-01

    Full Text Available In Denmark, as in other countries, education is seen as the most important way to make the country competitive in a global world and to solve problems relating to the welfare state. Many efforts are made to retain students in the educational system, but at the same time the system remains selective. In this paper, we present analyses that shed light on how a double agenda of selection and retention is played out within a school of studies in basic health and care and on how different groups of students respond to that. We find that the double agenda is handled in a manner where one agenda is reserved for one group of students and another for a different group of student. Our theoretical point of departure is the British tradition of Cultural Studies and particularly Paul Willis' study on working class boys’ resistance towards school.

  7. Pump apparatus including deconsolidator

    Energy Technology Data Exchange (ETDEWEB)

    Sonwane, Chandrashekhar; Saunders, Timothy; Fitzsimmons, Mark Andrew

    2014-10-07

    A pump apparatus includes a particulate pump that defines a passage that extends from an inlet to an outlet. A duct is in flow communication with the outlet. The duct includes a deconsolidator configured to fragment particle agglomerates received from the passage.

  8. Less healthy, but more active: Opposing selection biases when recruiting older people to a physical activity study through primary care

    Directory of Open Access Journals (Sweden)

    Carey Iain M

    2008-05-01

    Full Text Available Abstract Background Physical activity studies in older people experience poor recruitment. We wished to assess the influence of activity levels and health status on recruitment to a physical activity study in older people. Methods Comparison of participants and non-participants to a physical activity study using accelerometers in patients aged ≥ 65 years registered with a UK primary care centre. Logistic regression was used to calculate odds ratios (OR of participants in the accelerometer study with various adjustments. Analyses were initially adjusted for age, sex and household clustering; the health variables were then adjusted for physical activity levels and vice versa to look for independent effects. Results 43%(240/560 participated in the physical activity study. Age had no effect but males were more likely to participate than females OR 1.4(1.1–1.8. 46% (76/164 of non-participants sent the questionnaire returned it. The 240 participants reported greater physical activity than the 76 non-participants on all measures, eg faster walking OR 3.2(1.4–7.7, or 10.4(3.2–33.3 after adjustment for health variables. Participants reported more health problems; this effect became statistically significant after controlling for physical activity, eg disability OR 2.4(1.1–5.1. Conclusion Physical activity studies on older primary care patients may experience both a strong bias towards participants being more active and a weaker bias towards participants having more health problems and therefore primary care contact. The latter bias could be advantageous for physical activity intervention studies, where those with health problems need targeting.

  9. A cross selectional survey in a critical care: the job satisfaction and functioning team of the health professionals.

    Science.gov (United States)

    La Sala, Rachele; Boninsegni, Katiuscia; Tani, Alice; Rasi, Alice; Ricci, Barbara; Sansovini, Linda; Scarpelli, Giulia; Artioli, Giovanna; Sarli, Leopoldo

    2015-01-01

    Health care workers, especially those who are part of the OS core, are essential in the delivery of services, as they represent the institution at the time of the contact with the user and they represent also the image of the organization. Health administrations, therefore, are called to improve the performance through a better motivation and satisfaction of the staff, in view of two strategic aspects: job satisfaction of professionals and team collaboration. Between January and September 2014, a survey at the OU (UUOO) intensive care and sub intensive has been made inside three hospitals in Emilia Romagna. It' s been a multicentre cross-sectional quantitative study by administering a self-report questionnaire designed to investigate the different constructs. On 742 questionnaires were spread 454 professionals gave it back  (response rate = 73%). Of those, 273 (60.1%) were nurses, 119 (26.2%) were physicians and 62 (13.7%) were healthcare operators. 62 (13.7%) Job Satisfaction was measured with the McCloskey Mueller Satisfaction Scale. Team Functioning was measured with the Index of Interprofessional Team Collaboration. Results from MANOVA indicated that physicians were less satisfied of scheduling than both nurses and healthcare operators. For professional opportunities, instead, healthcare operators showed the lower level of satisfaction. The participants seem to perceive a high level of team effectiveness and therefore the professionals involved in the care of critically ill patients than the two dimensions analysed, (reflection between the processes and interdependent roles), also state a greater tendency to respect the roles interdisciplinary, maintaining their professional autonomy and a lower tendency to use critical thinking to act professionally in order to improve the effectiveness of care provided. The study results oriented healthcare administrators, to take paths that feed the job satisfaction and the collaboration of professionals by developing the

  10. Safety profile of modafinil across a range of prescribing indications, including off-label use, in a primary care setting in England: results of a modified prescription-event monitoring study.

    Science.gov (United States)

    Davies, Miranda; Wilton, Lynda; Shakir, Saad

    2013-04-01

    Modafinil (Provigil) was marketed in the UK in 1998 to promote wakefulness in the treatment of narcolepsy. In April 2004, the licence was extended to include chronic pathological conditions; 2 years later, the prescription of modafinil was restricted to patients with shift work sleep disorder, narcolepsy and obstructive sleep apnoea/hypopnoea syndrome. Following a recent review of the safety data, the licence has been further restricted to only treat patients with narcolepsy. The review highlighted the degree of off-label usage of modafinil, including patients with multiple sclerosis. The aim of this study was to examine the safety profile of modafinil in real-world clinical usage and across a range of prescribing indications, including multiple sclerosis. The study was conducted using the observational cohort technique of Modified Prescription-Event Monitoring. Patients were identified from dispensed prescriptions issued by primary care physicians from July 2004 to August 2005. Patient demographics and information on prescribing behaviour were included in the questionnaire sent to the prescribing general practitioner (GP) 6 months after the initial prescription for each patient. The questionnaire sought data on any events that patient may have experienced during that time, reasons for stopping treatment with modafinil, adverse drug reactions (ADRs), potential interaction with contraceptives, and pregnancies. Incidence densities (IDs) were calculated for all events, and stratified according to indication and dose. Specific events were evaluated by requesting further information. Of the 4,023 questionnaires sent to GPs, 2,416 were returned (response rate 60.1 %). Of these, only those patients issued modafinil after April 2004 (with the associated broadening of the indications for treatment) were included in the study, resulting in a final cohort of 1,096 patients: 497 (45.3 %) male, median age of 52 years (interquartile range [IQR] 41-63), and 599 (54.7

  11. Selecting Health Care Improvement Projects: A Methodology Integrating Cause-and-Effect Diagram and Analytical Hierarchy Process.

    Science.gov (United States)

    Testik, Özlem Müge; Shaygan, Amir; Dasdemir, Erdi; Soydan, Guray

    It is often vital to identify, prioritize, and select quality improvement projects in a hospital. Yet, a methodology, which utilizes experts' opinions with different points of view, is needed for better decision making. The proposed methodology utilizes the cause-and-effect diagram to identify improvement projects and construct a project hierarchy for a problem. The right improvement projects are then prioritized and selected using a weighting scheme of analytical hierarchy process by aggregating experts' opinions. An approach for collecting data from experts and a graphical display for summarizing the obtained information are also provided. The methodology is implemented for improving a hospital appointment system. The top-ranked 2 major project categories for improvements were identified to be system- and accessibility-related causes (45%) and capacity-related causes (28%), respectively. For each of the major project category, subprojects were then ranked for selecting the improvement needs. The methodology is useful in cases where an aggregate decision based on experts' opinions is expected. Some suggestions for practical implementations are provided.

  12. Optical modulator including grapene

    Science.gov (United States)

    Liu, Ming; Yin, Xiaobo; Zhang, Xiang

    2016-06-07

    The present invention provides for a one or more layer graphene optical modulator. In a first exemplary embodiment the optical modulator includes an optical waveguide, a nanoscale oxide spacer adjacent to a working region of the waveguide, and a monolayer graphene sheet adjacent to the spacer. In a second exemplary embodiment, the optical modulator includes at least one pair of active media, where the pair includes an oxide spacer, a first monolayer graphene sheet adjacent to a first side of the spacer, and a second monolayer graphene sheet adjacent to a second side of the spacer, and at least one optical waveguide adjacent to the pair.

  13. Selected Aspects of Mental Health of Elderly Patients with Chronic Back Pain Treated in Primary Care Centers.

    Science.gov (United States)

    Cabak, Anna; Dąbrowska-Zimakowska, Anna; Tomaszewski, Paweł; Łyp, Marek; Kaczor, Ryszard; Tomaszewski, Wiesław; Fijałkowska, Barbara; Kotela, Ireneusz

    2015-11-02

    Improvement of the effectiveness and efficiency of chronic back pain therapy is a continuing challenge on an international scale. The aim of the present study was to tentatively assess mental health of patients with chronic back pain treated in primary care centers. The study enrolled 100 persons over 50 years of age. The back pain group consisted of 53 patients with chronic back pain and the control group consisted of 47 pain-free persons. The assessment of mental health used a Polish version of the international Goldberger's General Health Questionnaire (GHQ-28). ANOVA (1- and 2-factor) analysis of variance, Tukey's test, and Pearson's simple correlation were used to analyze the significance of differences, with the significance level set at α=0.05. All patients with chronic back pain, regardless of their age and gender, displayed poorer mental well-being compared to the control group: their overall score was higher by over 7 points than in persons without back pain (F1.96=14.8; pmental health score from the questionnaire. Mental health was considerably poorer among patients occasionally (pmental health was markedly poorer in patients with chronic back pain than in healthy controls. A preliminary assessment of aspects of mental health should be given more attention in the rehabilitation of patients with chronic back pain treated in primary care center outpatient clinics.

  14. The selection of skin care products for use in hyperbaric chamber may depend on flammability acceptability indices score.

    Science.gov (United States)

    McCord, Darlene E; Newton, Barry E; Fore, Jane; Chiffoleau, Gwenael

    2008-02-01

    Current protocols call for stopping adjunctive skin care treatments during hyperbaric oxygen therapy (HBOT) because the hyperbaric environment is considered unsafe for skin care products. The elevated oxygen fraction and the increased pressure in the hyperbaric chamber dramatically increase the flammability potential of materials, leading to the need for rigorous standards to prevent flame ignition. A scientific method of evaluating the flammability risks associated with skin care products would be helpful. Several skin care products were tested, using established industrial techniques for determining flammability potential with some modification. The information obtained from these tests can help clinicians make more rational decisions about which topical products can be used safely on patients undergoing HBOT. Wendell Hull & Associates conducted independent studies, comparing the oxygen compatibility for leading skin care products. Oxygen compatibility was determined using autogenous ignition temperature (AIT), oxygen index (OI), and heat of combustion (HoC) testing. AIT, a relative indication of a material's propensity for ignition, is the minimum temperature needed to cause a sample to self-ignite at a given pressure and oxygen concentration. OI, a relative indication of a material's flammability, is the minimum oxygen percentage that, when mixed with nitrogen, will sustain burning. HoC is the absolute value of a material's energy release when burning, if ignition occurs. Products with a high AIT, a high OI, and a low HoC are more compatible in an oxygen-enriched atmosphere (OEA). An acceptability index (AI) based on these 3 factors was calculated for the products, so the testers could rank overall material compatibility in OEAs (Lapin A. Oxygen Compatibility of Materials. International Institute of Refrigeration Commission Meeting; Brighton, England; 1973). Test results for the skin products varied widely. The AIT, OI, HoC, and AI were determined for each

  15. Modeling Uptake of Selected Pharmaceuticals and Personal Care Products into Food Crops from Biosolids-Amended Soil

    DEFF Research Database (Denmark)

    Prosser, Ryan S.; Trapp, Stefan; Sibley, Paul K.

    2014-01-01

    Biosolids contain a variety of pharmaceuticals and personal care products (PPCPs). Studies have observed the uptake of PPCPs into plants grown in biosolids-amended soils. This study examined the ability of Dynamic Plant Uptake (DPU) model and Biosolids-amended Soil Level IV (BASL4) model to predict...... the concentration of eight PPCPs in the tissue of plants grown in biosolids-amended soil under a number of exposure scenarios. Concentrations in edible tissue predicted by the models were compared to concentrations reported in the literature by calculating estimated human daily intake values for both sets of data...... and comparing them to an acceptable daily intake value. The equilibrium partitioning (EqP) portion of BASL4 overpredicted the concentrations of triclosan, triclocarban, and miconazole in root and shoot tissue by two to three orders of magnitude, while the dynamic carrot root (DCR) portion overpredicted...

  16. Women's empowerment and male involvement in antenatal care: analyses of Demographic and Health Surveys (DHS) in selected African countries.

    Science.gov (United States)

    Jennings, Larissa; Na, Muzi; Cherewick, Megan; Hindin, Michelle; Mullany, Britta; Ahmed, Saifuddin

    2014-08-30

    Increasing women's status and male involvement are important strategies in reducing preventable maternal morbidity and mortality. While efforts to both empower women and engage men in maternal health care-seeking can work synergistically, in practice they may result in opposing processes and outcomes. This study examines whether a woman's empowerment status, in sum and across economic, socio-familial, and legal dimensions, is associated with male partner accompaniment to antenatal care (ANC). Women's empowerment was measured based on the sum of nine empowerment items in the 2010-2011 Demographic and Health Surveys in eight sub-Saharan African countries: Burkina Faso (n = 2,490), Burundi (n = 1,042), Malawi (n = 1,353), Mozambique (n = 414), Rwanda (n = 1,211), Senegal (n = 505), Uganda (n = 428) and Zimbabwe (n = 459). In cross-sectional analyses, bivariate and multivariable logistic regressions models were used to examine the odds of male partner accompaniment to ANC between women with above-average versus below-average composite and dimensional empowerment scores. In the majority of countries, male accompaniment to ANC was not uncommon. However, findings were mixed. Positive associations in women's composite empowerment and male involvement were observed in Burkina Faso (OR = 1.27, 95% CI: 1.08, 1.50) and Uganda (OR = 1.53, 95% CI: 1.00-2.35), and in the economic empowerment dimension in Burkina Faso (OR = 1.24, 95% CI: 1.05-1.47). In Malawi, significant negative associations were observed in the odds of male accompaniment to ANC and women's composite (OR = 0.77, 95% CI: 0.62-0.97) and economic empowerment scores (OR = 0.75, 95% CI: 0.59-0.94). No significant differences were observed in Burundi, Mozambique, Rwanda, Senegal, or Zimbabwe. Women's empowerment can be positively or negatively associated with male antenatal accompaniment. Male involvement efforts may benefit from empowerment initiatives that promote women's participation in social and economic spheres

  17. Listening to the voices of children in foster care: youths speak out about child welfare workforce turnover and selection.

    Science.gov (United States)

    Strolin-Goltzman, Jessica; Kollar, Sharon; Trinkle, Joanne

    2010-01-01

    Child welfare workforce turnover rates across private and public child welfare agencies are concerning. Although research about the causes of child welfare workforce turnover has been plentiful, empirical studies on the effects of turnover on child outcomes are sparse. Furthermore, the voices and experiences of youths within the system have been largely overlooked.The purpose ofthis study was, first, to explore the experiences and opinions about child welfare workforce turnover and retention of youths in the child welfare system; second, to explore a relationship between the number of caseworkers a youth has had and his or her number of foster care placements; and third, to harness the suggestions of youths in resolving the turnover problem. Youths in the child welfare system (N = 25) participated in focus groups and completed a small demographic survey. Findings suggest that youths experience multiple effects of workforce turnover, such as lack of stability; loss of trusting relationships; and, at times, second chances. The article concludes with suggestions for caseworkers, state trainers, local and state administrators, and social work researchers on engaging with youths in relationships that facilitate genuine systems change around social work practice and the child welfare workforce crisis.

  18. The effects of selected drugs, including chlorpromazine and non-steroidal anti-inflammatory agents, on polyclonal IgG synthesis and interleukin 1 production by human peripheral blood mononuclear cells in vitro.

    Science.gov (United States)

    Martinez, F; Coleman, J W

    1989-01-01

    We tested a range of drugs for their effects on in vitro polyclonal IgG synthesis by human peripheral blood mononuclear cells (PBMC) stimulated with the lectin pokeweed mitogen (PWM). The test drugs were selected on the basis of reported disruptive effects on immune function in vivo. IgG production between day 4 and days 7 or 8 of culture was measured by biotin-streptavidin sandwich ELISA. The anti-psychotic agent chlorpromazine (0.55-1.7 microM) enhanced IgG synthesis to approximately double control levels. In contrast, the non-steroidal anti-inflammatory drugs (NSAIDs) indomethacin, piroxicam, ibuprofen and aspirin inhibited IgG synthesis by up to 50%, with a rank order of potency that reflects their activity as inhibitors of cyclo-oxygenase. Phenytoin, procainamide, propylthiouracil, methimazole, D-penicillamine and D-penicillamine-L-cysteine all failed to modulate IgG synthesis at non-toxic concentrations. The potentiation and inhibition of IgG synthesis by chlorpromazine and indomethacin, respectively, was observed only when the drug was present during the first 24 h of culture. Neither chlorpromazine nor indomethacin, at non-toxic concentrations, affected PHA- and PWM-stimulated proliferation of PBMC. In addition, chlorpromazine, indomethacin and piroxicam, at concentrations which produced maximal modulation of IgG synthesis, and D-penicillamine and D-penicillamine-L-cysteine at 10 microM failed to influence production of interleukin-1-like activity. We conclude that chlorpromazine and NSAIDs, although they exert opposite effects on IgG synthesis, act at an early stage of B cell differentiation that appears to be independent of interleukin 1 synthesis and early proliferative events. PMID:2788047

  19. Institutional care paths: Development, implementation, and evaluation.

    Science.gov (United States)

    Leonard, Mandy C; Bauer, Seth R; Ahrens, Christine; Reddy, Anita; Katzan, Irene

    2017-09-15

    The Cleveland Clinic experience with care paths, including their creation and implementation, challenges overcome during development and testing, and outcomes of selected care path evaluations, is described. Care paths are tools to assist healthcare professionals in practicing evidence-based medicine. The Cleveland Clinic health system has implemented or is developing approximately 100 care paths, including care paths designed to optimize management of sepsis and septic shock and to promote timely use of i.v. tissue plasminogen activator and correct dosing of antithrombotics and statins in patients with stroke. Key steps in successful care path initiatives include (1) identifying key stakeholders, (2) achieving stakeholder consensus on a standardized approach to disease or condition management, (3) cultivating provider awareness of care paths, (4) incorporating care path tools into the electronic health record and workflow processes, and (5) securing the resources to develop, implement, and maintain care paths. Electronic health records facilitate the use of and adherence to care paths. After care path implementation, revisions are typically needed due to unexpected issues not initially identified and to optimize care path features and support resources for clinical practice. Ongoing evaluation is required to determine whether an implemented care path is producing the intended patient and quality performance outcomes. Care paths provide a standardized approach to treatment or prevention of a disease or condition, reducing unnecessary variability and expense while promoting optimal, cost-effective patient care. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  20. Monitoring selective components of primary health care: methodology and community assessment of vaccination, diarrhoea, and malaria practices in Conakry, Guinea. ACSI-CCCD team.

    Science.gov (United States)

    Dabis, F; Breman, J G; Roisin, A J; Haba, F

    1989-01-01

    The Africa Child Survival Initiative-Combatting Childhood Communicable Diseases (ACSI-CCCD) Project is a primary health care activity that focuses on antenatal care, immunization, diarrhoeal disease control, and malaria control in children under 5 years of age. In order to gauge progress made in the project, a community-based health interview survey to measure simultaneously several prevention and treatment indicators was carried out in 1986 in Conakry, Guinea. A sample of 1415 caretakers and their 2048 children aged under 5 years was visited using a cluster sampling technique. The survey documented the levels of literacy and health education awareness of the caretakers, measured the vaccination coverage levels for children and women of childbearing age, and determined treatment practices for diarrhoea and malaria. Of the 637 women who reported having given birth in the previous 12 months, 96% had visited an antenatal clinic, but only 49% had had two or more doses of tetanus toxoid, and 13% took weekly chemoprophylaxis against malaria. The vaccination coverage for measles was 16% for children aged 12-23 months. Oral rehydration therapy (ORT) was given to 16% of children with diarrhoea; however, only 43% of those who were administered ORT at home were treated according to standard guidelines. Of children with diarrhoea, 51% were given antidiarrhoeal or antimicrobial drugs by caretakers. Fever was treated at home for 79% of the febrile children, and 43% of those with fever also visited health units. The use of injectable antimalarials and prolonged treatments with chloroquine were common. Combining findings from a population-based community study with an assessment of practices in health facilities can provide reliable information for the implementation and monitoring of selective components of primary health care.

  1. Masseter muscle tension, chewing ability, and selected parameters of physical fitness in elderly care home residents in Lodz, Poland

    Directory of Open Access Journals (Sweden)

    Gaszynska E

    2014-07-01

    Full Text Available Ewelina Gaszynska,1 Malgorzata Godala,2 Franciszek Szatko,1 Tomasz Gaszynski3 1Department of Hygiene and Health Promotion, Medical University of Lodz, Poland; 2Department of Nutrition and Epidemiology, Medical University of Lodz, Poland; 3Department of Emergency Medicine and Disaster Medicine, Medical University of Lodz, Poland Background: Maintaining good physical fitness and oral function in old age is an important element of good quality of life. Disability-related impairment of oral function contributes to a deterioration of the diet of older people and to the reduction of their social activity.Objectives: Investigate the association between masseter muscle tension, dental status, and physical fitness parameters.Materials and methods: Two hundred fifty-nine elderly care home residents (97 men, 162 women; mean age, 75.3±8.9 years were involved in this cross-sectional study. Their chewing ability was evaluated by masseter muscle tension palpation, differences of masseter muscle thickness, self-reported chewing ability, number of present and functional teeth, and number of posterior tooth pairs. Masseter muscle thickness was measured by ultrasonography. To assess physical fitness, hand grip strength and the timed up-and-go test were performed. Nutritional status was assessed using body mass index and body cell mass index (BCMI, calculated on the basis of electrical bioimpedance measurements. Medical records were used to collect information on systemic diseases and the number of prescribed medications. Subjects were also evaluated for their ability to perform ten activities of daily living.Results: Ninety-seven percent of the subjects suffered from systemic diseases. The three most prevalent illnesses were cardiac/circulatory 64.5%, musculoskeletal 37.3%, and endocrine/metabolic/nutritional 29.3%. Of the participants, 1.5% were underweight and more than one third (34.4% were overweight. Malnutrition (BCMI below normal was found in almost

  2. Plan Selections by ZIP Code in the Marketplace April 2015

    Data.gov (United States)

    U.S. Department of Health & Human Services — The dataset provides the total number of Qualified Health Plan selections by ZIP Code for the 37 states that use the HealthCare.gov platform, including the...

  3. [Selective mutism].

    Science.gov (United States)

    Ytzhak, A; Doron, Y; Lahat, E; Livne, A

    2012-10-01

    Selective mutism is an uncommon disorder in young children, in which they selectively don't speak in certain social situations, while being capable of speaking easily in other social situations. Many etiologies were proposed for selective mutism including psychodynamic, behavioral and familial etc. A developmental etiology that includes insights from all the above is gaining support. Accordingly, mild language impairment in a child with an anxiety trait may be at the root of developing selective mutism. The behavior will be reinforced by an avoidant pattern in the family. Early treatment and followup for children with selective mutism is important. The treatment includes non-pharmacological therapy (psychodynamic, behavioral and familial) and pharmacologic therapy--mainly selective serotonin reuptake inhibitors (SSRI).

  4. Palliative Care Processes Embedded in the ICU Workflow May Reserve Palliative Care Teams for Refractory Cases.

    Science.gov (United States)

    Mun, Eluned; Umbarger, Lillian; Ceria-Ulep, Clementina; Nakatsuka, Craig

    2018-01-01

    Palliative Care Teams have been shown to be instrumental in the early identification of multiple aspects of advanced care planning. Despite an increased number of services to meet the rising consultation demand, it is conceivable that the numbers of palliative care consultations generated from an ICU alone could become overwhelming for an existing palliative care team. Improve end-of-life care in the ICU by incorporating basic palliative care processes into the daily routine ICU workflow, thereby reserving the palliative care team for refractory situations. A structured, palliative care, quality-improvement program was implemented and evaluated in the ICU at Kaiser Permanente Medical Center in Hawaii. This included selecting trigger criteria, a care model, forming guidelines, and developing evaluation criteria. These included the early identification of the multiple features of advanced care planning, numbers of proactive ICU and palliative care family meetings, and changes in code status and treatment upon completion of either meeting. Early identification of Goals-of-Care, advance directives, and code status by the ICU staff led to a proactive ICU family meeting with resultant increases in changes in code status and treatment. The numbers of palliative care consultations also rose, but not significantly. Palliative care processes could be incorporated into a daily ICU workflow allowing for integration of aspects of advanced care planning to be identified in a systematic and proactive manner. This reserved the palliative care team for situations when palliative care efforts performed by the ICU staff were ineffective.

  5. Selecting a dynamic simulation modeling method for health care delivery research-part 2: report of the ISPOR Dynamic Simulation Modeling Emerging Good Practices Task Force.

    Science.gov (United States)

    Marshall, Deborah A; Burgos-Liz, Lina; IJzerman, Maarten J; Crown, William; Padula, William V; Wong, Peter K; Pasupathy, Kalyan S; Higashi, Mitchell K; Osgood, Nathaniel D

    2015-03-01

    In a previous report, the ISPOR Task Force on Dynamic Simulation Modeling Applications in Health Care Delivery Research Emerging Good Practices introduced the fundamentals of dynamic simulation modeling and identified the types of health care delivery problems for which dynamic simulation modeling can be used more effectively than other modeling methods. The hierarchical relationship between the health care delivery system, providers, patients, and other stakeholders exhibits a level of complexity that ought to be captured using dynamic simulation modeling methods. As a tool to help researchers decide whether dynamic simulation modeling is an appropriate method for modeling the effects of an intervention on a health care system, we presented the System, Interactions, Multilevel, Understanding, Loops, Agents, Time, Emergence (SIMULATE) checklist consisting of eight elements. This report builds on the previous work, systematically comparing each of the three most commonly used dynamic simulation modeling methods-system dynamics, discrete-event simulation, and agent-based modeling. We review criteria for selecting the most suitable method depending on 1) the purpose-type of problem and research questions being investigated, 2) the object-scope of the model, and 3) the method to model the object to achieve the purpose. Finally, we provide guidance for emerging good practices for dynamic simulation modeling in the health sector, covering all aspects, from the engagement of decision makers in the model design through model maintenance and upkeep. We conclude by providing some recommendations about the application of these methods to add value to informed decision making, with an emphasis on stakeholder engagement, starting with the problem definition. Finally, we identify areas in which further methodological development will likely occur given the growing "volume, velocity and variety" and availability of "big data" to provide empirical evidence and techniques

  6. Capacity assessment of selected health care facilities for the pilot implementation of Package for Essential Non-communicable Diseases (PEN) intervention in Ghana.

    Science.gov (United States)

    Nyarko, Kofi Mensah; Ameme, Donne Kofi; Ocansey, Dennis; Commeh, Efua; Markwei, Mehitabel Tori; Ohene, Sally-Ann

    2016-01-01

    Non-communicable diseases (NCDs) continue to pose threats to human health and development worldwide. Though preventable, NCDs kill more people annually than all other diseases combined. The four major NCDs namely cardiovascular diseases, chronic respiratory diseases, diabetes and cancers share common modifiable risk factors. In order to prevent and control NCDs, Ghana has adopted the World Health Organisation Package for Essential NCD (WHO-PEN) intervention, to be piloted in selected districts before a nationwide scale-up. We assessed the capacity of these facilities for the implementation of the WHO-PEN pilot. We conducted a cross-sectional health facility-based survey using a multistage sampling technique. We collected data on human resource, equipment, service utilization, medicines availability and health financing through interviews and observation. Descriptive data analysis was performed and expressed in frequencies and relative frequencies. In all, 23 health facilities comprising two regional hospitals, three district hospitals, nine health centres and nine Community-based Health Planning and Services (CHPS) compounds from three regions were surveyed. All the hospitals had medical officers whilst 4 (44.4%) of the health centres had physician assistants. Health financing is mainly by the National Health Insurance Scheme (NHIS). None of the health facilities had spacers and only one health centre had oxygen cylinder, glucometer and nebulizer. Gaps exist in the human resource capacity and service delivery at the primary care levels, the focus of WHO-PEN intervention. Adequately equipping the primary health care level with trained health workers, basic equipment, medications and diagnostics will optimize the performance of WHO-PEN intervention when implemented.

  7. Selected Lectures of the 2nd International Workshop “Intensive Care of the Newborn”; Verona (Italy; March 9-10, 2018

    Directory of Open Access Journals (Sweden)

    --- Various Authors

    2018-03-01

    Full Text Available Selected Lectures of the 2nd International Workshop “Intensive Care of the Newborn”; Verona (Italy; March 9-10, 2018 CONGRESS PRESIDENT Paolo Biban  Guest Editor: Paolo BibanLECT 1. RESUSCITATION OF EXTREMELY PREMATURE INFANTS: HOW TO IMPROVE EVEN FURTHER • J.M. PerlmanLECT 2. MAINTAINING NORMAL TEMPERATURE IN THE NEWLY BORN: NOT A TRIVIAL GAME • J. WyllieLECT 3. PRESENT AND FUTURE OF SURFACTANT AD­MINISTRATION IN PRETERM INFANTS WITH RESPIRATORY DISTRESS SYNDROME (RDS • A. KribsLECT 4. CONTINUOUS POSITIVE AIRWAY PRES­SURE (CPAP, SURFACTANT, OR BOTH? A DILEMMA STILL WAITING TO BE SOLVED • D. De LucaLECT 5. NON-INVASIVE RESPIRATORY SUPPORT AND RESPIRATORY DISTRESS SYNDROME (RDS: IS NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE (nCPAP ALWAYS ENOUGH? • G. Lista, I. BresestiLECT 6. NEURALLY ADJUSTED VENTILATORY ASSIST (NAVA IN THE NEWBORN: A NEW STANDARD OF CARE? • H. SteinLECT 7. HIGH-FREQUENCY, MULTI-FREQUENCY OSCIL­LA­TION, JET VENTILATION: WHERE ARE WE? • J.J. PillowLECT 8. SURVIVAL AND NEURODEVELOPMENTAL OUT­COME IN PERIVIABLE INFANTS • N. YoungeLECT 9. PATHOPHYSIOLOGY AND TREATMENT OF SEPTIC SHOCK IN NEONATES • H.R. WongLECT 10. CLINICAL METABOLOMICS IN NEONATAL SEPSIS • V. FanosLECT 11. OPTIMIZING EARLY NUTRITION SUPPORT IN VERY LOW BIRTH WEIGHT (VLBW INFANTS • T. SenterreLECT 12. LONG-TERM ADVERSE EFFECTS OF EARLY GROWTH ACCELERATION OR CATCH-UP GROWTH • A. SinghalLECT 13. ROLE OF NEAR INFRARED SPECTROSCOPY DURING NEONATAL TRANSITION • B. UrlesbergerLECT 14. HEART RATE CHARACTERISTICS AS PHYSIO­MARKERS FOR DETECTION OF SEPSIS AND OTHER DISEASES • K.D. FairchildLECT 15. ENHANCED CARDIORESPIRATORY MONI­TORING OF THE PRETERM INFANT DURING STABILIZA­TION IN THE DELIVERY ROOM • E. Dempsey

  8. Home Care Services

    Science.gov (United States)

    Home care is care that allows a person with special needs stay in their home. It might be for people who are getting ... are chronically ill, recovering from surgery, or disabled. Home care services include Personal care, such as help ...

  9. Beyond metformin: safety considerations in the decision-making process for selecting a second medication for type 2 diabetes management: reflections from a diabetes care editors' expert forum.

    Science.gov (United States)

    Cefalu, William T; Buse, John B; Del Prato, Stefano; Home, Philip D; LeRoith, Derek; Nauck, Michael A; Raz, Itamar; Rosenstock, Julio; Riddle, Matthew C

    2014-09-01

    The trend toward personalized management of diabetes has focused attention on the differences among available pharmacological agents in terms of mechanisms of action, efficacy, and, most important, safety. Clinicians must select from these features to develop individualized therapy regimens. In June 2013, a nine-member Diabetes Care Editors' Expert Forum convened to review safety evidence for six major diabetes drug classes: insulin, sulfonylureas (SUs), thiazolidinediones (TZDs), glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium glucose cotransporter 2 inhibitors. This article, an outgrowth of the forum, summarizes well-delineated and theoretical safety concerns related to these drug classes, as well as the panelists' opinions regarding their best use in patients with type 2 diabetes. All of the options appear to have reasonably wide safety margins when used appropriately. Those about which we know the most-metformin, SUs, insulin, and perhaps now also TZDs-are efficacious in most patients and can be placed into a basic initial algorithm. However, these agents leave some clinical needs unmet. Selecting next steps is a more formidable process involving newer agents that are understood less well and for which there are unresolved questions regarding risk versus benefit in certain populations. Choosing a specific agent is not as important as implementing some form of early intervention and advancing rapidly to some form of combination therapy as needed. When all options are relatively safe given the benefits they confer, therapeutic decision making must rely on a personalized approach, taking into account patients' clinical circumstances, phenotype, pathophysiological defects, preferences, abilities, and costs. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  10. Self-care as a health resource of elders

    DEFF Research Database (Denmark)

    Høy, Bente; Hall, E.O.C.; Wagner, L.

    2007-01-01

    : In this integrative review from 2006, we selected theoretical and empirical articles published between 1990 and 2006, where self-care was related to elders' health promotion. Data were extracted from primary sources and included definitions of self-care, critical attributes, antecedents, goals and outcomes. We......AIM: To review the literature related to self-care and health promotion for elders and to develop an understanding of self-care as a health resource. BACKGROUND: Self-care may improve health and prevent illness and disabilities in elders. Although studies of self-care are numerous, the significance...... interactively compared data and display matrices to describe self-care as a health resource. RESULTS: Fifty-seven articles addressed health self-care and were integrated into a framework of self-care as a health resource of elders. Self-care was identified as a two-dimensional construct including action...

  11. An Outbreak of Clostridium difficile Ribotype 027 Associated with Length of Stay in the Intensive Care Unit and Use of Selective Decontamination of the Digestive Tract: A Case Control Study.

    Directory of Open Access Journals (Sweden)

    Yvette H van Beurden

    Full Text Available An outbreak of Clostridium difficile ribotype 027 infection (CDI occurred at an university hospital, involving 19 departments. To determine what hospital-associated factors drove the outbreak of this particular strain we performed a case-control study.Cases (n = 79, diagnosed with CDI due to C. difficile ribotype 027 were matched for age and treating medical specialty to four control patients (n = 316. Patients diagnosed with CDI due to other ribotypes were included as a second control group. A random selection of C. difficile ribotype 027 strains (n = 10 was genotyped by Whole Genome Sequencing (WGS.WGS showed the outbreak was likely caused by a single strain of C. difficile (two or less single-nucleotide variants between isolates. Ninety-five percent of cases had used antibiotics, compared to 56% of controls. Previous admission to the intensive care unit (ICU (OR: 2.4, 95% CI 1.0-5.6, longer length of stay (LOS, and recent hospital admission were associated with CDI ribotype 027. Cases were less likely to have been admitted to a ward with a known isolated CDI patient (OR: 0.2, 95% CI 0.1-0.6. Analysis of patients who stayed at the ICU (35 cases; 51 controls, indicated that the use of selective decontamination of the digestive tract (SDD and a longer LOS in the ICU were associated with CDI risk.In this large outbreak, any antibiotic use, including SDD use, appeared as a prerequisite for acquisition of the outbreak strain. The role of use of SDD and prolonged stay on the ICU could not be disentangled, but both factors can play a biologically plausible role in C. difficile acquisition and infection.

  12. Design and Synthesis of a Series of L-trans-4-Substituted Prolines as Selective Antagonists for the Ionotropic Glutamate Receptors Including Functional and X-ray Crystallographic Studies of New Subtype Selective Kainic Acid Receptor Subtype 1 (GluK1) Antagonist (2S,4R)-4-(2-Carboxyphenoxy)pyrrolidine-2-carboxylic Acid

    DEFF Research Database (Denmark)

    Krogsgaard-Larsen, Niels; Delgar, Claudia; Koch, Karina

    2017-01-01

    to the structure with glutamate, consistent with 1b being an antagonist. A structure-activity relationship study showed that the chemical nature of the tethering atom (C,O, or S) linking the pyrrolidine ring and the phenyl ring plays a key role in the receptor selectivity profile and that substituents...

  13. COMMUNITY MEDICINE & PRIMARY HEALTH CARE

    African Journals Online (AJOL)

    ajiboro

    Nigeria has one of the largest stocks of. In all situations, volunteers add to the quality and human resources for ... profit making enterprise by the partners the health care objectives, including the involved.Rather, it is a health ..... Investing in volunteerism: The impact of service initiatives in selected state agencies. Austin, TX: ...

  14. Scope selection and control

    International Nuclear Information System (INIS)

    Guglielmi, F.

    2011-01-01

    OPG is preparing for a 4-unit refurbishment program at Darlington later in this decade. Key efforts underway include the selection of the right refurbishment scope that will allow Darlington to achieve top-decile performance post-refurbishment. For this to be possible, it is imperative that (1) plant/equipment condition be well understood, (2) post-refurbishment performance objectives be clearly defined, and (3) regulatory and other risks be carefully assessed and mitigated. Significant engineering, operations and maintenance support is required to complete this phase of the project cycle.

  15. Recent advances in multidisciplinary critical care.

    Science.gov (United States)

    Blot, Stijn; Afonso, Elsa; Labeau, Sonia

    2015-01-01

    The intensive care unit is a work environment where superior dedication is crucial for optimizing patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the numerous research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovation in the field. This article broadly summarizes new developments in multidisciplinary intensive care. It provides elementary information about advanced insights in the field via brief descriptions of selected articles grouped by specific topics. Issues considered include care for heart patients, mechanical ventilation, delirium, nutrition, pressure ulcers, early mobility, infection prevention, transplantation and organ donation, care for caregivers, and family matters. ©2015 American Association of Critical-Care Nurses.

  16. Hepatitis B vaccination coverage and the determinants of vaccination among health care workers in selected health facilities in Lusaka district, Zambia: an exploratory study.

    Science.gov (United States)

    Mungandi, Namwaka; Makasa, Mpundu; Musonda, Patrick

    2017-01-01

    Hepatitis B is a viral infection of the liver and causes both acute and chronic disease. It is transmitted through contact with an infected person's bodily fluids. It is an occupational hazard for healthcare workers and can be prevented by the administration of a vaccine. It is recommended that healthcare workers be vaccinated against vaccine preventable diseases including hepatitis B. The study objective was to determine the prevalence and determinants of hepatitis B vaccination among healthcare workers in selected health facilities in Lusaka. The study took place in seven health facilities across Lusaka district in Zambia. A total sample size of 331 healthcare workers was selected of which; 90 were nurses, 88 were doctors, 86 were laboratory personnel and 67 were general workers. A self-administered structured questionnaire was given to a total of 331 healthcare workers. Investigator led stepwise approach was used to select the best predictor variables in a multiple logistic regression model and all analyses were performed using STATA software, version 12.1 SE (Stata Corporation, College Station, TX, USA). Only 64(19.3%) of the healthcare workers were vaccinated against hepatitis B, with 35 (54.7%) of these being fully vaccinated and 29 (45.3%) partially vaccinated. Analysis showed that; age of the healthcare worker, sharp injuries per year and training in infection control were the variables that were statistically significant in predicting a healthcare worker's vaccination status. It is reassuring to learn that healthcare workers have knowledge regarding hepatitis B and the vaccine and are willing to be vaccinated against it. Health institutions should bear the cost for vaccinating staff and efforts should be made for appropriate health education regarding hepatitis B infection and its prevention. Establishment of policies on compulsory hepatitis B vaccination for healthcare workers in Zambia is recommended.

  17. Impact of a multi-faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute-care geriatric wards and physical rehabilitation units.

    Science.gov (United States)

    Eveillard, Matthieu; Raymond, Françoise; Guilloteau, Véronique; Pradelle, Marie-Thérèse; Kempf, Marie; Zilli-Dewaele, Marina; Joly-Guillou, Marie-Laure; Brunel, Patrick

    2011-10-01

    To assess the impact of a multi-faceted training program on the compliance with hand hygiene and gloving practices. Hand hygiene is considered as the cornerstone of the prevention of hospital-acquired infections. Several studies have enhanced the poor effectiveness of training programs in improving hand hygiene compliance. A before-after evaluation study. The study was conducted in four healthcare settings before and after an intervention program which included the performance feedback of the first evaluation phase, three six-h training sessions, the assessment of hand hygiene performance with teaching boxes and the organisation of one full-day session devoted to institutional communication around hand hygiene in each setting. Hand hygiene compliance and quality of hand rubbing were evaluated. Hand hygiene opportunities were differentiated into extra-series opportunities (before or after a single contact and before the first contact or after the last contact of a series of consecutive contacts) and intra-series opportunities (from the opportunity following the first contact to the opportunity preceding the last in the same series). Overall, 969 contacts corresponding to 1,470 hand hygiene opportunities (760 during the first phase and 710 during the second) were observed. A significant improvement of observed practices was recorded for the hand hygiene compliance in intra-series opportunities (39·0% vs. 19·0%; p < 10(-5) ), the proportion of gloves worn if indicated (71·4% vs. 52·0%; p < 0·001) and the quality of hand rubbing (85·0% vs. 71·9%; p < 10(-5) ). Some of the performances measured for both hand hygiene and gloving practices were improved. We plan to extend this investigation by performing a qualitative study with experts in behavioural sciences to try improving practices for which adherence was still weak after the training program such as hand hygiene in intra-series opportunities. This study underscored the usefulness of implementing

  18. Surveillance-guided selective digestive decontamination of carbapenem-resistant Enterobacteriaceae in the intensive care unit: A cost-effectiveness analysis.

    Science.gov (United States)

    You, Joyce H S; Li, Hong-Kiu; Ip, Margaret

    2018-03-01

    Clinical findings have shown effectiveness and safety of selective digestive decontamination (SDD) for eradication of carbapenem-resistant Enterobacteriaceae (CRE) in high-risk carriers. We aimed to evaluate the cost-effectiveness of SDD guided by CRE surveillance in the intensive care unit (ICU). Outcomes of surveillance-guided SDD (test-guided SDD) and no screening (control) in the ICU were compared by Markov model simulations. Model outcomes were CRE infection and mortality rates, direct costs, and quality-adjusted life year (QALY) loss. Model inputs were estimated from clinical literature. Sensitivity analyses were conducted to examine the robustness of base case results. Test-guided SDD reduced infection (4.8% vs 5.0%) and mortality (1.8% vs 2.1%) rates at a higher cost ($1,102 vs $1,074) than the control group in base case analysis, respectively. Incremental cost per QALY saved (incremental cost-effectiveness ratio [ICER]) by the test-guided SDD group was $557 per QALY. Probabilistic sensitivity analysis showed that test-guided SDD was effective in saving QALYs in 100% of 10,000 Monte Carlo simulations, and cost-saving 59.1% of time. The remaining 40.9% of simulations found SDD to be effective at an additional cost, with ICERs accepted as cost-effective per the willingness-to-pay threshold. Surveillance-guided SDD appears to be cost-effective in reducing CRE infection and mortality with QALYs saved. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  19. Effects of increased nurses’ workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province

    Directory of Open Access Journals (Sweden)

    Rhulani C. Shihundla

    2016-05-01

    Full Text Available Background: Recording of information on multiple documents increases professional nurses’ responsibilities and workload during working hours. There are multiple registers and books at Primary Health Care (PHC facilities in which a patient’s information is to be recorded for different services during a visit to a health professional. Antenatal patients coming for the first visit must be recorded in the following documents: tick register; Prevention of Mother-ToChild Transmission (PMTCT register; consent form for HIV and AIDS testing; HIV Counselling and Testing (HCT register (if tested positive for HIV and AIDS then this must be recorded in the Antiretroviral Therapy (ART wellness register; ART file with an accompanying single file, completion of which is time-consuming; tuberculosis (TB suspects register; blood specimen register; maternity case record book and Basic Antenatal Care (BANC checklist. Nurses forget to record information in some documents which leads to the omission of important data. Omitting information might lead to mismanagement of patients. Some of the documents have incomplete and inaccurate information. As PHC facilities in Vhembe District render twenty four hour services through a call system, the same nurses are expected to resume duty at 07:00 the following morning. They are expected to work effectively and when tired a nurse may record illegible information which may cause problems when the document is retrieved by the next person for continuity of care. Objectives: The objective of this study was to investigate and describe the effects of increased nurses’ workload on quality documentation of patient information at PHC facilities in Vhembe District, Limpopo Province. Methods: The study was conducted in Vhembe District, Limpopo Province, where the effects of increased nurses’ workload on quality documentation of information is currently experienced. The research design was explorative, descriptive and contextual in

  20. Effects of increased nurses' workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province.

    Science.gov (United States)

    Shihundla, Rhulani C; Lebese, Rachel T; Maputle, Maria S

    2016-05-13

    Recording of information on multiple documents increases professional nurses' responsibilities and workload during working hours. There are multiple registers and books at Primary Health Care (PHC) facilities in which a patient's information is to be recorded for different services during a visit to a health professional. Antenatal patients coming for the first visit must be recorded in the following documents: tick register; Prevention of Mother-ToChild Transmission (PMTCT) register; consent form for HIV and AIDS testing; HIV Counselling and Testing (HCT) register (if tested positive for HIV and AIDS then this must be recorded in the Antiretroviral Therapy (ART) wellness register); ART file with an accompanying single file, completion of which is time-consuming; tuberculosis (TB) suspects register; blood specimen register; maternity case record book and Basic Antenatal Care (BANC) checklist. Nurses forget to record information in some documents which leads to the omission of important data. Omitting information might lead to mismanagement of patients. Some of the documents have incomplete and inaccurate information. As PHC facilities in Vhembe District render twenty four hour services through a call system, the same nurses are expected to resume duty at 07:00 the following morning. They are expected to work effectively and when tired a nurse may record illegible information which may cause problems when the document is retrieved by the next person for continuity of care. The objective of this study was to investigate and describe the effects of increased nurses' workload on quality documentation of patient information at PHC facilities in Vhembe District, Limpopo Province. The study was conducted in Vhembe District, Limpopo Province, where the effects of increased nurses' workload on quality documentation of information is currently experienced. The research design was explorative, descriptive and contextual in nature. The population consisted of all nurses who

  1. How continuity of care is experienced within the context of integrated palliative care: A qualitative study with patients and family caregivers in five European countries.

    Science.gov (United States)

    den Herder-van der Eerden, Marlieke; Hasselaar, Jeroen; Payne, Sheila; Varey, Sandra; Schwabe, Sven; Radbruch, Lukas; Van Beek, Karen; Menten, Johan; Busa, Csilla; Csikos, Agnes; Vissers, Kris; Groot, Marieke

    2017-12-01

    Patients with advanced diseases often experience deficient continuity of care. Although integrated palliative care promotes continuity of care, it is not clear how it can be optimized to improve continuity of care experiences. To examine how relational, informational and management continuity of care are experienced by patients with advanced diseases and their family caregivers receiving care from several integrated palliative care initiatives in five European countries. We adopted a longitudinal qualitative study design including two interviews (interval 3 months) with patients and family caregivers focusing on how health care professionals responded to their needs. Interviews were audio-recorded and transcribed verbatim. Analysis involved a two-step qualitative content approach. A total of 22 integrated palliative care initiatives (established local palliative care collaborations) were selected in Belgium, Germany, Hungary, the Netherlands and the United Kingdom. We recruited 152 patients (63% cancer, 24% chronic obstructive pulmonary disease, 13% heart failure; life expectancy care professionals to receive tailored care and easily access help were essential. Relational continuity was often deficient, especially with general practitioners. Although informational and management continuity was often lacking in care provision, collaborative integrated palliative care initiatives were related to consistent and coherent care. Patients and family caregivers most likely experience continuity of care by having a small number of trusted health care professionals who are available, provide multidisciplinary care and regularly transfer information to all health care professionals involved. Optimizing continuity of care requires further integration of integrated palliative care initiatives with other health care professionals involved in the patients' care networks.

  2. Selected Abstracts of the 6th International Congress of UENPS; Valencia (Spain; November 23rd-25th 2016; Session “Neonatology and NICU clinical care and practices”

    Directory of Open Access Journals (Sweden)

    --- Various Authors

    2016-11-01

    Full Text Available Selected Abstracts of the 6th International Congress of UENPS; Valencia (Spain; November 23rd-25th 2016; Session “Neonatology and NICU clinical care and practices”ABS 1. BILATERAL CLAVICLE FRACTURE: A RARE CAUSE OF PERSISTENT CRYING • P. Cruz, P. Mendes, M. Anselmo, L. GonçalvesABS 2. NEONATAL TRANSPORT DURATION AND SHORT-TERM OUTCOME IN VERY-LOW-GESTATIONAL-AGE NEONATES • A. Matic, M. Gavrilovic LatinovicABS 3. PEMPHIGOID GESTATIONIS – A RARE CASE IN TWIN PREGNANCY • L. Gonçalves, E. Scortenschi, P. Cruz, P. Mendes, M. AnselmoABS 4. DEVELOPMENT OF A CLINICIAN-REPORTED OUTCOME (ClinRO MEASURE TO ASSESS READINESS FOR DISCHARGE FROM NEONATAL CARE AMONG EXTREMELY PRETERM INFANTS • M. Turner, R. Ward, J. Higginson, I. Hansen-Pupp, M. Vanya, E. Flood, G. Quiggle, A. Tocoian, A. Mangili, N. Barton, S. SardaABS 5. THE EFFECT OF THYROID HORMONES ON NICU ADMISSION DUE TO TRANSIENT TACHYPNEA OF NEWBORN IN LATE PRETERM AND TERM INFANTS • T. Gursoy, S. Ercin, P. Kayiran, B. GurakanABS 6. IMPROVING THE QUALITY OF PROLONGED JAUNDICE WORK-UPS IN THE OUTPATIENT DEPARTMENT IN A TERTIARY NEONATAL CENTRE • C.M. Moore, J. O’Loughlin, B.C. HayesABS 7. SAVE THE DATE? CORRECT RECORDING OF DAY OF LIFE AND CORRECTED GESTATIONAL AGE IN NICU • C.M. Moore, A.F. El-KhuffashABS 8. PARENTS IN NICU: THE IMPORTANCE OF INTEGRATION BETWEEN THE CURE AND THE CARE • G. De Bernardo, M. Svelto, M. Giordano, D. SordinoABS 9. THE PREVALENCE OF HEREDITARY HEARING LOSS IN 41,152 NEWBORNS DURING THE PERIOD 2011-2015 • S.T. Hsu, C.C. Hung, Y.N. Su, C.Y. Chen, H.C. Chou, W.S. Hsieh, C.C. Wu, P.N. TsaoABS 10. DEFICIENCY OF MULTIPLE acyl-CoA DEHYDROGENASE OR GLUTARIC ACIDURIA TYPE II • M. Torres, L. Geronès, J. Herrero, M.C. Cèspedes, F. Camba, J.A. Arranz, M. del Toro, F. CastilloABS 11. TEN YEARS OF EXPERIENCE IN CARRIER SCREENING FOR SPINAL MUSCULAR ATROPHY IN TAIWAN • C.Y. Chuang, C.C. Hung, Y.N. Su, P.N. TsaoABS 12. REDUCING MEDICATION ERRORS ON THE

  3. Mathematics++ selected topics beyond the basic courses

    CERN Document Server

    Kantor, Ida; Šámal, Robert

    2015-01-01

    Mathematics++ is a concise introduction to six selected areas of 20th century mathematics providing numerous modern mathematical tools used in contemporary research in computer science, engineering, and other fields. The areas are: measure theory, high-dimensional geometry, Fourier analysis, representations of groups, multivariate polynomials, and topology. For each of the areas, the authors introduce basic notions, examples, and results. The presentation is clear and accessible, stressing intuitive understanding, and it includes carefully selected exercises as an integral part. Theory is comp

  4. Antibiotic-Induced Within-Host Resistance Development of Gram-Negative Bacteria in Patients Receiving Selective Decontamination or Standard Care

    NARCIS (Netherlands)

    Noteboom, Yvonne; Ong, David S. Y.; Oostdijk, Evelien A.; Schultz, Marcus J.; de Jonge, Evert; Purmer, Ilse; Bergmans, Dennis; Fijen, Jan Willem; Kesecioglu, Jozef; Bonten, Marc J. M.

    2015-01-01

    To quantify antibiotic-associated within-host antibiotic resistance acquisition rates in Pseudomonas aeruginosa, Klebsiella species, and Enterobacter species from lower respiratory tract samples of ICU patients receiving selective digestive decontamination, selective oropharyngeal decontamination,

  5. Consensus on quality indicators to assess the organisation of palliative cancer and dementia care applicable across national healthcare systems and selected by international experts

    NARCIS (Netherlands)

    Paap, J.; Vernooij-Dassen, M.J.F.J.; Droes, R.M.; Radbruch, L.; Vissers, K.; Engels, Y.M.

    2014-01-01

    BACKGROUND: Large numbers of vulnerable patients are in need of palliative cancer and dementia care. However, a wide gap exists between the knowledge of best practices in palliative care and their use in everyday clinical practice. As part of a European policy improvement program, quality indicators

  6. The visual difficulties of selected artists and limitations of ophthalmological care during the 19th and early 20th centuries (an AOS thesis).

    Science.gov (United States)

    Ravin, James G

    2008-01-01

    To investigate the effects of eye diseases on several important artists who have been given little attention from a medical-historical viewpoint. The examples chosen demonstrate problems artists have had to face from different types of eye disease, including cataract, glaucoma, and retinal diseases. The ophthalmological care provided is described in terms of scientific knowledge at the time. Investigation of primary and secondary source material. Discussion with art historians and ophthalmic historians. Examination of work by the artists. Artists can be markedly affected by ocular diseases that change their ability to see the world. The individuals described here worked during the 19th century and first half of the 20th century. Homer Martin suffered from cataracts, and his works reveal changes in details and color as he aged. Henri Harpignies, who had an extremely long career, undoubtedly had cataracts and may also have had macular degeneration. Angle-closure glaucoma blinded Jules Chéret. Auguste Ravier suffered from neovascular glaucoma in one eye and was able to work with his remaining eye, which developed a cataract. Louis Valtat suffered from what was in all likelihood open-angle glaucoma, but specific changes due to this disease are not apparent in his work. Roger Bissière developed glaucoma and did well following filtration surgery. George Du Maurier lost one eye from what was probably a retinal detachment and later suffered from a central retinal problem in the other eye. Diseases of the eye may profoundly influence artists by altering their perception of the world. The specific effects may vary, depending on the disease, its severity, and the psychology of the artist. Cataracts typically affect an artist's ability to depict color and detail. The effect of glaucoma generally depends on whether central vision is preserved. Disease that affects the center of the retina has a substantial effect on an artist's ability to depict fine details. Ophthalmological

  7. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  8. Effectiveness of score card-based antenatal risk selection, care pathways, and multidisciplinary consultation in the Healthy Pregnancy 4 All study (HP4ALL): study protocol for a cluster randomized controlled trial.

    Science.gov (United States)

    Vos, Amber A; van Voorst, Sabine F; Waelput, Adja J M; de Jong-Potjer, Lieke C; Bonsel, Gouke J; Steegers, Eric A P; Denktaş, Semiha

    2015-01-06

    Promotion of healthy pregnancies has gained high priority in the Netherlands because of relatively unfavorable perinatal outcomes. In response, a nationwide study, 'Healthy Pregnancy 4 All' (HP4ALL), has been initiated. Part of this study involves systematic and broadened antenatal risk assessment (the Risk Assessment substudy). Risk selection in current clinical practice is mainly based on medical risk factors. Despite the increasing evidence for the influence of nonmedical risk factors (social status, lifestyle or ethnicity) on perinatal outcomes, these risk factors remain highly unexposed. Systematic risk selection, combined with customized care pathways to reduce or treat detected risks, and regular and structured consultation between community midwives, gynecologists and other care providers such as social workers, is part of this study. Neighborhoods in 14 municipalities with adverse perinatal outcomes above national and municipal averages are selected for participation. The study concerns a cluster randomized controlled trial. Municipalities are randomly allocated to intervention (n = 3,500 pregnant women) and control groups (n = 3,500 pregnant women). The intervention consists of systematic risk selection with the Rotterdam Reproductive Risk Reduction (R4U) score card in pregnant women at the booking visit, and referral to corresponding care pathways. A risk score, based on weighed risk factors derived from the R4U, above a predefined threshold determines structured multidisciplinary consultation. Primary outcomes of this trial are dysmaturity (birth weight < p10), prematurity (birth <37 weeks), and efficacy of implementation. The 'HP4ALL' study introduces a systematic approach in antenatal health care that may improve perinatal outcomes and, thereby, affect future health status of a new generation in the Netherlands. Dutch Trial Registry ( NTR-3367) on 20 March 2012.

  9. Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017); Venice (Italy); October 31-November 4, 2017; Session "Quality Improvement, Parents Centered Care"

    OpenAIRE

    --- Various Authors

    2017-01-01

    Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017); Venice (Italy); October 31-November 4, 201758th ESPR Annual Meeting, 7th International Congress of UENPS, 3rd International Congress of EFCNIORGANIZING INSTITUTIONSEuropean Society for Paediatric Research (ESPR), European Society for Neonatology (ESN), Union of European Neonatal & Perinatal Societies (UENPS), European Foundation for the Care of Newborn Infants (EFCNI)ORGANIZING COMMITTEELuc Zi...

  10. Selected Abstracts of the 2nd International Workshop “Intensive Care of the Newborn”; Verona (Italy; March 9-10, 2018

    Directory of Open Access Journals (Sweden)

    --- Various Authors

    2018-03-01

    Full Text Available Selected Abstracts of the 2nd International Workshop “Intensive Care of the Newborn”; Verona (Italy; March 9-10, 2018CONGRESS PRESIDENTPaolo Biban  Guest Editor: Paolo BibanABS 1. DOES DELAYED CORD CLAMPING (DCC AFFECT UMBILICAL CORD pH IN PRETERM INFANTS? • V.M. Samedi, L. Irvine, S. Thomas, D. Kowal, J. Rabi, A. Stritzke, N. Singhal, A. Abou MehremABS 2. SNAP-PE SCORE. MORBIDITY AND MOR­TALI­TY INDEX IN NICUs • A. Konstantinidi, R. Sokou, S. Parastatidou, A. Tsantes, N. IacovidouABS 3. EARLY PERINATAL INTERVENTIONS IM­PROVES NEONATAL OUTCOMES • A. Ansary, R. Lee, S. KinmondABS 4. DILATED CARDIOMYOPATHY AND VITAMIN D DEFICIENCY: CASE REPORT IN A PRETERM INFANT • A. Proto, S. Fiocchi, I. Gatelli, L. Ilardi, S. MartinelliABS 5. SURVEY ON PERINATAL PALLIATIVE CARE ACROSS ITALY: PRELIMINARY RESULTS • M.E. Cavicchiolo, F. Rusalen, F. Benini, P. LagoABS 6. PLASMA ERYTHROPOIETIN AND FETO-NEONATAL ASPHYXIA IN TERM AND PRETERM NEWBORNS • F. Dituri, L. Orfeo, A. Di PaoloABS 7. A CHALLENGING CASE OF CONGENITAL INFANTILE FIBROSARCOMA • A. Ganarin, F. DeCorti, P. Dall’Igna, N. Doglioni, A. Berizzi, G. Bisogno, E. Baraldi, P.G. GambaABS 8. BIRTH ASPHYXIA IN LIMITED-RESOURCE SETTINGS: ASSOCIATED FACTORS AND OUT­COMES IN RURAL AFGHANISTAN • R. Baiocchi, M. Usuelli, P. Crosignani, E. Bruni, K. Picucci, M. Valenti, M. Langer, G. StradaABS 9. NEONATAL HEMORRHAGE FOLLOWING MA­TER­NAL LOW MOLECULAR WEIGHT HEPA­RIN (LMWH ADMINISTRATION • A. Konstantinidi, R. Sokou, S. Parastatidou, G. Patsouras, E. Isaakidou, K. Lampropoulou, K. Adamopoulos, A. Tsantes, N. IacovidouABS 10. NEONATAL/INFANTILE PINOCYTOSIS. AN UN­USU­AL CASE OF HAEMOLYTIC ANEMIA • R. Sokou, G. Patsouras, K. Lampropoulou, E. Tavoulari, K. Adamopoulos, M. Theodoraki, M. Kollia, A. KonstantinidiABS 11. THROMBOCYTOSIS IN NEONATES WITH NEONATAL ABSTINENCE SYNDROME THAT WERE HOSPITALIZED AT THE NICU OF GENERAL HOSPITAL OF NIKAIA • R. Sokou, E. Isaakidou, G. Patsouras, K

  11. Value of care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Value of care displays – national data. This data set includes national-level data for the value of care displays associated with an episode of care for heart...

  12. An Ounce of Prevention: An Administrative Guide for Day Care Center Directors.

    Science.gov (United States)

    Gray, Norma; Hall, Don

    One of three training manuals developed for day care center staff, this administrative guide was written to assist day care center directors in developing policies and procedures aimed at improving all aspects of the day care program, and thus reducing the risk of child abuse. Four chapters focus on (1) selection of staff, including recruiting,…

  13. Monitoring selective components of primary health care: methodology and community assessment of vaccination, diarrhoea, and malaria practices in Conakry, Guinea. ACSI-CCCD team.

    OpenAIRE

    Dabis, F.; Breman, J. G.; Roisin, A. J.; Haba, F.

    1989-01-01

    The Africa Child Survival Initiative-Combatting Childhood Communicable Diseases (ACSI-CCCD) Project is a primary health care activity that focuses on antenatal care, immunization, diarrhoeal disease control, and malaria control in children under 5 years of age. In order to gauge progress made in the project, a community-based health interview survey to measure simultaneously several prevention and treatment indicators was carried out in 1986 in Conakry, Guinea. A sample of 1415 caretakers and...

  14. Monitoring selective components of primary health care: methodology and community assessment of vaccination, diarrhoea, and malaria practices in Conakry, Guinea. ACSI-CCCD team.

    OpenAIRE

    Dabis , François; Breman , J. G.; Roisin , A. J.; Haba , F.; Team , Acsi-Cccd

    1989-01-01

    International audience; The Africa Child Survival Initiative-Combatting Childhood Communicable Diseases (ACSI-CCCD) Project is a primary health care activity that focuses on antenatal care, immunization, diarrhoeal disease control, and malaria control in children under 5 years of age. In order to gauge progress made in the project, a community-based health interview survey to measure simultaneously several prevention and treatment indicators was carried out in 1986 in Conakry, Guinea. A sampl...

  15. Assessing the prevalence of the Metabolic Syndrome according to NCEP ATP III in Germany: feasibility and quality aspects of a two step approach in 1550 randomly selected primary health care practices

    Directory of Open Access Journals (Sweden)

    Jöckel, Karl-Heinz

    2006-10-01

    Full Text Available Objective: Metabolic Syndrome (MetSyn describes a cluster of metabolic disorders and is considered a risk factor for development of cardiovascular disease. Although a high prevalence is commonly assumed in Germany data about the degree of its occurrence in the population and in subgroups are still missing. The aim of this study was to assess the prevalence of the MetSyn according to the NCEP ATP-III (National Cholesterol Education Program Adult Treatment Panel III criteria in persons aged ≥18 years attending a general practitioner in Germany. Here we describe in detail the methods used and the feasibility of determining the MetSyn in a primary health care setting. Research design and methods: The German-wide cross-sectional study was performed during two weeks in October 2005. Blood samples were analyzed in a central laboratory. Waist circumference and blood pressure were assessed, data on smoking, life style, fasting status, socio-demographic characteristics and core information from non-participants collected. Quality control procedures included telephone-monitoring and random on-site visits. In order to achieve a maximal number of fasting blood samples with a minimal need for follow-up appointments a stepwise approach was developed. Basic descriptive statistics were calculated, the Taylor expansion method used to estimate standard errors needed for calculation of confidence intervals for clustered observations. Results: In total, 1511 randomly selected general practices from 397 out of 438 German cities and administrative districts enrolled 35,869 patients (age range: 18-99, women 61.1%. More than 50,000 blood samples were taken. Fasting blood samples were available for 49% of the participants. Of the participating patients 99.3% returned questionnaires to the GP, only 12% were not filled out completely. The overall prevalence of the MetSyn (NCEP/ATP III 2001 was found to be 19.8%, with men showing higher prevalence rates than women (22

  16. A simple and highly selective molecular imprinting polymer-based methodology for propylparaben monitoring in personal care products and industrial waste waters.

    Science.gov (United States)

    Vicario, Ana; Aragón, Leslie; Wang, Chien C; Bertolino, Franco; Gomez, María R

    2018-02-05

    In this work, a novel molecularly imprinted polymer (MIP) proposed as solid phase extraction sorbent was developed for the determination of propylparaben (PP) in diverse cosmetic samples. The use of parabens (PAs) is authorized by regulatory agencies as microbiological preservative; however, recently several studies claim that large-scale use of these preservatives can be a potential health risk and harmful to the environment. Diverse factors that influence on polymer synthesis were studied, including template, functional monomer, porogen and crosslinker used. Morphological characterization of the MIP was performed using SEM and BET analysis. Parameters affecting the molecularly imprinted solid phase extraction (MISPE) and elution efficiency of PP were evaluated. After sample clean-up, the analyte was analyzed by high performance liquid chromatography (HPLC). The whole procedure was validated, showing satisfactory analytical parameters. After applying the MISPE methodology, the extraction recoveries were always better than 86.15%; the obtained precision expressed as RSD% was always lower than 2.19 for the corrected peak areas. Good linear relationship was obtained within the range 8-500ngmL -1 of PP, r 2 =0.99985. Lower limits of detection and quantification after MISPE procedure of 2.4 and 8ngmL -1 , respectively were reached, in comparison with previously reported methodologies. The development of MISPE-HPLC methodology provided a simple an economic way for accomplishing a clean-up/preconcentration step and the subsequent determination of PP in a complex matrix. The performance of the proposed method was compared against C-18 and silica solid phase extraction (SPE) cartridges. The recovery factors obtained after applying extraction methods were 96.6, 64.8 and 0.79 for MISPE, C18-SPE and silica-SPE procedures, respectively. The proposed methodology improves the retention capability of SPE material plus robustness and possibility of reutilization, enabling it to be

  17. Timely and Effective Care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - national data. This data set includes national-level data for measures of heart attack care, heart failure care, pneumonia care,...

  18. Timely and Effective Care - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - state data. This data set includes state-level data for measures of heart attack care, heart failure care, pneumonia care,...

  19. Timely and Effective Care - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of heart attack care, heart failure care, pneumonia care,...

  20. Interprofessional Care and Teamwork in the ICU.

    Science.gov (United States)

    Donovan, Anne L; Aldrich, J Matthew; Gross, A Kendall; Barchas, Denise M; Thornton, Kevin C; Schell-Chaple, Hildy M; Gropper, Michael A; Lipshutz, Angela K M

    2018-03-07

    We describe the importance of interprofessional care in modern critical care medicine. This review highlights the essential roles played by specific members of the interprofessional care team, including patients and family members, and discusses quality improvement initiatives that require interprofessional collaboration for success. Studies were identified through MEDLINE search using a variety of search phrases related to interprofessional care, critical care provider types, and quality improvement initiatives. Additional articles were identified through a review of the reference lists of identified articles. Original articles, review articles, and systematic reviews were considered. Manuscripts were selected for inclusion based on expert opinion of well-designed or key studies and review articles. "Interprofessional care" refers to care provided by a team of healthcare professionals with overlapping expertise and an appreciation for the unique contribution of other team members as partners in achieving a common goal. A robust body of data supports improvement in patient-level outcomes when care is provided by an interprofessional team. Critical care nurses, advanced practice providers, pharmacists, respiratory care practitioners, rehabilitation specialists, dieticians, social workers, case managers, spiritual care providers, intensivists, and nonintensivist physicians each provide unique expertise and perspectives to patient care, and therefore play an important role in a team that must address the diverse needs of patients and families in the ICU. Engaging patients and families as partners in their healthcare is also critical. Many important ICU quality improvement initiatives require an interprofessional approach, including Awakening and Breathing Coordination, Delirium, Early Exercise/Mobility, and Family Empowerment bundle implementation, interprofessional rounding practices, unit-based quality improvement initiatives, Patient and Family Advisory Councils

  1. Attracting Health Insurance Buyers through Selective Contracting: Results of a Discrete-Choice Experiment among Users of Hospital Services in the Netherlands

    Directory of Open Access Journals (Sweden)

    Evelien Bergrath

    2014-04-01

    Full Text Available In 2006, the Netherlands commenced market based reforms in its health care system. The reforms included selective contracting of health care providers by health insurers. This paper focuses on how health insurers may increase their market share on the health insurance market through selective contracting of health care providers. Selective contracting is studied by eliciting the preferences of health care consumers for attributes of health care services that an insurer could negotiate on behalf of its clients with health care providers. Selective contracting may provide incentives for health care providers to deliver the quality that consumers need and demand. Selective contracting also enables health insurers to steer individual patients towards selected health care providers. We used a stated preference technique known as a discrete choice experiment to collect and analyze the data. Results indicate that consumers care about both costs and quality of care, with healthy consumers placing greater emphasis on costs and consumers with poorer health placing greater emphasis on quality of care. It is possible for an insurer to satisfy both of these criteria by selective contracting health care providers who consequently purchase health care that is both efficient and of good quality.

  2. Competencies for supporting a healthy sexual development of young people in care : interviews with a selection of professionals in Belgium, Denmark and The Netherlands

    NARCIS (Netherlands)

    Walpot, Mirjam; Riis Hansen, Gitte; Moentjes, Gwendy; Bernaards, Claire

    2017-01-01

    This report describes the results of the interviews that were held with professionals, policy makers, and researchers (working in the field of sexuality and/or residential and foster care) in three countries in order to answer the following question: ‘Which competencies (i.e. knowledge, skills, and

  3. Construction and validation of a scoring system for the selection of high-quality data in a Spanish population primary care database (SIDIAP

    Directory of Open Access Journals (Sweden)

    Ma del Mar García-Gil

    2011-06-01

    Conclusions SIDIAP is highly representative of the population of Catalonia in terms of geographical, age and sex distributions. We report the usefulness of rate comparison as a valid method to establish research-usable data within primary care electronic medical records.

  4. Selection of empirical antibiotics for health care-associated pneumonia via integration of pneumonia severity index and risk factors of drug-resistant pathogens.

    Science.gov (United States)

    Wang, Ping-Huai; Wang, Hao-Chien; Cheng, Shih-Lung; Chang, Hou-Tai; Laio, Chun-Hsing

    2016-05-01

    The pneumonia severity index (PSI) both contains some risk factors of drug-resistant pathogens (DRPs) and represents the severity of health care-associated pneumonia. The aim of this study was to investigate whether the PSI could be used to predict DRPs and whether there were risk factors beyond the PSI. A retrospective observational study enrolled 530 patients with health care-associated pneumonia who were admitted from January 2005 to December 2010 in a tertiary care hospital. A total of 206 patients (38.9%) had DRPs, of which the most common was Pseudomonas aeruginosa (24.3%). The incidence of DRPs increased with increasing PSI classes (6.7%, 25.5%, 36.9%, and 44.6% in PSI II, III, IV, and V, respectively). An analysis of the risk factors for DRPs by PSI classes revealed that wound care was associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in PSI V (p = 0.045). Nasogastric tube feeding (odds ratio, 3.88; 95% confidence interval, 1.75-8.60; p = 0.006), and bronchiectasis (odds ratio, 3.12; 95% confidence interval, 0.66-14.69; p = 0.007) were risk factors for DRPs in PSI III and IV. The area under the receiver operating characteristic curve progressed from 0.578 to 0.651 while integrating these risk factors with PSI classes. The findings suggested that PSI plus risk factors predicted the risk of DRPs. PSI II had a low risk of DRPs and could be treated as community-acquired pneumonia. Antibiotics of PSI III and IV with risk factors could be targeted DRPs. PSI V with wound care had a higher risk of MRSA, and empirical anti-MRSA antibiotics could be added. Copyright © 2015. Published by Elsevier B.V.

  5. Including social impacts in LCIA

    DEFF Research Database (Denmark)

    Dreyer, Louise Camilla; Hauschild, Michael Zwicky; Schierbeck, Jens

    2004-01-01

    environmental impacts and, therefore, recommendations based on LCA fail to address both social and economic concerns. This has raised questions about LCA's ability to support sustainable development decisions. In a research project carried out at Brødrene Hartmann A/S and the Technical University of Denmark...... a frameowork for social LCA is currently being developed. The project quantifies social impacts and makes them operational in the traditional LCIA framework by developing measureable indicators. These indicators are selected to provide a meaningful and sufficient overall description of social impacts of all...

  6. GGVS. Ordinance on road transport of hazardous materials, including the European agreement on international road transport of hazardous materials (ADR), in their wording. Annexes A and B. Ordinances regarding exceptions from GGVS and from the ordinance on rail transport of hazardous materials, GGVE. Reasons. Selected guidelines. List of materials. 6. rev. and enlarged ed.

    International Nuclear Information System (INIS)

    Ridder, K.

    1990-01-01

    The brochure contains the following texts: (1) Ordinance on road transport of hazardous materials (GGVS), including the European agreement on international road transport of hazardous materials (ADR), as of 1990: Skeleton ordinance, annexes A and B, reasons given for the first version, and for the first amendment in 1988, execution guidelines - RS 002 (guidelines for executing the ordinance on road transport of hazardous materials, with catalogue of penalties), guidelines for drawing up written instructions for the event of accidents - RS 006, guiding principles for the training of vehicle conductors; (2) ordinance regarding exceptions from the ordinance on road transport of hazardous materials; (3) ordinance regarding exceptions from the ordinance on rail transport of hazardous materials; (4) selected guidelines: Technical guidelines TR IBC K 001, TRS 003, TRS 004, TRS 005, TRS 006; (5) listing of materials and objects governed by the ordinance on hazardous materials transport; (6) catalogue of penalties relative to road transport of hazardous materials. (orig./HP) [de

  7. Women’s empowerment and male involvement in antenatal care: analyses of Demographic and Health Surveys (DHS) in selected African countries

    OpenAIRE

    Jennings, Larissa; Na, Muzi; Cherewick, Megan; Hindin, Michelle; Mullany, Britta; Ahmed, Saifuddin

    2014-01-01

    Background Increasing women’s status and male involvement are important strategies in reducing preventable maternal morbidity and mortality. While efforts to both empower women and engage men in maternal health care-seeking can work synergistically, in practice they may result in opposing processes and outcomes. This study examines whether a woman’s empowerment status, in sum and across economic, socio-familial, and legal dimensions, is associated with male partner accompaniment to antenatal ...

  8. Systematic Staff Selection.

    Science.gov (United States)

    Murphy, Norman L.

    1979-01-01

    Describes the process of staff selection for the general studies department at Piedmont Technical College. Makes suggestions on how to write a job description, establish selection criteria, develop the selection process, and make the selection itself. Includes sample forms used in the process. (DR)

  9. Selecting Treatments and Monitoring Outcomes: The Circle of Evidence-Based Practice and Client-Centered Care in Treating a Preschool Child Who Stutters

    Science.gov (United States)

    Ratner, Nan Bernstein

    2018-01-01

    Purpose: The purpose of the present clinical forum is to compare how 2 clinicians might select among therapy options for a preschool-aged child who presents with stuttering close to onset. Method: I discuss approaches to full evaluation of the child's profile, advisement of evidence-based practice options open to the family, the need for…

  10. Preconception Care and Prenatal Care

    Science.gov (United States)

    ... Twitter Pinterest Email Print About Preconception Care and Prenatal Care What is preconception care? Preconception care is the ... improve the health of your child. What is prenatal care? Prenatal care is the health care a woman ...

  11. Family-centered care in neonatal intensive care unit: a concept analysis.

    Science.gov (United States)

    Ramezani, Tahereh; Hadian Shirazi, Zahra; Sabet Sarvestani, Raheleh; Moattari, Marzieh

    2014-10-01

    The concept of family- centered care in neonatal intensive care unit has changed drastically in protracted years and has been used in various contexts differently. Since we require clarity in our understanding, we aimed to analyze this concept. This study was done on the basis of developmental approach of Rodgers's concept analysis. We reviewed the existing literature in Science direct, PubMed, Google Scholar, Scopus, and Iran Medex databases from 1980 to 2012. The keywords were family-centered care, family-oriented care, and neonatal intensive care unit. After all, 59 out of 244 English and Persian articles and books (more than 20%) were selected. The attributes of family-centered care in neonatal intensive care unit were recognized as care taking of family (assessment of family and its needs, providing family needs), equal family participation (participation in care planning, decision making, and providing care from routine to special ones), collaboration (inter-professional collaboration with family, family involvement in regulating and implementing care plans), regarding family's respect and dignity (importance of families' differences, recognizing families' tendencies), and knowledge transformation (information sharing between healthcare workers and family, complete information sharing according to family learning style). Besides, the recognized antecedents were professional and management-organizational factors. Finally, the consequences included benefits related to neonate, family, and organization. The findings revealed that family centered-care was a comprehensive and holistic caring approach in neonatal intensive care. Therefore, it is highly recommended to change the current care approach and philosophy and provide facilities for conducting family-centered care in neonatal intensive care unit. 

  12. Surveillance for Certain Health Behaviors, Chronic Diseases, and Conditions, Access to Health Care, and Use of Preventive Health Services Among States and Selected Local Areas
- Behavioral Risk Factor Surveillance System, United States, 2012.

    Science.gov (United States)

    Chowdhury, Pranesh P; Mawokomatanda, Tebitha; Xu, Fang; Gamble, Sonya; Flegel, David; Pierannunzi, Carol; Garvin, William; Town, Machell

    2016-04-29

    Chronic diseases (e.g., heart diseases, cancer, chronic lower respiratory disease, stroke, diabetes, and arthritis) and unintentional injuries are the leading causes of morbidity and mortality in the United States. Behavioral risk factors (e.g., tobacco use, poor diet, physical inactivity, excessive alcohol consumption, failure to use seat belts, and insufficient sleep) are linked to the leading causes of death. Modifying these behavioral risk factors and using preventive health services (e.g., cancer screenings and influenza and pneumococcal vaccination of adults aged ≥65 years) can substantially reduce morbidity and mortality in the U.S. Continuous monitoring of these health-risk behaviors, chronic conditions, and use of preventive services are essential to the development of health promotion strategies, intervention programs, and health policies at the state, city, and county level. January-December 2012. The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed landline- and cellular-telephone survey of noninstitutionalized adults aged ≥18 years residing in the United States. BRFSS collects data on health-risk behaviors, chronic diseases and conditions, access to health care, and use of preventive health services related to the leading causes of death and disability. This report presents results for all 50 states, the District of Columbia, participating U.S. territories that include the Commonwealth of Puerto Rico (Puerto Rico) and Guam, 187 Metropolitan/Micropolitan Statistical Areas (MMSAs), and 210 counties (n = 475,687 survey respondents) for the year 2012. In 2012, the estimated prevalence of health-risk behaviors, chronic diseases or conditions, access to health care, and use of preventive health services substantially varied by state and territory, MMSA, and county. The following portion of the abstract lists a summary of results by selected BRFSS measures. Each set of proportions refers to the range of

  13. Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices.

    Science.gov (United States)

    Conway, Sarah J; Himmelrich, Sarah; Feeser, Scott A; Flynn, John A; Kravet, Steven J; Bailey, Jennifer; Hebert, Lindsay C; Donovan, Susan H; Kachur, Sarah G; Brown, Patricia M C; Baumgartner, William A; Berkowitz, Scott A

    2018-02-02

    Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process - (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration - reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area. It then reviews the ultimate selection of priorities for the coming year and early thoughts on implementation. After the robust review process, key stakeholders voted to select interventions targeted at care coordination, post-acute care, and specialty integration including Part B drug and imaging costs. The interventions selected incorporate a mixture of enhancing current ACO initiatives, working collaboratively and synergistically on other health system initiatives, and taking on new projects deemed targeted, cost-effective, and manageable in scope. The annual strategic review has been an essential and iterative process based on performance data and informed by the collective experience of other organizations. The process allows for an evidence-based strategic plan for the ACO in pursuit of the best care for patients.

  14. (including travel dates) Proposed itinerary

    Indian Academy of Sciences (India)

    Ashok

    31 July to 22 August 2012 (including travel dates). Proposed itinerary: Arrival in Bangalore on 1 August. 1-5 August: Bangalore, Karnataka. Suggested institutions: Indian Institute of Science, Bangalore. St Johns Medical College & Hospital, Bangalore. Jawaharlal Nehru Centre, Bangalore. 6-8 August: Chennai, TN.

  15. Taking care of Care

    NARCIS (Netherlands)

    Evelien Eggink; Debbie Oudijk; Isolde Woittiez

    2010-01-01

    Original title: Zorgen voor Zorg. The Dutch population will become increasingly older over the coming decades. This will have consequences for the use of care and consequently the demand for staff, especially in the nursing and care sectors (home care, nursing homes and residential care

  16. Helping You Choose Quality Behavioral Health Care

    Science.gov (United States)

    Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special thought and attention. The Joint Commission on ...

  17. Malignant lymphomas (including myeloproliferative disorders)

    International Nuclear Information System (INIS)

    Todd, I.D.H.

    1985-01-01

    This chapter deals with the radiotherapy and cytotoxic chemotherapy of the malignant lymphomas. Included within this group are Hodgkin's disease, non-Hodgkin's lymphoma, mycosis fungoides, and chronic lymphatic leukaemia. A further section deals with the myeloproliferative disorders, including granulocytic leukaemia, polycythaemia vera, and primary thrombocythaemia. Excluded are myeloma and reticulum cell sarcoma of bone and acute leukaemia. With regard to Hodgkin's disease, the past 25 years have seen general recognition of the curative potential of radiotherapy, at least in the local stages, and, more recently, awareness of the ability to achieve long-term survival after combination chemotherapy in generalised or in recurrent disease. At the same time the importance of staging has become appreciated and the introduction of procedures such as lymphography, staging laparotomy, and computer tomography (CT) has enormously increased its reliability. Advances have not been so dramatic in the complex group of non-Hodgkins's lymphomas, but are still very real

  18. Reflecting on healthcare and self-care in the Intensive Care Unit: our story

    Directory of Open Access Journals (Sweden)

    Allan Peterkin

    2014-12-01

    Full Text Available Health care professionals working in Intensive Care Units (ICUs are exposed to high levels of stress-provoking stimuli. Some may unconsciously employ negative coping skill s which may contribute to burnout and negatively affect patient care. We chose to explore ways of facilitating and encouraging self-reflective practice in an effort to increase empathic traits and enhance communication. A narrative medicine series, which included six sessions that were focused on different narrative approaches, was organized for staff of an academic teaching hospital. Totally, 132 interdisciplinary ICU staff attended the sessions. They were generally open to exploring the selected approaches and discussing their reflections within the interdisciplinary environment. The narrative medicine series provided tools for health care professionals to enhance self-reflective skills utilizing a team-based learning approach. The anticipated outcomes were improved self-care, increased empathy and communication skills, enhanced team functioning, which all contribute to better patient care at the bedside.

  19. [Integrative and complementary health practices: the supply and production of care in the Unified National Health System and in selected municipalities in Brazil].

    Science.gov (United States)

    Sousa, Islândia Maria Carvalho de; Bodstein, Regina Cele de Andrade; Tesser, Charles Dalcanale; Santos, Francisco de Assis da Silva; Hortale, Virginia Alonso

    2012-11-01

    The world of Traditional/Complementary and Alternative Medicine has grown and its importance has been emphasized in several studies. In Brazil, the National Policy on Integrative and Complementary Practices encourages their inclusion and empowerment in primary care. This study attempted to identify the provision of services and integrative practices in the Unified National Health System and the production of consultations from 2000 to 2011, contrasting the analysis of available information in national databases with the primary care data collected locally in Campinas (São Paulo State), Florianópolis (Santa Catarina State), and Recife (Pernambuco State). Analysis of the data revealed a mismatch between records in information systems and actual practices in these cities. This mismatch is due largely to lack of definition on the scope of what are understood as integrative and complementary practices in the Brazilian National Policy, thereby posing a major limitation to their measurement and evaluation, since current information does not allow adequate recording of such practices.

  20. Critical care medicine: opportunities and strategies for improvement.

    Science.gov (United States)

    Cohen, I L; Fitzpatrick, M; Booth, F V

    1996-02-01

    Like other areas of health care, critical care faces increasing pressure to improve the quality while reducing the cost of care. Strategies drawn from the literature and the authors' experiences are presented. Ten process- or structure-related areas are targeted as strategically important focuses of improvement: (1) restructuring administrative lines to better suit key processes; (2) physician leadership in critical care units; (3) management training for critical care managers; (4) triage; (5) multidisciplinary critical care; (6) standardization of care; (7) developing alternatives to critical care units; (8) timeliness of care delivery; (9) appropriate use of critical care resources; and (10) tracking quality improvement. Whatever the root cause(s) of unnecessary delays, the result is inefficient use of critical care resources-and ultimately either a need for more resources or longer wait times. Innovations designed to reduce wait times and waste, such as the establishment of a microchemistry stat laboratory, may prove valuable. Possible strategies for the appropriate use of critical care resources include better selection of well-informed patients who undergo procedures. Reduction in variation among physicians and organizations in providing therapies will also likely lead to a reduction in some high-risk procedures offering little or no benefit, and therefore a reduction in need for critical care services. Better preparation of patients and families should also make end-of-life decisions easier when questions of "futility" arise. Better information on outcomes and cost-effectiveness and consensus on withdrawal of critical care treatments represent two additional strategies.

  1. Selected papers

    CERN Document Server

    Tamm, I E; Frenkel, V Ya

    1991-01-01

    I.E. Tamm is one of the great figures of 20th-century physics and the mentor of the late A.D. Sakharov. Together with I.M. Frank, he received the Nobel Prize in 1958 for the explanation of the Cherenkov effect. This book contains an annotated selection of his most important contributions to physics literature and essays on his contemporaries - Mandelstam, Einstein, Landau and Bohr as well as his contributions to the Pugwash conferences. About a third of the selections originally appeared in Russian and are now available to Western readers. This volume includes a preface by Sir Rudolf Peierls, a biography compiled by Tamm's former students, V.Ya. Frenkel and B.M. Bolotovskii, and a complete bibliography. This monograph on quantum theory, science history, particles and fields and the Cherenkov effect is intended for students, researchers, mathematicians and natural scientists in general.

  2. Device including a contact detector

    DEFF Research Database (Denmark)

    2011-01-01

    The present invention relates to a probe for determining an electrical property of an area of a surface of a test sample, the probe is intended to be in a specific orientation relative to the test sample. The probe may comprise a supporting body defining a first surface. A plurality of cantilever...... of cantilever arms (12) contacting the surface of the test sample when performing the movement....... arms (12) may extend from the supporting body in co-planar relationship with the first surface. The plurality of cantilever arms (12) may extend substantially parallel to each other and each of the plurality of cantilever arms (12) may include an electrical conductive tip for contacting the area...

  3. Opinions of maternity care professionals and other stakeholders about integration of maternity care: a qualitative study in the Netherlands.

    Science.gov (United States)

    Perdok, Hilde; Jans, Suze; Verhoeven, Corine; Henneman, Lidewij; Wiegers, Therese; Mol, Ben Willem; Schellevis, François; de Jonge, Ank

    2016-07-26

    This study aims to give insight into the opinions of maternity care professionals and other stakeholders on the integration of midwife-led care and obstetrician-led care and on the facilitating and inhibiting factors for integrating maternity care. Qualitative study using interviews and focus groups from November 2012 to February 2013 in the Netherlands. Seventeen purposively selected stakeholder representatives participated in individual semi-structured interviews and 21 in focus groups. One face-to-face focus group included a combined group of midwives, obstetricians and a paediatrician involved in maternity care. Two online focus groups included a group of primary care midwives and a group of clinical midwives respectively. Thematic analysis was performed using Atlas.ti. Two researchers independently coded the interview and focus group transcripts by means of a mind map and themes and relations between them were described. Three main themes were identified with regard to integrating maternity care: client-centred care, continuity of care and task shifting between professionals. Opinions differed regarding the optimal maternity care organisation model. Participants considered the current payment structure an inhibiting factor, whereas a new modified payment structure based on the actual amount of work performed was seen as a facilitating factor. Both midwives and obstetricians indicated that they were afraid to loose autonomy. An integrated maternity care system may improve client-centred care, provide continuity of care for women during labour and birth and include a shift of responsibilities between health care providers. However, differences of opinion among professionals and other stakeholders with regard to the optimal maternity care organisation model may complicate the implementation of integrated care. Important factors for a successful implementation of integrated maternity care are an appropriate payment structure and maintenance of the autonomy of

  4. Improving staff selection processes.

    Science.gov (United States)

    Cerinus, Marie; Shannon, Marina

    2014-11-11

    This article, the second in a series of articles on Leading Better Care, describes the actions undertaken in recent years in NHS Lanarkshire to improve selection processes for nursing, midwifery and allied health professional (NMAHP) posts. This is an area of significant interest to these professions, management colleagues and patients given the pivotal importance of NMAHPs to patient care and experience. In recent times the importance of selecting staff not only with the right qualifications but also with the right attributes has been highlighted to ensure patients are well cared for in a safe, effective and compassionate manner. The article focuses on NMAHP selection processes, tracking local, collaborative development work undertaken to date. It presents an overview of some of the work being implemented, highlights a range of important factors, outlines how evaluation is progressing and concludes by recommending further empirical research.

  5. Point of Health Care Entry for Youth With Concussion Within a Large Pediatric Care Network.

    Science.gov (United States)

    Arbogast, Kristy B; Curry, Allison E; Pfeiffer, Melissa R; Zonfrillo, Mark R; Haarbauer-Krupa, Juliet; Breiding, Matthew J; Coronado, Victor G; Master, Christina L

    2016-07-05

    Previous epidemiologic research on concussions has primarily been limited to patient populations presenting to sport concussion clinics or to emergency departments (EDs) and to those high school age or older. By examining concussion visits across an entire pediatric health care network, a better estimate of the scope of the problem can be obtained. To comprehensively describe point of entry for children with concussion, overall and by relevant factors including age, sex, race/ethnicity, and payor, to quantify where children initially seek care for this injury. In this descriptive epidemiologic study, data were collected from primary care, specialty care, ED, urgent care, and inpatient settings. The initial concussion-related visit was selected and variation in the initial health care location (primary care, specialty care, ED, or hospital) was examined in relation to relevant variables. All patients aged 0 to 17 years who received their primary care from The Children's Hospital of Philadelphia's (CHOP) network and had 1 or more in-person clinical visits for concussion in the CHOP unified electronic health record (EHR) system (July 1, 2010, to June 30, 2014) were selected. Frequency of initial concussion visits at each type of health care location. Concussion visits in the EHR were defined based on International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes indicative of concussion. A total of 8083 patients were included (median age, 13 years; interquartile range, 10-15 years). Overall, 81.9% (95% CI, 81.1%-82.8%; n = 6624) had their first visit at CHOP within primary care, 5.2% (95% CI, 4.7%-5.7%; n = 418) within specialty care, and 11.7% (95% CI, 11.0%-12.4%; n = 947) within the ED. Health care entry varied by age: 52% (191/368) of children aged 0 to 4 years entered CHOP via the ED, whereas more than three-quarters of those aged 5 to 17 years entered via primary care (5-11 years: 1995/2492; 12-14 years: 2415

  6. Continuity of Care and Outcomes in Residential Care: A Comparison of Two Care Giving Models

    Science.gov (United States)

    Jones, Loring

    2006-01-01

    This study examined differences in two residential care giving models (houseparent vs. child care worker) in providing continuity of care for youth in residential placement, and the effect that a care giving model had on selected program outcomes. Data for this research were collected in a residential facility that used both models. Youth with…

  7. Photoactive devices including porphyrinoids with coordinating additives

    Science.gov (United States)

    Forrest, Stephen R; Zimmerman, Jeramy; Yu, Eric K; Thompson, Mark E; Trinh, Cong; Whited, Matthew; Diev, Vlacheslav

    2015-05-12

    Coordinating additives are included in porphyrinoid-based materials to promote intermolecular organization and improve one or more photoelectric characteristics of the materials. The coordinating additives are selected from fullerene compounds and organic compounds having free electron pairs. Combinations of different coordinating additives can be used to tailor the characteristic properties of such porphyrinoid-based materials, including porphyrin oligomers. Bidentate ligands are one type of coordinating additive that can form coordination bonds with a central metal ion of two different porphyrinoid compounds to promote porphyrinoid alignment and/or pi-stacking. The coordinating additives can shift the absorption spectrum of a photoactive material toward higher wavelengths, increase the external quantum efficiency of the material, or both.

  8. A selective review of prenatal exercise guidelines since the 1950s until present: written for women, health care professionals, and female athletes

    Science.gov (United States)

    Kehler, Ainslie K.; Heinrich, Katie M.

    2017-01-01

    Background Traditional society values have long-held the notion that the pregnant woman is construed as a risk to her growing fetus and is solely responsible for controlling this risk to ensure a healthy pregnancy. It is hard to ignore the participation of pregnant women in sport and exercise today, especially in high-level sports and popular fitness programs such as CrossFit™. This challenges both traditional and modern prenatal exercise guidelines from health care professionals and governing health agencies. The guidelines and perceived limitations of prenatal exercise have drastically evolved since the 1950’s. Aim The goal of this paper is to bring awareness to the idea that much of the information regarding exercise safety during pregnancy is hypersensitive and dated, and the earlier guidelines had no scientific rigor. Research is needed on the upper limits of exercise intensity and exercise frequency, as well as their potential risks (if any) on the woman or fetus. Discussion Pregnant women are physically capable of much more than what was once thought. There is still disagreement about the types of exercise deemed appropriate, the stage at which exercise should begin and cease, the frequency of exercise sessions, as well as the optimal level of intensity during prenatal exercise. Conclusion Research is needed to determine the upper limits of exercise frequency and intensity for pregnant women who are already trained. Healthy women and female athletes can usually maintain their regular training regime once they become pregnant. PMID:26210535

  9. National Health Care Survey

    Science.gov (United States)

    This survey encompasses a family of health care provider surveys, including information about the facilities that supply health care, the services rendered, and the characteristics of the patients served.

  10. Day Care Centers

    Data.gov (United States)

    Department of Homeland Security — This database contains locations of day care centers for 50 states and Washington D.C. and Puerto Rico. The dataset only includes center based day care locations...

  11. Phytotherapy in primary health care

    Science.gov (United States)

    Antonio, Gisele Damian; Tesser, Charles Dalcanale; Moretti-Pires, Rodrigo Otavio

    2014-01-01

    OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population. PMID:25119949

  12. Phytotherapy in primary health care

    Directory of Open Access Journals (Sweden)

    Gisele Damian Antonio

    2014-06-01

    Full Text Available OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population.

  13. Phytotherapy in primary health care.

    Science.gov (United States)

    Antonio, Gisele Damian; Tesser, Charles Dalcanele; Moretti-Pires, Rodrigo Otavio

    2014-06-01

    OBJECTIVE To characterize the integration of phytotherapy in primary health care in Brazil. METHODS Journal articles and theses and dissertations were searched for in the following databases: SciELO, Lilacs, PubMed, Scopus, Web of Science and Theses Portal Capes, between January 1988 and March 2013. We analyzed 53 original studies on actions, programs, acceptance and use of phytotherapy and medicinal plants in the Brazilian Unified Health System. Bibliometric data, characteristics of the actions/programs, places and subjects involved and type and focus of the selected studies were analyzed. RESULTS Between 2003 and 2013, there was an increase in publications in different areas of knowledge, compared with the 1990-2002 period. The objectives and actions of programs involving the integration of phytotherapy into primary health care varied: including other treatment options, reduce costs, reviving traditional knowledge, preserving biodiversity, promoting social development and stimulating inter-sectorial actions. CONCLUSIONS Over the past 25 years, there was a small increase in scientific production on actions/programs developed in primary care. Including phytotherapy in primary care services encourages interaction between health care users and professionals. It also contributes to the socialization of scientific research and the development of a critical vision about the use of phytotherapy and plant medicine, not only on the part of professionals but also of the population.

  14. Personal Care Product Use in Men and Urinary Concentrations of Select Phthalate Metabolites and Parabens: Results from the Environment And Reproductive Health (EARTH) Study.

    Science.gov (United States)

    Nassan, Feiby L; Coull, Brent A; Gaskins, Audrey J; Williams, Michelle A; Skakkebaek, Niels E; Ford, Jennifer B; Ye, Xiaoyun; Calafat, Antonia M; Braun, Joseph M; Hauser, Russ

    2017-08-18

    Personal care products (PCPs) are exposure sources to phthalates and parabens; however, their contribution to men's exposure is understudied. We examined the association between PCP use and urinary concentrations of phthalate metabolites and parabens in men. In a prospective cohort, at multiple study visits, men self-reported their use of 14 PCPs and provided a urine sample (2004-2015, Boston, MA). We measured urinary concentrations of 9 phthalate metabolites and methylparaben, propylparaben, and butylparaben. We estimated the covariate-adjusted percent change in urinary concentrations associated with PCP use using linear mixed and Tobit mixed regressions. We also estimated weights for each PCP in a weighted binary score regression and modeled the resulting composite weighted PCP use. Four hundred men contributed 1,037 urine samples (mean of 3/man). The largest percent increase in monoethyl phthalate (MEP) was associated with use of cologne/perfume (83%, p -valueparabens was associated with the use of suntan/sunblock lotion (66-156%) and hand/body lotion (79-147%). Increases in MEP and parabens were generally greater with PCP use within 6 h of urine collection. A subset of 10 PCPs that were used within 6 h of urine collection contributed to at least 70% of the weighted score and predicted a 254-1,333% increase in MEP and parabens concentrations. Associations between PCP use and concentrations of the other phthalate metabolites were not statistically significant. We identified 10 PCPs of relevance and demonstrated that their use within 6 h of urine collection strongly predicted MEP and paraben urinary concentrations. https://doi.org/10.1289/EHP1374.

  15. The pulley suture: A reliable option for closure of selected soft tissue defects under tension- three years experience of a tertiary care hospital.

    Science.gov (United States)

    Saeed, Sadaf; Ahmed, Syed Kamran; Chinoy, Muhammad Amin; Khan, Mansoor Ali

    2015-03-01

    To assess the outcome of closure of soft tissue defects through pulley suture in different clinical situations. The descriptive chart review was conducted at The Indus Hospital, Karachi, and comprised data from May 2008 to November 2011. A detailed questionnaire was developed to address variables of interest. All patients with less than three months of follow-up or inadequate information were excluded. The data was collected through Health Management Information System. Data was entered and analysed by SPSS 16. There were 259 patients with 289 wounds in the study. The mean age was 29.2±11.9 years. At follow-up of two weeks, there was wound dehiscence in 2.07%, infection in 0.69% and partial flap necrosis in 1.03% patients. At 12 weeks, hypertrophic scar was reported in 2.07% and stretched scar in 0.3% patients. Acute pain was not reported in the first week of surgery. Type of wound was found to have significant association with complications (p valuepulley suture can lead to primary closure of selected soft tissue defects under moderate tension. The technique, however, needs to be utilised by surgeons experienced in soft tissue reconstruction.

  16. Residential Care

    Science.gov (United States)

    ... skilled nursing facility, long-term care facility, custodial care) Nursing homes provide round-the-clock care and long- ... as nutrition, care planning, recreation, spirituality and medical care. Different nursing homes have different staff-to-resident ratios. Also, ...

  17. Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017; Venice (Italy; October 31-November 4, 2017; Session "Quality Improvement, Parents Centered Care"

    Directory of Open Access Journals (Sweden)

    --- Various Authors

    2017-10-01

    Full Text Available Selected Abstracts of the 2nd Congress of joint European Neonatal Societies (jENS 2017; Venice (Italy; October 31-November 4, 201758th ESPR Annual Meeting, 7th International Congress of UENPS, 3rd International Congress of EFCNIORGANIZING INSTITUTIONSEuropean Society for Paediatric Research (ESPR, European Society for Neonatology (ESN, Union of European Neonatal & Perinatal Societies (UENPS, European Foundation for the Care of Newborn Infants (EFCNIORGANIZING COMMITTEELuc Zimmermann (President of ESPR, Morten Breindahl (President of ESN, Manuel Sánchez Luna (President of UENPS, Silke Mader (Chairwoman of the Executive Board and Co-Founder of EFCNISCIENTIFIC COMMITTEEVirgilio P. Carnielli (Congress President Chair, Pierre Gressens (Past Scientific President, Umberto Simeoni, Manon Benders, Neil Marlow, Ola D. Saugstad, Petra Hüppi, Agnes van den HoogenSession "Quality Improvement, Parents Centered Care"ABS 1. REDUCING MEDICATION ERRORS IN NICU – A QUALITY IMPROVEMENT PROJECT • D.A. Al Masri, B. Ofoegbu, L. Yahya, K. Catroon, A. Saliba, H. IbrahimABS 2. PRETERM INFANTS WITH MEDICAL COM­PLEXITY: IMPACT ON HEALTH CARE RESOURCE USE, FAMILY EMPLOYMENT AND NEURODEVELOPMENTAL OUTCOMES • D. Nassel, C. Chartrand, M.-J. Doré-Bergeron, M. Ballantyne, F. Lefebvre, T.M. LuuABS 3. BREAST MILK DONATION IN THE MUSLIM POPULATION • S. Jebali, E. Ayachi, R. Terki Hassaine, A. Giuseppi, D. Vaiman, S. Brunet, V. RigourdABS 4. CORE OUTCOMES IN NEONATOLOGY: PRELIMINARY RESULTS • J. Webbe, N. Modi, C. Gale, on behalf of the COIN Steering GroupABS 5. A PILOT STUDY ASSESSING THE EFFECTIVENESS OF A FAMILY-CENTERED CARE INTERVENTION IN PRETERM INFANTS IN CHINA • R. Zhang, R. Huang, X. Gao, X. Peng, L. Zhu, R. Ramanathan, J. LatourABS 6. TO DETERMINE HOW MANY MOTHERS OF PRETERM BABIES, WHO WERE DELIVERED BETWEEN 24 AND 34 WEEKS GESTATION AND WERE ADMITTED TO NEONATAL UNIT AT ST. MARY’ S HOSPITAL, DID NOT RECEIVE ANTENATAL STEROIDS • A. Arunoday, A. Manou

  18. Hepatitis B vaccination coverage and the determinants of vaccination among health care workers in selected health facilities in Lusaka district, Zambia: an exploratory study

    OpenAIRE

    Mungandi, Namwaka; Makasa, Mpundu; Musonda, Patrick

    2017-01-01

    Background Hepatitis B is a viral infection of the liver and causes both acute and chronic disease. It is transmitted through contact with an infected person’s bodily fluids. It is an occupational hazard for healthcare workers and can be prevented by the administration of a vaccine. It is recommended that healthcare workers be vaccinated against vaccine preventable diseases including hepatitis B. The study objective was to determine the prevalence and determinants of hepatitis B vaccination a...

  19. Cancer Survivorship Care in Advanced Primary Care Practices: A Qualitative Study of Challenges and Opportunities.

    Science.gov (United States)

    Rubinstein, Ellen B; Miller, William L; Hudson, Shawna V; Howard, Jenna; O'Malley, Denalee; Tsui, Jennifer; Lee, Heather Sophia; Bator, Alicja; Crabtree, Benjamin F

    2017-12-01

    Despite a decade of effort by national stakeholders to bring cancer survivorship to the forefront of primary care, there is little evidence to suggest that primary care has begun to integrate comprehensive services to manage the care of long-term cancer survivors. To explain why primary care has not begun to integrate comprehensive cancer survivorship services. Comparative case study of 12 advanced primary care practices in the United States recruited from March 2015 to February 2017. Practices were selected from a national registry of 151 workforce innovators compiled for the Robert Wood Johnson Foundation. Practices were recruited to include diversity in policy context and organizational structure. Researchers conducted 10 to 12 days of ethnographic data collection in each practice, including interviews with practice personnel and patient pathways with cancer survivors. Fieldnotes, transcripts, and practice documents were analyzed within and across cases to identify salient themes. Description of cancer survivorship care delivery in advanced patient-centered medical homes, including identification of barriers and promotional factors related to that care. The 12 practices came from multiple states and policy contexts and had a mix of clinicians trained in family or internal medicine. All but 3 were recognized as National Committee on Quality Assurance level 3 patient-centered medical homes. None of the practices provided any type of comprehensive cancer survivorship services. Three interdependent explanatory factors emerged: the absence of a recognized, distinct clinical category of survivorship in primary care; a lack of actionable information to treat this patient population; and current information systems unable to support survivorship care. To increase the potential for primary care transformation efforts to integrate survivorship services into routine care, survivorship must become a recognized clinical category with actionable care plans supported by a

  20. Evidence from Students’ Information Seeking Diaries Underscores the Importance of Including Librarians in Undergraduate Education. A Review of: Lee, J. Y., Paik, W., & Joo, S. (2012). Information resource selection of undergraduate students in academic search tasks. Information Research, 17(1), paper511. Retrieved 8 Aug., 2012 from http://informationr.net/ir/17-1/paper511.html

    OpenAIRE

    Maria Melssen

    2012-01-01

    Objective – To determine what informationresources undergraduate students choose tocomplete assignments for their courses, whythey choose those resources, the process ofselecting those resources and the factors thatcontributed to selecting the resources, andtheir perceptions of those resources.Design – Semi-structured information seekingdiary.Setting – Private university in Seoul, Korea.Subjects – 233 undergraduate students fromall majors and all years.Methods – Students selected one assignme...

  1. Health care transition for youth with special health care needs.

    Science.gov (United States)

    Bloom, Sheila R; Kuhlthau, Karen; Van Cleave, Jeanne; Knapp, Alixandra A; Newacheck, Paul; Perrin, James M

    2012-09-01

    Youth with special health care needs (YSHCN) increasingly live into adulthood, and approximately 500,000 U.S. youth transition from pediatric to adult health care systems annually. Through a systematic literature review, we sought to (1) determine adult outcomes for YSHCN who have no special transition interventions and (2) identify evidence for strategies that lead to better outcomes, in particular, access to adult health care. We searched the medical, nursing, psychology, and social science literature and reviewed selected articles' reference lists. Transition experts also recommended relevant articles. Search criteria included health conditions, transition-related activities, and health care and related outcomes. We selected English-language articles published from 1986 to 2010, with an abstract, description of transition-related interventions (objective 2), and posttransition outcomes. Investigators abstracted study design, population, sample size, description of intervention, data collection methods, and findings. The search yielded 3,370 articles, of which 15 met study criteria. Although many YSHCN appear to make the transition to adult health providers successfully, some experience serious gaps in outcomes; those with more complex conditions or with conditions affecting the nervous system appear to have less good transitions. Some evidence supports introducing YSHCN to adult providers before leaving the pediatric system; one study supports using care coordinators to improve outcomes. Evidence regarding programs to facilitate transition for YSHCN is inconclusive. Weak evidence suggests that meeting adult providers before transfer may facilitate posttransition access to care. We recommend additional studies with strong research designs to guide best practice in preparing YSHCN for adulthood. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  2. Digital screen visits in home care services

    DEFF Research Database (Denmark)

    Zarakit, Mohamad; Nors Hansen, Louise; Evron, Lotte Orr

    2017-01-01

    The use of digital technology is increasing in home care services in Denmark. In the municipality of Copenhagen digital screens visits are being used as an alternative version of the traditional (physical) home visit to a selected population to increase quality and efficiency in the home care...... services. The aim of this pilot study is to investigate how the intercultural communication is used during digital home visits in a Copenhagen community when caring for older patients with a minority ethnic background. Methods: document analysis teaching material including two video cases combined...... with participant observation of three selected screen visits with older patients with a minority ethnic background. Analysis: thematic analysis based on a hermeneutic approach. Primarily results indicate that older patients with a minority ethnic background are screened out during the recruitment phase for digital...

  3. Provision of mental health care within primary care in Peru: A qualitative study exploring the perspectives of psychologists, primary health care providers, and patients.

    Science.gov (United States)

    Cavero, Victoria; Diez-Canseco, Francisco; Toyama, Mauricio; Flórez Salcedo, Gustavo; Ipince, Alessandra; Araya, Ricardo; Miranda, J Jaime

    2018-01-01

    Background: This study aimed to understand the offer of mental health care at the primary care level, collecting the views of psychologists, primary health care providers (PHCPs), and patients, with a focus on health services in which patients attend regularly and who present a higher prevalence of mental disorders. Methods: A qualitative study was conducted in antenatal care, tuberculosis, HIV/AIDS, and chronic diseases services from six primary health care centers. Semi-structured interviews were conducted with psychologists, PHCPs, and patients working in or attending the selected facilities.  Results: A total of 4 psychologists, 22 PHCPs, and 37 patients were interviewed. A high perceived need for mental health care was noted. PHCPs acknowledged the emotional impact physical health conditions have on their patients and mentioned that referral to psychologists was reserved only for serious problems. Their approach to emotional problems was providing emotional support (includes listening, talk about their patients' feelings, provide advice). PHCPs identified system-level barriers about the specialized mental health care, including a shortage of psychologists and an overwhelming demand, which results in brief consultations and lack in continuity of care. Psychologists focus their work on individual consultations; however, consultations were brief, did not follow a standardized model of care, and most patients attend only once. Psychologists also mentioned the lack of collaborative work among other healthcare providers. Despite these limitations, interviewed patients declared that they were willing to seek specialized care if advised and considered the psychologist's care provided as helpful; however, they recognized the stigmatization related to seeking mental health care. Conclusions: There is a perceived need of mental health care for primary care patients. To attend these needs, PHCPs provide emotional support and refer to psychology the most severe cases

  4. [The use of social healthcare resources and informal care characteristics care of immobilised homecare patients].

    Science.gov (United States)

    García Alcaraz, Francisco; Delicado Useros, Victoria; Alfaro Espín, Antonia; López-Torres Hidalgo, Jesús

    2015-04-01

    To describe the use of social healthcare resources by immobilised patients and informal care characteristics and the level/degree of satisfaction with home care services. Descriptive observational study carried out in primary care. The target group were 369 randomly selected immobilised home care patients in the area of Albacete, Spain. The variables included were: socio-demographic data of the patient and carer; the use of social healthcare resources; perceived social support (DUKE-UNK questionnaire); family function (APGAR questionnaire); nursing care and home care services satisfaction (SATISFAD 10 questionnaire). 66.9% of immobilised homecare patients have high dependency and 18.6% have bedsores. The majority of informal carers are women (83.1%) with an average of 57.7 years of age (DE 15.1). The average intensity of care is 15.7 hours per day (DE 8.5) and the average length of care is 5 years. The average number of visits from nurses per month is 2.1 (DE 2.1), although this measurement is higher in patients with bedsores or multiple diseases. The most widely used social health care resources are telephone care (34.2%) and home care (20.3%), for which 65.6% of immobilised homecare patients receive dependency benefits. Overall satisfaction with home care is of a high degree. Musculoskeletal disorders is the main reason for immobilisation in home care patients. Most informal carers are older women. The length and intensity of care is high and the main support comes from healthcare professionals. Patients make limited use of social healthcare resources. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  5. [Evaporation of selected cytotoxic drugs and permeation of protective gloves--research into the occupational risks of health care personnel handling hazardous cytotoxic drugs (CYTO project)].

    Science.gov (United States)

    Dolezalová, L; Odráska, P; Gorná, L; Prudilová, M; Vejpustková, R; Bláha, L

    2009-01-01

    The CYTO project studies an important aspect of healthcare provision -long-term occupational exposure, both threshold and below-threshold, to chemical agents with carcinogenic and mutagenic properties, with the major focus on antineoplastic drugs.This contribution presents experimental results from the first stages of the project's experimental work, i.e. an evaluation of the physico-chemical characteristics of cytostatic agents (evaporation) and an investigation into protective glove permeation. In co-operation with IUTA (Institut für Energie- und Umwelttechnik e.V., Duisburg, Germany), the vapour pressure of paclitaxel, doxorubicin and dacarbazine was measured following OECD guideline No. 104: Vapour pressure curve--vapour pressure balance. Furthermore, the evaporation of cytostatic drugs was examined in actual laboratory conditions by monitoring the airborne concentration using the passive sampling technique. Besides the evaporation of selected drugs, the permeation of cisplatin, cyclophosphamide, doxorubicin, 5-fluorouracil and paclitaxel through different types of gloves (vinyl, latex, nitrile) was assessed. Although our experiments showed relatively slow evaporation of the evaluated cytostatic drugs (the highest pressure in paclitaxel was 0.024 Pa), equilibrium concentrations may go up to milligrams per cubic metre. Nevertheless, analytical measurements of airborne contamination did not confirm these concentration levels. The glove permeation experiments with cytostatics showed good resistance of nitrile gloves (which were impermeable to all five drugs). Other materials should be avoided while handling cytostatic agents (e.g. maximum permeation of cyclophosphamide through latex was 19 microg/sq cm/hr). Although the volatility of cytostatic agents is low, it cannot be neglected considering the chronic character of exposure. However, in order to estimate actual occupational exposure, future research should focus on the development of sensitive analytical

  6. [Contracts including performance and management of uncertainty].

    Science.gov (United States)

    Duru, G; Garassus, P; Auray, J-P

    2013-09-01

    Since many decades in France, the most important part of ambulatory health care expenditure is represented by drug consumption. By the fact, French patient is indeed the greatest world consumer of pharmaceuticals treatments. Therefore, the regulation authorities by successive strategies, attempt to limit or even restrict market access for new drugs in the health care sector secured by public social insurance coverage. Common objectives are to assess the reimbursement to scientific studies and to fix the price of therapeutics at an acceptable level for both industries and government. New trends try then to determine recently the drug price in a dual approach, as a component of global and effective contract, including performance and outcome. The first diffusion authorization is diffusion concerned, but this concept takes into account the eventual success of new produces in long-term survey. Signed for a fixed period as reciprocal partnership between regulation authorities and pharmaceutics industries, the contract integrates two dimensions of incertitude. The first one is represented by the strategy of new treatments development according to efficacy and adapted price, and the second one is linked to the result of diffusion and determines adapted rules if eventual non-respects of the previous engagement are registered. This paper discusses problems related to this new dimension of incertitude affected by conditional drug prices in market access strategy and the adapted follow-up of new treatment diffusion fixed by "outcome" contract between French regulation administration and pharmaceutics industries in our recent economic context. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  7. A framework for including family health spillovers in economic evaluation

    NARCIS (Netherlands)

    H. Al-Janabi (Hareth); N.J.A. van Exel (Job); W.B.F. Brouwer (Werner); J. Coast (Joanna)

    2016-01-01

    textabstractHealth care interventions may affect the health of patients' family networks. It has been suggested that these health spillovers? should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health

  8. Gestational Weight Gain and Breastfeeding Outcomes in Group Prenatal Care.

    Science.gov (United States)

    Brumley, Jessica; Cain, M Ashley; Stern, Marilyn; Louis, Judette M

    2016-09-01

    This study sought to examine the differences in pregnancy outcomes with a focus on gestational weight gain for women attending group prenatal care compared to standard individual prenatal care. A matched case-control study was conducted including 65 women who chose group care and 130 women who chose standard individual care. Women were matched based on prepregnancy body mass index (BMI) category, eligibility for midwifery care, and age within 5 years. Women choosing group prenatal care and women choosing standard individual care had similar gestational weight gain, birth weight, gestational age at birth, and mode of birth. Women choosing group prenatal care did have a significantly higher rate of exclusive breastfeeding at 6 weeks postpartum (odds ratio [OR], 4.07; 95% confidence interval [CI], 1.81-9.15; P care. Group prenatal care participation resulted in equivalent gestational weight gain as well as pregnancy outcomes as compared to standard individual care. Breastfeeding rates were improved for women choosing group prenatal care. Randomized controlled trials are needed in order to eliminate selection bias. © 2016 by the American College of Nurse-Midwives.

  9. The views of nurses regarding caring in the workplace

    Directory of Open Access Journals (Sweden)

    A. Minnaar

    2003-03-01

    Full Text Available This survey describes caring in the workplace in selected health services and is part of a greater study conducted in KwaZulu-Natal, South Africa. This study describes the views of nurse managers and nurses regarding caring in the workplace. Human competence, recovery and healing are central to caring. To ensure caring and healing of patients in health services it is of the utmost importance for nurse managers to ensure a healthy and caring environment in the management of nurses. When caring is present in the workplace, nurses are more able to render caring nursing practices in the patient care environment. It is clear that to become a caring person, one must be treated in a caring way and that caring may be impaired or reinforced by the environment. The environment of interest to this study was the environment in which nurses practise. A descriptive survey with a convenience sampling explored caring in the workplace of nurses. The questionnaire was divided into two sections. Section A comprised demographic information and in section B the questionnaire consisted of Likert type questions, open-ended questions and yes/no questions. Analysis included descriptive statistics.

  10. Differences and similarities of motivating and demotivating factors of emergency nursing care in rural and urban emergency units – A study of selected rural and urban emergency units in the Volta Region of Ghana

    Directory of Open Access Journals (Sweden)

    Confidence Alorse Atakro

    Full Text Available Objective: The objective of this study was to explore differences and similarities of motivating and demotivating factors of emergency nursing care in selected rural and urban emergency units in the Volta Region of Ghana. Materials and methods: This study was conducted at selected rural and urban emergency units in the Volta Region of Ghana. The study utilised qualitative exploratory descriptive design. Purposive sampling technique was employed in selecting emergency units and nurses. Data were collected through semi-structured interviews of 30 nurses. Data saturation was determined after interviewing 30 participants. Data analysis was done through qualitative content analysis. Results: Twenty-six (26 out of a total of thirty (30 participants were between the ages of twenty-five (25 and twenty-nine (29. Nurses working in the emergency units studied general nursing at the Nurses Training Colleges (NTCs. None of the respondents studied emergency nursing as a degree programme. Twenty four (24 out of thirty (30 participants had worked for about two years in emergency units. Four thematic categories that represented differences and similarities of motivating and demotivating factors for nurses in rural and urban emergency units were extracted from data. The thematic categories are: a Support from hospital management for provision of material resources; b Task shifting to nurses; c Stimulant for learning; d Interpersonal relations. Discussions: Evidence available in this study suggests that there are differences as well as similarities of motivating and demotivating factors within emergency units of rural and urban settings in the Volta Region of Ghana. Differences in resource allocation and task shifting was identified. Stimulating environments of emergency unit for learning and excellent interpersonal relations were found to be common motivations for both rural and urban emergency unit nurses. Keywords: Motivating, Demotivating, Emergency

  11. Transitional care in skilled nursing facilities: a multiple case study.

    Science.gov (United States)

    Toles, Mark; Colón-Emeric, Cathleen; Naylor, Mary D; Barroso, Julie; Anderson, Ruth A

    2016-05-17

    Among hospitalized older adults who transfer to skilled nursing facilities (SNF) for short stays and subsequently transfer to home, twenty two percent require additional emergency department or hospital care within 30 days. Transitional care services, that provide continuity and coordination of care as older adults transition between settings of care, decrease complications during transitions in care, however, they have not been examined in SNFs. Thus, this study described how existing staff in SNFs delivered transitional care to identify opportunities for improvement. In this prospective, multiple case study, a case was defined as an individual SNF. Using a sampling plan to assure maximum variation among SNFs, three SNFs were purposefully selected and 54 staff, patients and family caregivers participated in data collection activities, which included observations of care (N = 235), interviews (N = 66) and review of documents (N = 35). Thematic analysis was used to describe similarities and differences in transitional care provided in the SNFs as well as organizational structures and the quality of care-team interactions that supported staff who delivered transitional care services. Staff in Case 1 completed most key transitional care services. Staff in Cases 2 and 3, however, had incomplete and/or absent services. Staff in Case 1, but not in Cases 2 and 3, reported a clear understanding of the need for transitional care, used formal transitional care team meetings and tracking tools to plan care, and engaged in robust team interactions. Organizational structures in SNFs that support staff and interactions among patients, families and staff appeared to promote the ability of staff in SNFs to deliver evidence-based transitional care services. Findings suggest practical approaches to develop new care routines, tools, and staff training materials to enhance the ability of existing SNF staff to effectively deliver transitional care.

  12. Tracheostomy care

    Science.gov (United States)

    Respiratory failure - tracheostomy care; Ventilator - tracheostomy care; Respiratory insufficiency - tracheostomy care ... to help you learn to talk with your tracheostomy. This is usually possible once your condition improves.

  13. Evidence from Students’ Information Seeking Diaries Underscores the Importance of Including Librarians in Undergraduate Education. A Review of: Lee, J. Y., Paik, W., & Joo, S. (2012. Information resource selection of undergraduate students in academic search tasks. Information Research, 17(1, paper511. Retrieved 8 Aug., 2012 from http://informationr.net/ir/17-1/paper511.html

    Directory of Open Access Journals (Sweden)

    Maria Melssen

    2012-12-01

    Full Text Available Objective – To determine what informationresources undergraduate students choose tocomplete assignments for their courses, whythey choose those resources, the process ofselecting those resources and the factors thatcontributed to selecting the resources, andtheir perceptions of those resources.Design – Semi-structured information seekingdiary.Setting – Private university in Seoul, Korea.Subjects – 233 undergraduate students fromall majors and all years.Methods – Students selected one assignmentfrom their elective course and recorded thefollowing in a diary: what the assignment was,the topic they needed to research to completethe assignment, resources used, the factors thatcontributed to choosing the resources, andperceptions of those resources.Main Results – Data were analyzed bothqualitatively and quantitatively. The factorsthat affected the students’ resource selectionwere analyzed qualitatively using an opencoding method created by the researchers. Thefactors were not predetermined by theresearchers, but were selected based on thefactors identified by the students. Onlineresources (67.1% were the most frequentlyselected resources by the students compared tohuman resources (11.5%, print materials (11.5%, and mass media (3%. Students used an average of 5.28 resources to complete one assignment. Factors that affected the students’ selection of resources were the type of information provided by the resource, the features of the resource, the search strategy used when searching in the resource, and the students’ interaction with other people when selecting and using the resource. More than one factor typically contributed to the students’ selection of the resource. The students’ perceptions of the resources they selected were analyzed quantitatively: perceptions were analyzed in six content areas using a five point scale. Correlations and similarities across the six content areas were also analyzed. Perceptions of resources

  14. Selected writings

    CERN Document Server

    Galilei, Galileo

    2012-01-01

    'Philosophy is written in this great book which is continually open before our eyes - I mean the universe...' Galileo's astronomical discoveries changed the way we look at the world, and our place in the universe. Threatened by the Inquisition for daring to contradict the literal truth of the Bible, Galileo ignited a scientific revolution when he asserted that the Earth moves. This generous selection from his writings contains all the essential texts for a reader to appreciate his lasting significance. Mark Davie's new translation renders Galileo's vigorous Italian prose into clear modern English, while William R. Shea's version of the Latin Sidereal Message makes accessible the book that created a sensation in 1610 with its account of Galileo's observations using the newly invented telescope. All Galileo's contributions to the debate on science and religion are included, as well as key documents from his trial before the Inquisition in 1633. A lively introduction and clear notes give an overview of Galileo's...

  15. Site selection

    International Nuclear Information System (INIS)

    Olsen, C.W.

    1983-07-01

    The conditions and criteria for selecting a site for a nuclear weapons test at the Nevada Test Site are summarized. Factors considered are: (1) scheduling of drill rigs, (2) scheduling of site preparation (dirt work, auger hole, surface casing, cementing), (3) schedule of event (when are drill hole data needed), (4) depth range of proposed W.P., (5) geologic structure (faults, Pz contact, etc.), (6) stratigraphy (alluvium, location of Grouse Canyon Tuff, etc.), (7) material properties (particularly montmorillonite and CO 2 content), (8) water table depth, (9) potential drilling problems (caving), (10) adjacent collapse craters and chimneys, (11) adjacent expended but uncollapsed sites, (12) adjacent post-shot or other small diameter holes, (13) adjacent stockpile emplacement holes, (14) adjacent planned events (including LANL), (15) projected needs of Test Program for various DOB's and operational separations, and (16) optimal use of NTS real estate

  16. Evaluation of Student Care Process in Urban and Rural Health Care Centers and Health House in Tabriz Using Tracer Methodology

    Directory of Open Access Journals (Sweden)

    Neda Kabiri

    2015-08-01

    Full Text Available Background and Objectives : Tracer methodology is a novel evaluation method which its purpose is to provide an accurate assessment of systems and processes for the delivery of care, treatment, and services at a health care organization. This study aimed to assess student care process in Tabriz using Tracer methodology. Material and Methods : This cross-sectional study was conducted in autumn 1391. Population study consisted of all the students who were covered by Tabriz health care center and study sample included an urban health care center, a rural health care center, a health house, and two schools in urban and rural areas which were selected by simple sampling method. Also, all the complicated and problematic processes were chosen to be assessed. Data were collected by interviewing, observing, and surveying documents and were compared with current standards. Results : The results of this study declared the percentage of points that each target group gained from tracer evaluation in student care process was 77% in health house, 90% in rural health care center and 83% in urban health care center. Findings indicated that documentation was the main weak point. Conclusion : According to the results of this study, student care process is sufficient; despite the fact that there are some deficiencies in caring process, as it may be improved through appropriate strategies. Furthermore, tracer methodology seems to be a proper method to evaluate various levels of health care system. ​

  17. Selecting Landscape Plants: Shade Trees

    OpenAIRE

    Relf, Diane; Appleton, Bonnie Lee, 1948-2012; Close, David

    2015-01-01

    Because of the permanency of trees and their importance in the landscape, care must be taken to select the best species for each situation. This publication goes over how to choose landscape trees that are shade tolerant.

  18. Child Care Centres.

    Science.gov (United States)

    Australian Dept. of Labour and National Service, Melbourne. Women's Bureau.

    This document is an English-language abstract (approximately 1,500 words) in which Australian child care facilities are surveyed to include those providing full-day care and therefore excludes kindergartens, play centers, nursery schools, and child minding centers that provide care for only part of the day. The document presents a breakdown of…

  19. Value of care - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Value of care displays – national data. This data set includes national-level data for the value of care displays associated with an episode of care for heart...

  20. Measuring Nursing Care Value.

    Science.gov (United States)

    Welton, John M; Harper, Ellen M

    2016-01-01

    The value of nursing care as well as the contribution of individual nurses to clinical outcomes has been difficult to measure and evaluate. Existing health care financial models hide the contribution of nurses; therefore, the link between the cost and quality o nursing care is unknown. New data and methods are needed to articulate the added value of nurses to patient care. The final results and recommendations of an expert workgroup tasked with defining and measuring nursing care value, including a data model to allow extraction of key information from electronic health records to measure nursing care value, are described. A set of new analytic metrics are proposed.

  1. Assessing Palliative Care Content in Dementia Care Guidelines: A Systematic Review.

    Science.gov (United States)

    Durepos, Pamela; Wickson-Griffiths, Abigail; Hazzan, Afeez Abiola; Kaasalainen, Sharon; Vastis, Vasilia; Battistella, Lisa; Papaioannou, Alexandra

    2017-04-01

    Families of persons with dementia continue to report unmet needs during end of life (EOL). Strategies to improve care and quality of life for persons with dementia include development of clinical practice guidelines (CPGs) and an integrative palliative approach. We aimed to assess palliative care content in dementia CPGs to identify the presence or limitations of recommendations and discussion pertaining to common issues or domains affected by illness as described by the Canadian Hospice Palliative Care Association "Square of Care." A systematic review of databases and gray literature was conducted for recent CPGs. Guidelines meeting inclusion criteria were evaluated using the Appraisal of Guidelines for Research and Evaluation II instrument. Quality CPGs were analyzed through organizational template analysis using illness domains described by the "Canadian Hospice Palliative Care Association Model." The study protocol is registered at PROSPERO (CRD 42015025369). Eleven CPGs were selected and analyzed from 3779 citations. Nine guidelines demonstrated the maximum level of content regarding physical, psychological, and social care. Conversely, spiritual care was either absent (three) or minimal (three) in CPGs. Six CPGs did not address loss or grief, and seven CPGs did not address or had minimal content regarding EOL care. The lack of content surrounding grief represents a gap for this population at high risk for complicated grief and chronic sorrow. Results of this review require attention by CPG developers and researchers to develop evidence-based recommendations surrounding spiritual care, EOL, and grief. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  2. Relationship of Hospital Architecture to Nursing Staff Caring for Self, Caring for Patients, and Job Satisfaction

    Directory of Open Access Journals (Sweden)

    Mary Ann Hozak

    2016-03-01

    Full Text Available Historically, the fields of architecture (design and nursing (health have been separate disciplines without much intersection. In recent years, the healthcare building boom has created a specialty practice for architects, focusing on healthcare design. With this new focus and specialty within architecture, the science of evidence-based design and the collaboration with clinical care staff have created a new partnership paradigm that is improving the built environment. Ten dimensions of caring have been espoused by Watson’s Caritas Theory to comprise the construct of caring, which in turn facilitates healing for both the care giver and care recipient (Nelson & Watson, 2012. This article describes a study that examined the relationship between selected elements of architectural design and other factors (recent architectural change, unit size and shape, intersecting hallways, number and proximity of bathrooms and supply rooms, availability of nourishment, number and availability of computers, and rooms for staff gathering, for solitude, and for practice of Watson Caring Factors and outcomes of caring that are important to nursing, including clinical staff caring for self, caring for others, and job satisfaction. The study took place in a hospital that was implementing Watson’s concepts of caring within their framework of care delivery. Statistically significant relationships were: Caring for self was negatively related to number of supply rooms and number of Watson rooms or boxes. Caring for patients as reported by staff was negatively related to number of Watson rooms or boxes. Job satisfaction was positively related to number of bathrooms and negatively related to number of supply rooms. A small sample size required adjustment of the alpha to .15 and an effect size of .25, suggesting that replication studies with larger sample sizes may assist with development of a model of architecture that promotes behaviors as proposed by Watson and better

  3. Hospice care

    Science.gov (United States)

    Palliative care - hospice; End-of-life care - hospice; Dying - hospice; Cancer - hospice ... it may change who will be providing the care. ... Share feelings How to cope after death (bereavement care)

  4. 42 CFR 410.100 - Included services.

    Science.gov (United States)

    2010-10-01

    ...-language pathology services and respiratory therapy services. (i) Nursing care services. Nursing care... the rehabilitation goals of the physical therapy, occupational therapy, speech-language pathology, or... subpart B. (b) Physical therapy services. (1) These services include— (i) Testing and measurement of the...

  5. Anesthesia for day-care surgeries: Current perspectives

    Directory of Open Access Journals (Sweden)

    Sukhminder Jit Singh Bajwa

    2017-01-01

    Full Text Available Day-care surgery has become a popular modality of surgical intervention throughout the globe. Numerous factors including the economic and financial issues are driving this therapeutic modality to a widespread acceptance among surgeons and anesthesiologists. Advancements in anesthesia and surgical techniques as well as availability of newer drugs are largely responsible for the progress of day-care surgeries. Numerous challenges are still faced by anesthesiologists and surgeons in carrying out day-care surgeries, especially in spite of these advancements, at resource-limited setups. The first right step in successfully delivering the day-care surgical services includes proper selection of the patients. The preanesthetic evaluation is highly essential in determining the suitability of the patient for day-care anesthesia and surgery as well as the formulation of various anesthetic plans and strategies. The current review is intended to highlight inherent challenges and probable solutions to them for this rapidly progressing anesthesia.

  6. Self-Care Among Older Adults With Heart Failure

    Directory of Open Access Journals (Sweden)

    Sumayya Attaallah MSN, RN

    2016-12-01

    Full Text Available Background: It is estimated that 5.7 million Americans are living with heart failure (HF today. Despite the fact that HF is one of the most common reasons people aged 65 years and older are admitted into the hospital, few studies describe the self-care in this older adult population. Purpose: The purpose of the study was to review the current literature on self-care in this population to better understand the influence of selected factors on self-care and health outcomes. Methods: A literature search was completed and resulted in including 28 studies. Results: Multiple factors have been reported as barriers to self-care including depression and presence of peripheral arterial disease. Factors having a positive effect on self-care are male gender, number of cardiologist referrals, and self-efficacy. There were few studies that described the association between cognitive functioning and self-care. There is a lack of strong evidence to support the association between self-care and health outcomes such as readmission rate, but recent studies suggest that a 30-day readmission is not a valid predictor of health outcomes. Implications: The assessment of the psychological factors and health care resource utilization patterns that may influence self-care is recommended. More research that addresses the role of cognitive factors in influencing self-care is needed.

  7. The relationship between organizational commitment and nursing care behavior.

    Science.gov (United States)

    Naghneh, Mohammad Hossein Khalilzadeh; Tafreshi, Mansoureh Zagheri; Naderi, Manijeh; Shakeri, Nehzat; Bolourchifard, Fariba; Goyaghaj, Naser Sedghi

    2017-07-01

    Nursing care encompasses physical, emotional, mental and social needs, in order to improve a patient's health and wellbeing. Caring is the central core and the essence of nursing. The important issue of care is access to proper care and increasing patients' satisfaction. Job performance of nurses is affected by many factors including organizational commitment. This study aimed to determine the relationship between organizational commitment and nurses caring behavior. In this cross-sectional study, 322 nurses from selected Hospitals of Shahid Beheshti University of Medical Sciences in Tehran were randomly selected and enrolled in the study in 2015. The self-reported data by nurses were collected through demographic characteristics questionnaire, Meyer & Allen organizational commitment model and Caring Behavior Inventory (CBI). Data were analyzed with SPSS statistical software version 20, using t-test and ANOVA. The majority of nurses (63%) were female. The mean score and standard deviation of organizational commitment and caring behavior of nurses were 74.12±9.61 and 203.1±22.46, respectively. The results showed a significantly positive correlation between organizational commitment and caring behavior (p=0.001). In this study the caring behavior of nurses with higher organizational commitment were significantly better than the others. Managers and nurse leaders should pay more attention to improve organizational commitment of nurses, in order to improve nurses' performance.

  8. Critical Care Organizations: Building and Integrating Academic Programs.

    Science.gov (United States)

    Moore, Jason E; Oropello, John M; Stoltzfus, Daniel; Masur, Henry; Coopersmith, Craig M; Nates, Joseph; Doig, Christopher; Christman, John; Hite, R Duncan; Angus, Derek C; Pastores, Stephen M; Kvetan, Vladimir

    2018-04-01

    Academic medical centers in North America are expanding their missions from the traditional triad of patient care, research, and education to include the broader issue of healthcare delivery improvement. In recent years, integrated Critical Care Organizations have developed within academic centers to better meet the challenges of this broadening mission. The goal of this article was to provide interested administrators and intensivists with the proper resources, lines of communication, and organizational approach to accomplish integration and Critical Care Organization formation effectively. The Academic Critical Care Organization Building section workgroup of the taskforce established regular monthly conference calls to reach consensus on the development of a toolkit utilizing methods proven to advance the development of their own academic Critical Care Organizations. Relevant medical literature was reviewed by literature search. Materials from federal agencies and other national organizations were accessed through the Internet. The Society of Critical Care Medicine convened a taskforce entitled "Academic Leaders in Critical Care Medicine" on February 22, 2016 at the 45th Critical Care Congress using the expertise of successful leaders of advanced governance Critical Care Organizations in North America to develop a toolkit for advancing Critical Care Organizations. Key elements of an academic Critical Care Organization are outlined. The vital missions of multidisciplinary patient care, safety, and quality are linked to the research, education, and professional development missions that enhance the value of such organizations. Core features, benefits, barriers, and recommendations for integration of academic programs within Critical Care Organizations are described. Selected readings and resources to successfully implement the recommendations are provided. Communication with medical school and hospital leadership is discussed. We present the rationale for critical

  9. Patients' preferences in palliative care: A systematic mixed studies review.

    Science.gov (United States)

    Sandsdalen, Tuva; Hov, Reidun; Høye, Sevald; Rystedt, Ingrid; Wilde-Larsson, Bodil

    2015-05-01

    It is necessary to develop palliative care to meet existing and future needs of patients and their families. It is important to include knowledge of patient preferences when developing high-quality palliative care services. Previous reviews have focused on patient preferences with regard to specific components of palliative care. There is a need to review research on patient's combined preferences for all elements that constitute palliative care. The aim of this study is to identify preferences for palliative care among patients in the palliative phase of their illness, by synthesizing existing research. Studies were retrieved by searching databases - the Cochrane Library, Medline, CINAHL, PsycINFO, Scopus and Sociological Abstracts - from 1946 to 2014, and by hand searching references in the studies included. A systematic mixed studies review was conducted. Two reviewers independently selected studies for inclusion and extracted data according to the eligibility criteria. Data were synthesized using integrative thematic analysis. The 13 qualitative and 10 quantitative studies identified included participants with different illnesses in various settings. Four themes emerged representing patient preferences for care. The theme 'Living a meaningful life' illustrated what patients strived for. The opportunity to focus on living required the presence of 'Responsive healthcare personnel', a 'Responsive care environment' and 'Responsiveness in the organization of palliative care'. The four themes may be useful for guiding clinical practice and measurements of quality, with the overall goal of meeting future needs and improving quality in palliative care services to suit patients' preferences. © The Author(s) 2015.

  10. Electrolyte solutions including a phosphoranimine compound, and energy storage devices including same

    Science.gov (United States)

    Klaehn, John R.; Dufek, Eric J.; Rollins, Harry W.; Harrup, Mason K.; Gering, Kevin L.

    2017-09-12

    An electrolyte solution comprising at least one phosphoranimine compound and a metal salt. The at least one phosphoranimine compound comprises a compound of the chemical structure ##STR00001## where X is an organosilyl group or a tert-butyl group and each of R.sup.1, R.sup.2, and R.sup.3 is independently selected from the group consisting of an alkyl group, an aryl group, an alkoxy group, or an aryloxy group. An energy storage device including the electrolyte solution is also disclosed.

  11. ANESTHESIA AND INTENSIVE CARE IN HEART RETRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    V. N. Poptsov

    2011-01-01

    Full Text Available In this review we describe our own experience of anesthetic management and early intensive care of two patients after heart retransplantation. As shown in this article, preretransplant clinical condition (severity of organs dys- function influences on character of intra- and postoperative periods including duration of anesthesia, surgery, postoperative ventilation and ICU stay, intra- and postoperative bleeding, volume of blood product transfusion, infection complications, need in renal replacement therapy, selective LPS-adsorption and other therapeutic op- tions. 

  12. Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania

    Directory of Open Access Journals (Sweden)

    Kessy Flora

    2011-05-01

    Full Text Available Abstract Background The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. Methods Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. Results The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". Conclusions Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker

  13. Introducing consumer directed care in residential care settings for older people in Australia: views of a citizens' jury.

    Science.gov (United States)

    Laver, Kate; Gnanamanickam, Emmanuel; Whitehead, Craig; Kurrle, Susan; Corlis, Megan; Ratcliffe, Julie; Shulver, Wendy; Crotty, Maria

    2018-01-01

    Objectives Health services worldwide are increasingly adopting consumer directed care approaches. Traditionally, consumer directed care models have been implemented in home care services and there is little guidance as to how to implement them in residential care. This study used a citizens' jury to elicit views of members of the public regarding consumer directed care in residential care. Methods A citizens' jury involving 12 members of the public was held over two days in July 2016, exploring the question: For people with dementia living in residential care facilities, how do we enable increased personal decision making to ensure that care is based on their needs and preferences? Jury members were recruited through a market research company and selected to be broadly representative of the general public. Results The jury believed that person-centred care should be the foundation of care for all older people. They recommended that each person's funding be split between core services (to ensure basic health, nutrition and hygiene needs are met) and discretionary services. Systems needed to be put into place to enable the transition to consumer directed care including care coordinators to assist in eliciting resident preferences, supports for proxy decision makers, and accreditation processes and risk management strategies to ensure that residents with significant cognitive impairment are not taken advantage of by goods and service providers. Transparency should be increased (perhaps using technologies) so that both the resident and nominated family members can be sure that the person is receiving what they have paid for. Conclusions The views of the jury (as representatives of the public) were that people in residential care should have more say regarding the way in which their care is provided and that a model of consumer directed care should be introduced. Policy makers should consider implementation of consumer directed care models that are economically viable

  14. Doctors Adjacent to Private Pharmacies: The New Ambulatory Care Provider for Mexican Health Care Seekers.

    Science.gov (United States)

    López-Manning, Mauricio; García-Díaz, Rocío

    2017-12-01

    In 2010 Mexican health authorities enacted an antibiotic sale, prescription, and dispensation bill that increased the presence of a new kind of ambulatory care provider, the doctors adjacent to private pharmacies (DAPPs). To analyze how DAPPs' presence in the Mexican ambulatory care market has modified health care seekers' behavior following a two-stage health care provider selection decision process. The first stage focuses on individuals' propensity to captivity to the health care system structure before 2010. The second stage analyzes individuals' medical provider selection in a health system including DAPPs. This two-stage process analysis allowed us not only to show the determinants of each part in the decision process but also to understand the overall picture of DAPPs' impact in both the Mexican health care system and health care seekers, taking into account conditions such as the origins, evolution, and context of this new provider. We used data from individuals (N = 97,549) participating in the Mexican National Survey of Health and Nutrition in 2012. We found that DAPPs have become not only a widely accepted but also a preferred option among the Mexican ambulatory care providers that follow no specific income-level population user group (in spite of its original low-income population target). Our results showed DAPPs as an urban and rapidly expanded phenomenon, presumably keeping the growing pace of new communities and adapting to demographic changes. Individuals opt for DAPPs when they look for health care: in a nearby provider, for either the most recent or common ailments, and in an urban setting; regardless of most socioeconomic background. The relevance of location and accessibility variables in our study provides evidence of the role taken by this provider in the Mexican health care system. Copyright © 2017. Published by Elsevier Inc.

  15. Selection of paediatric patients for intensive care

    African Journals Online (AJOL)

    illness, particularly near-drowning, cardiomyopathy, gastro- enteritis and complicated infectious illness (Table Ill). Cardiorespiratory resuscitation prior to ICU admission was associated with increased mortality (7/11 v. 27/106,. P < 0,05, two-tailed Fisher's exact test). There were no deaths in patients with polytrauma without ...

  16. Patients' perceptions of palliative care: adaptation of the Quality from the Patient's Perspective instrument for use in palliative care, and description of patients' perceptions of care received.

    Science.gov (United States)

    Sandsdalen, Tuva; Rystedt, Ingrid; Grøndahl, Vigdis Abrahamsen; Hov, Reidun; Høye, Sevald; Wilde-Larsson, Bodil

    2015-11-02

    Instruments specific to palliative care tend to measure care quality from relative perspectives or have insufficient theoretical foundation. The instrument Quality from the Patient's Perspective (QPP) is based on a model for care quality derived from patients' perceptions of care, although it has not been psychometrically evaluated for use in palliative care. The aim of this study was to adapt the QPP for use in palliative care contexts, and to describe patients' perceptions of the care quality in terms of the subjective importance of the care aspects and the perceptions of the care received. A cross-sectional study was conducted between November 2013 and December 2014 which included 191 patients (73% response rate) in late palliative phase at hospice inpatient units, hospice day-care units, wards in nursing homes that specialized in palliative care and homecare districts, all in Norway. An explorative factor analysis using principal component analysis, including data from 184 patients, was performed for psychometric evaluation. Internal consistency was assessed by Cronbach's alpha and paired t-tests were used to describe patients' perceptions of their care. The QPP instrument was adapted for palliative care in four steps: (1) selecting items from the QPP, (2) modifying items and (3) constructing new items to the palliative care setting, and (4) a pilot evaluation. QPP instrument specific to palliative care (QPP-PC) consists of 51 items and 12 factors with an eigenvalue ≥1.0, and showed a stable factor solution that explained 68.25% of the total variance. The reliability coefficients were acceptable for most factors (0.79-0.96). Patients scored most aspects of care related to both subjective importance and actual care received as high. Areas for improvement were symptom relief, participation, continuity, and planning and cooperation. The QPP-PC is based on a theoretical model of quality of care, and has its roots in patients' perspectives. The instrument was

  17. Shared care between specialised psychiatric services and primary care: The experiences and expectations of General Practitioners in Ireland.

    LENUS (Irish Health Repository)

    Agyapong, Vincent Israel Opoku

    2012-04-17

    Objective. The study aims to explore the views of General Practitioners in Ireland on shared care between specialised psychiatric services and primary care. Method. A self-administered questionnaire was designed and posted to 400 randomly selected General Practitioners working in Ireland. Results. Of the respondents, 189 (94%) reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 124 (61.4%) reported that they foresaw difficulties for patients in implementing such a policy including: a concern that primary care is not adequately resourced with allied health professionals to support provision of psychiatric care (113, 53.2%); a concern this would result in increased financial burden on some patients (89, 48.8%); a lack of adequate cooperation between primary care and specialised mental health services (84, 41.8%); a concern that some patients may lack confidence in GP care (55, 27.4%); and that primary care providers are not adequately trained to provide psychiatric care (29, 14.4% ). Conclusion. The majority of GPs in Ireland would support a policy of shared care of psychiatric patients; however they raise significant concerns regarding practical implications of such a policy in Ireland.

  18. Point-of-Care Platforms

    Science.gov (United States)

    Gauglitz, Günter

    2014-06-01

    Point-of-care applications are gaining increasing interest in clinical diagnostics and emergency applications. Biosensors are used to monitor the biomolecular interaction process between a disease biomarker and a recognition element such as a reagent. Essential are the quality and selectivity of the recognition elements and assay types used to improve sensitivity and to avoid nonspecific interactions. In addition, quality measures are influenced by the detection principle and the evaluation strategies. For these reasons, this review provides a survey and validation of recognition elements, assays, and various types of detection methods for point-of-care testing (POCT) platforms. Common applications of clinical parameters are discussed and considered. In this ever-changing field, a snapshot of current applications is needed. We provide such a snapshot by way of a table including literature citations and also discuss these applications in more detail throughout.

  19. Mating and Parental Care in Lake Tanganyika's Cichlids

    Directory of Open Access Journals (Sweden)

    Kristina M. Sefc

    2011-01-01

    Full Text Available Cichlid fishes of Lake Tanganyika display a variety of mating and parental care behaviors, including polygamous and monogamous mouthbrooding and substrate breeding, cooperative breeding, as well as various alternative reproductive tactics such as sneaking and piracy. Moreover, reproductive behaviors sometimes vary within species both in space and in time. Here, I survey reports on mating and parenting behaviors of Lake Tanganyika cichlid species and address the evolution of mating and parental care patterns and sexual dimorphism. Notes on measures of sexual selection intensity and the difficulties of defining mating systems and estimating selection intensities at species level conclude the essay.

  20. Barriers to providing dental care for older people.

    Science.gov (United States)

    Carson, Susan J; Edwards, Maura

    2014-03-01

    The Medline, Embase and CINAHL databases were searched together with the reference lists of selected publications. Studies published since January 1990 and published in English that looked at barriers, experienced by dentists, to delivering oral health care to people over the age of 65 were included. Study quality was assessed independently using criteria developed by the Dutch Cochrane Centre. Study assessment and data extraction were carried out independently by two reviewers and a qualitative summary presented. Seven cross-sectional studies were included. The focus was primarily on dentists delivering oral health care to older people in care homes with only one focused on barriers experienced by dentists working in their own practice and delivering oral health care to community-dwelling older people. The most common barriers to delivering oral health care to older people were identified respectively as: the lack of adequate equipment in a care home and no area for treatment available (n = 4) and the lack of adequate reimbursement for working in a care home (n = 5). In addition, the inadequate training and experience in delivering oral health care to older care home residents (n = 2) were mentioned. Four publications indicated the loss of time from private practice as a barrier to delivering oral health care in a care home. Most articles retrieved described barriers experienced by dentists delivering oral health in care homes: much less is known about oral health care for community-dwelling older people. Therefore, we suggest that additional research should be initiated to investigate in more detail the barriers dentists experience in delivering oral health care to older people in their own dental practices.

  1. Knowledge of intensive care nurses in selected care areas ...

    African Journals Online (AJOL)

    ICUs) in respect of pain management, glycaemic control and weaning from mechanical ventilation. Methods. An analytical, cross-sectional survey design was used. All ICU-trained and non-ICU-trained registered nurses (N=136) working in the ...

  2. Solar Energy Education. Reader, Part II. Sun story. [Includes glossary

    Energy Technology Data Exchange (ETDEWEB)

    1981-05-01

    Magazine articles which focus on the subject of solar energy are presented. The booklet prepared is the second of a four part series of the Solar Energy Reader. Excerpts from the magazines include the history of solar energy, mythology and tales, and selected poetry on the sun. A glossary of energy related terms is included. (BCS)

  3. The epidemiology of skin care provided by nurses at home: a multicentre prevalence study.

    Science.gov (United States)

    Kottner, Jan; Boronat, Xavier; Blume-Peytavi, Ulrike; Lahmann, Nils; Suhr, Ralf

    2015-03-01

    The aim of this study was to estimate the frequencies and patterns of skin care and applied skin care products in the home care nursing setting in Germany. Skin care belongs to the core activities of nursing practice. Especially in aged and long-term care settings, clients are vulnerable to various skin conditions. Dry skin is one of the most prevalent problems. Using mild skin cleansers and the regular application of moisturizing leave-on products is recommended. Until today, there are no quantitative empirical data about nursing skin care practice at home in the community. A multicentre cross-sectional study was conducted in July 2012. Home care clients from the German home care nursing setting were randomly selected. Instructed nurse raters performed the data collection using standardized forms. Variables included demographics, skin care needs and skin caring activities. Approximately 60% of home care clients received skin care interventions. The majority were washed and two-thirds received a leave-on product once daily. There was large heterogeneity in cleansing and skin care product use. Most often the product labels were unknown or product types were selected haphazardly. Skin care interventions play a significant role in home care and nurses have a considerable responsibility for skin health. Skin care provided does not meet recent recommendations. The importance of targeted skin cleansing and care might be underestimated. There are a confusing variety of skin care products available and often the labels provide little information regarding the ingredients or guidance about how they affect skin health. © 2014 John Wiley & Sons Ltd.

  4. A highly active nickel electrocatalyst shows excellent selectivity for CO2 reduction in acidic media? ?Electronic supplementary information (ESI) available: Including full experimental details, surface coverage measurements and supporting electrochemical measurements. See DOI: 10.1039/c5sc03225c Click here for additional data file.

    OpenAIRE

    Neri, Gaia; Aldous, Iain M.; Walsh, James J.; Hardwick, Laurence J.; Cowan, Alexander J.

    2015-01-01

    The development of selective electrocatalysts for CO2 reduction in water offers a sustainable route to carbon based fuels and feedstocks. However, molecular catalysts are typically studied in non-aqueous solvents, in part to avoid competitive H2 evolution. [Ni(cyclam)]2+ (1) is one of the few known electrocatalysts that operate in water and 30 years after its report its activity remains a rarely surpassed benchmark. Here we report that [Ni(cyclam-CO2H)]2+ (cyclam-CO2H = 1,4,8,11-tetraazacyclo...

  5. Compressors selection and sizing

    CERN Document Server

    Brown, Royce N

    2005-01-01

    This practical reference provides in-depth information required to understand and properly estimate compressor capabilities and to select the proper designs. Engineers and students will gain a thorough understanding of compression principles, equipment, applications, selection, sizing, installation, and maintenance. The many examples clearly illustrate key aspects to help readers understand the ""real world"" of compressor technology.Compressors: Selection and Sizing, third edition is completely updated with new API standards. Additions requested by readers include a new section on di

  6. [The quality of chronic care in Germany].

    Science.gov (United States)

    Fullerton, Birgit; Nolte, Ellen; Erler, Antje

    2011-01-01

    Over the last ten years changes in the legal framework of the German health care system have promoted the development of new health service models to improve chronic care. Recent innovations include the nation-wide introduction of disease management programmes (DMPs), integrated care contracts, community nurse programmes, the introduction of General Practitioner (GP)-centred care contracts, and new opportunities to offer interdisciplinary outpatient care in polyclinics. The aim of this article is to describe the recent developments regarding both the implementation of new health care models by statutory health insurance companies and their evaluation. As part of a European project on the development and validation of disease management evaluation methods (DISMEVAL), we carried out a selective literature search to identify relevant models and evaluation studies. However, on the basis of the currently available evaluation and study results it is difficult to judge whether these developments have actually led to an improvement in the quality of chronic care in Germany. Only for DMPs, evaluation is legally mandatory; its methods are inappropriate, though, for studying the effectiveness of DMPs. Further study results on the effectiveness of DMPs mostly focus on the DMP Diabetes mellitus type II and show consistent improvements regarding process parameters such as regular routine examinations, adherence to treatment guidelines, and quality of life. More research will be needed to determine whether DMPs can also help reduce the incidence of secondary disease and mortality in the long term. Copyright © 2011. Published by Elsevier GmbH.

  7. Relación entre el estado nutricional y el riesgo de presentar úlceras por presión en pacientes incluidos en el programa de atención domiciliaria = Relationship between nutritional status and the risk of having pressure ulcers in patients included in a home care program

    NARCIS (Netherlands)

    Sancho, A.; Albiol, R.; Mach Casellas, N.

    2012-01-01

    Objective: The objective of the present study was to evaluate the relationship between the nutritional status and the risk of pressure ulcers (PU) in patients within home care programs (ATDOM). We also evaluated the relationship between the level of cognitive impairment, physical dependence,

  8. Sexually transmitted infections, including HIV, in the Netherlands in 2006

    NARCIS (Netherlands)

    MG van Veen; FDH Koedijk; IVF van der Broek; ELM Op de Coul; IM de Boer; AI van Sighem; MAB van der Sande; soa-centra; Stichting HIV Monitoring; EPI/Cib

    2007-01-01

    The nationally covered low threshold STI centres offering STI care targeted at high risk groups, provide surveillance data to monitor national trends in STI, including HIV. In 2006, chlamydia remained the most commonly diagnosed bacterial STI in the Netherlands in the STI centres, in spite of

  9. An Integrated Biochemistry Laboratory, Including Molecular Modeling

    Science.gov (United States)

    Hall, Adele J. Wolfson Mona L.; Branham, Thomas R.

    1996-11-01

    The dilemma of designing an advanced undergraduate laboratory lies in the desire to teach and reinforce basic principles and techniques while at the same time exposing students to the excitement of research. We report here on a one-semester, project-based biochemistry laboratory that combines the best features of a cookbook approach (high success rate, achievement of defined goals) with those of an investigative, discovery-based approach (student involvement in the experimental design, excitement of real research). Individual modules may be selected and combined to meet the needs of different courses and different institutions. The central theme of this lab is protein purification and design. This laboratory accompanies the first semester of biochemistry (Structure and Function of Macromolecules, a course taken mainly by junior and senior chemistry and biological chemistry majors). The protein chosen as the object of study is the enzyme lysozyme, which is utilized in all projects. It is suitable for a student lab because it is easily and inexpensively obtained from egg white and is extremely stable, and its high isoelectric point (pI = 11) allows for efficient separation from other proteins by ion-exchange chromatography. Furthermore, a literature search conducted by the resourceful student reveals a wealth of information, since lysozyme has been the subject of numerous studies. It was the first enzyme whose structure was determined by crystallography (1). Hendrickson et al. (2) have previously described an intensive one-month laboratory course centered around lysozyme, although their emphasis is on protein stability rather than purification and engineering. Lysozyme continues to be the focus of much exciting new work on protein folding and dynamics, structure and activity (3 - 5). This lab course includes the following features: (i) reinforcement of basic techniques, such as preparation of buffers, simple enzyme kinetics, and absorption spectroscopy; (ii

  10. Nurse leaders as managers of ethically sustainable caring cultures.

    Science.gov (United States)

    Salmela, Susanne; Koskinen, Camilla; Eriksson, Katie

    2017-04-01

    The aim of this study was to identify the distinctive foundations of the care culture and how nurse leaders (NL) can manage and strengthen these in a quest for ethically sustainable caring cultures. Sustainability presupposes an ethical leadership, a management of the good care and a well-educated staff, but research on NLs as managers of ethically sustainable caring cultures is not available. The study has a quantitative design with elements of a qualitative research approach. Data were collected through a web-based questionnaire sent to staff at eight selected units at a hospital in western Finland during September 2013; the reply rate was 32%. The data material was comprised of opinion questions, the ranking of values and two open-ended questions on lodestars in care and ethical principles in care work. NLs manage a care culture that rests on a solid foundation, where staff are co-creators of an ethically sustainable caring culture that includes good traditions for the praxis of care. NLs as managers are therefore responsible for realizing and passing on ethically sustainable caring cultures and creating prerequisites for staff's growth and development. The basis of good care, patient safety and sustainability is comprised of ethics with a respectful and dignified care that is evidence-based and economically stable. Through their management NLs have a responsibility to nurture and protect the core of caring and create contextual, professional and cultural prerequisites to maintain the core and art of caring as well as care staff's ethical and professional competence. © 2016 John Wiley & Sons Ltd.

  11. Pediatric Primary Care as a Component of Systems of Care

    Science.gov (United States)

    Brown, Jonathan D.

    2010-01-01

    Systems of care should be defined in a manner that includes primary care. The current definition of systems of care shares several attributes with the definition of primary care: both are defined as community-based services that are accessible, accountable, comprehensive, coordinated, culturally competent, and family focused. However, systems of…

  12. Palliative care needs in Malawi: Care received by people living with HIV

    Directory of Open Access Journals (Sweden)

    Esmie Mkwinda

    2016-02-01

    Full Text Available Background: Infection with human immunodeficiency virus (HIV has changed from an acute to a chronic illness in the past decade, because of highly active antiretroviral therapy (ART. Malawi’s response to the HIV challenge included provision of ART for people living with HIV or AIDS (PLWHA, which significantly reduced HIV- and AIDS-related mortality. In addition, palliative care for PLWHA was introduced as a strategy that improves the success of ART.Objective: The purpose of the study was to explore the needs of PLWHA concerning care received from primary caregivers and palliative care nurses in Malawi.Methods: A qualitative, explorative design was used and 18 participants were selected purposefully and interviewed individually using a semi-structured interview guide. Data were analysed using NVivo software package version 10.Results: Results revealed that PLWHA needed physical care from the primary caregivers due to severity of illness, integration of healthcare services, and continuity of care and proper care from nurses. They also needed knowledge from nurses in several areas which affected decision-making and needed financial and nutritional support.Conclusion: More could be done in meeting needs of PLWHA to improve their health and survival and assist them to achieve a better quality of life.Keywords: people living with HIV/AIDS, palliative care, palliative care nurse, primary caregiver, support

  13. Youth with special health care needs: transition to adult health care services.

    Science.gov (United States)

    Oswald, Donald P; Gilles, Donna L; Cannady, Mariel S; Wenzel, Donna B; Willis, Janet H; Bodurtha, Joann N

    2013-12-01

    Transition to adult services for children and youth with special health care needs (CYSHCN) has emerged as an important event in the life course of individuals with disabilities. Issues that interfere with efficient transition to adult health care include the perspectives of stakeholders, age limits on pediatric service, complexity of health conditions, a lack of experienced healthcare professionals in the adult arena, and health care financing for chronic and complex conditions. The purposes of this study were to develop a definition of successful transition and to identify determinants that were associated with a successful transition. The 2007 Survey of Adult Transition and Health dataset was used to select variables to be considered for defining success and for identifying predictors of success. The results showed that a small percentage of young adults who participated in the 2007 survey had experienced a successful transition from their pediatric care.

  14. Determining level of care appropriateness in the patient journey from acute care to rehabilitation

    Directory of Open Access Journals (Sweden)

    Bashford Guy

    2011-10-01

    Full Text Available Abstract Background The selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care and rehabilitation teams around patient appropriateness and readiness for transfer. Methods Cohort study of patients in a large acute referral hospital in Australia followed with the InterQual utilization review tool, modified to also include reasons why utilization criteria are not met. Additional data on team decision making about appropriateness for rehabilitation, and readiness for transfer, were collected on a subset of patients. Results There were 696 episodes of care (7189 bed days. Days meeting acute level of care criteria were 56% (stroke, hip fracture and joint replacement patients and 33% (other patients, from the time of referral. Most inappropriate days in acute care were due to delays in processes/scheduling (45% or being more appropriate for rehabilitation or lower level of care (30%. On the subset of patients, the acute care team and the utilization review tool deemed patients ready for rehabilitation transfer earlier than the rehabilitation team (means of 1.4, 1.3 and 4.0 days from the date of referral, respectively. From when deemed medically stable for transfer by the acute care team, 28% of patients became unstable. From when deemed stable by the rehabilitation team or utilization review, 9% and 11%, respectively, became unstable. Conclusions A high proportion of patient days did not meet acute level of care criteria, due predominantly to inefficiencies in care processes, or to patients being more appropriate for an alternative level of

  15. Women: A Select Bibliography.

    Science.gov (United States)

    Kusnerz, Peggy A., Comp.; Pollack, Ann M., Comp.

    This select bibliography lists books, monographs, journals and newsletters which relate to feminism, women's studies, and other perspectives on women. Selections are organized by topic: general, bibliographies, art and literature, biography/autobiography, economics, education, family and marriage, history, politics and sex roles. Also included is…

  16. Review of Aviator Selection

    Science.gov (United States)

    2006-07-01

    achieved by a battery that reliably and accurately measures general intelligence: psychomotor skills; selective and divided attention; working memory ...aviator selection, including the Minnesota Multiphasic Personality Inventory (Caldwell, O’Hara, Caldwell, Stephens, & Krueger, 1993), Eysenck Personality...administered tests measuring psychomotor skills, short-term memory , time- sharing ability, and attitudes toward risk-taking. Across several studies, the

  17. Selective Fatalism.

    OpenAIRE

    Sunstein, Cass R

    1998-01-01

    Human beings are selectively fatalistic. Some risks appear as "background noise," whereas other, quantitatively identical risks cause enormous concern. This essay explores the reasons for selective fatalism and possible legal responses. Sometimes selective fatalism is a product of distributional issues, as people focus especially on risks that face particular groups; sometimes people adapt their preferences and beliefs so as to reduce concern with risks that they perceive themselves unable to...

  18. Finnish care integrated?

    Directory of Open Access Journals (Sweden)

    Jouni Niskanen

    2002-06-01

    Full Text Available The public Finnish social and health care system has been challenged by the economic crisis, administrative reforms and increased demands. Better integration as a solution includes many examples, which have been taken to use. The most important are the rewritten national and municipals strategies and quality recommendations, where the different sectors and the levels of care are seen as one entity. Many reorganisations have taken place, both nationally and locally, and welfare clusters have been established. The best examples of integrated care are the forms of teamwork, care management, emphasis on non-institutional care and the information technology.

  19. Nurses\\' perception of caring behaviors in intensive care units in hospitals of Lorestan University of Medical Sciences, Iran

    Directory of Open Access Journals (Sweden)

    Asadi SE

    2014-11-01

    Full Text Available Background and Objective: Caring is the core of nursing however, different individules have different perceptions of it. Continuous assessment and measurement of caring behaviors results in the identification of their problems. The careful planning of interventions and problem solving will improve care. The aim of this study was to identify nurses' perception of caring behaviors in the intensive care units. Materials and Method: In this descriptive-analytic study, 140 nurses were selected from intensive care units of hospitals affiliated to Lorestan University of Medical Sciences, Iran, using the census method in 2012. The data collection tool was the Caring Behaviors Inventory for Elders (CBI-E. This questionnaire consisted of two parts including demographic information and 28 items related to care. Face and content validity of the Persian version of the questionnaire were provided by professionals, and after deletion of 4 items a 24-item questionnaire was provided. Cronbach's alpha coefficient was calculated to assess reliability (&alpha = 0.71. Data were analyzed using SPSS software version 18 and descriptive-analytic statistics (Kruskal-Wallis test and Mann-Whitney test. Results: Based on the findings, nurses paid more attention to the physical–technical aspects (95.71 ± 12.76 of care in comparison to its psychosocial aspects (75.41 ± 27.91. Nurses had the highest score in care behavior of "timely performance of medical procedures and medication administration". Conclusion: Since nurses paid more attention to the technical aspects of care than its psychosocial aspects, by providing nurses with a correct perception of care, patients can be provided with needs-based care. This will increase patient satisfaction with nursing care, and indirectly result in the positive attitude of patients and society toward the nursing profession and its services. Moreover, nursing education officials can use these results to assist nurses in meeting

  20. Systematic Quality Monitoring For Specialized Palliative Care Services: Development of a Minimal Set of Quality Indicators for Palliative Care Study (QPAC).

    Science.gov (United States)

    Leemans, Kathleen; Deliens, L; Van den Block, L; Vander Stichele, R; Francke, A L; Cohen, J

    2017-07-01

    A feasibility evaluation of a comprehensive quality indicator set for palliative care identified the need for a minimal selection of these indicators to monitor quality of palliative care services with short questionnaires for the patients, caregivers, and family carers. To develop a minimal indicator set for efficient quality assessment in palliative care. A 2 round modified Research ANd Development corporation in collaboration with the University of California at Los Angeles (RAND/UCLA) expert consultation. Thirteen experts in palliative care (professionals and patient representatives). In a home assignment, experts were asked to score 80 developed indicators for "priority" to be included in the minimal set on a scale from 0 (lowest priority) to 9 (highest priority). The second round consisted of a plenary meeting in which the minimal set was finalized. Thirty-nine of the 80 indicators were discarded, while 19 were definitely selected after the home assignment, and 22 were proposed for discussion during the meeting; 12 of these survived the selection round. The final minimal indicator set for palliative care consists of 5 indicators about the physical aspects of care; 6 about the psychosocial aspects of care; 13 about information, communication, and care planning; 5 about type of care; and 2 about continuity of care. A minimal set of 31 indicators reflecting all the important issues in palliative care was created for palliative care services to assess the quality of their care in a quick and efficient manner. Additional topic-specific optional modules are available for more thorough assessment of specific aspects of care.

  1. Care partner: A concept analysis.

    Science.gov (United States)

    Bennett, Paul N; Wang, Wei; Moore, Mel; Nagle, Cate

    The use of the term care partner has increased, particularly in the chronic disease literature; however, the concept has not been well defined. The purpose of this concept analysis was to define and assist nurses to better understand the concept of care partner. The method by Walker and Avant was used for this literature-based concept analysis. Care partnering includes providing assistance to an individual with a health condition to meet their self-care deficits, the commitment to a care partner relationship, and the recognition that people with self-care deficits are care partners contributing to their own care. Emphasizing the care partner dyad in nursing may contribute to improved patient care outcomes both in the acute and chronic settings. It is recommended that nurses view the person with the condition as a contributor and partner in their own care in the context of a larger care partnership. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Diabetes Care in Brazil.

    Science.gov (United States)

    Coutinho, Walmir F; Silva Júnior, Wellington Santana

    2015-01-01

    The diabetes epidemic affects most countries across the world and is increasing at alarming rates in Latin America. Nearly 12 million individuals have diabetes in Brazil, and the current prevalence ranges from 6.3% to 13.5%, depending on the region and the diagnostic criteria adopted in each study. To provide an overview of diabetes care in Brazil, focusing on studies of diabetes epidemiology, prevalence of patients within the standard targets of care, and economic burden of diabetes and its complications. SciELO and PubMed searches were performed for the terms "diabetes," "Brazil," "Brazilian," and "health system"; relevant literature from 1990 to 2015 was selected. Additional articles identified from reference list searches were also included. All articles selected were published in Portuguese and/or English. Recent studies detected a prevalence of gestational diabetes mellitus of nearly 20%. Among patients with type 1 diabetes, almost 90% fail to reach target of glycemic control, with less than 30% receiving treatment for both hypertension and dyslipidemia. More than 75% of patients with type 2 diabetes are either overweight or obese. Most of these patients fail to reach glycemic targets (42.1%) and less than 30% reached the target for systolic and diastolic blood pressure, body mass index, or low-density lipoprotein cholesterol. Only 0.2% of patients reach all these anthropometric and metabolic targets. Brazil is the fourth country in the world in number of patients with diabetes. Regardless of the diabetes type, the majority of patients do not meet other metabolic control goals. The economic burden of diabetes and its complications in Brazil is extremely high, and more effective approaches for preventions and management are urgently needed. Copyright © 2015. Published by Elsevier Inc.

  3. Quantum interaction. Selected papers

    Energy Technology Data Exchange (ETDEWEB)

    Atmanspacher, Harald [Eidgenoessische Technische Hochschule, Zurich (Switzerland); Haven, Emmanuel [Leicester Univ. (United Kingdom). School of Management; Kitto, Kirsty [Queensland Univ. of Technology, Brisbane, QLD (Australia); Raine, Derek (ed.) [Leicester Univ. (United Kingdom). Centre for Interdisciplinary Science

    2014-07-01

    This book constitutes the refereed proceedings of the 7th International Conference on Quantum Interaction, QI 2013, held in Leicester, UK, in July 2013. The 31 papers presented in this book were carefully selected from numerous submissions. The papers cover various topics on quantum interaction and revolve around four themes: information processing/retrieval/semantic representation and logic; cognition and decision making; finance/economics and social structures and biological systems.

  4. Spiritual Care Education of Health Care Professionals

    Directory of Open Access Journals (Sweden)

    Donia Baldacchino

    2015-05-01

    Full Text Available Nurses and health care professionals should have an active role in meeting the spiritual needs of patients in collaboration with the family and the chaplain. Literature criticizes the impaired holistic care because the spiritual dimension is often overlooked by health care professionals. This could be due to feelings of incompetence due to lack of education on spiritual care; lack of inter-professional education (IPE; work overload; lack of time; different cultures; lack of attention to personal spirituality; ethical issues and unwillingness to deliver spiritual care. Literature defines spiritual care as recognizing, respecting, and meeting patients’ spiritual needs; facilitating participation in religious rituals; communicating through listening and talking with clients; being with the patient by caring, supporting, and showing empathy; promoting a sense of well-being by helping them to find meaning and purpose in their illness and overall life; and referring them to other professionals, including the chaplain/pastor. This paper outlines the systematic mode of intra-professional theoretical education on spiritual care and its integration into their clinical practice; supported by role modeling. Examples will be given from the author’s creative and innovative ways of teaching spiritual care to undergraduate and post-graduate students. The essence of spiritual care is being in doing whereby personal spirituality and therapeutic use of self contribute towards effective holistic care. While taking into consideration the factors that may inhibit and enhance the delivery of spiritual care, recommendations are proposed to the education, clinical, and management sectors for further research and personal spirituality to ameliorate patient holistic care.

  5. SEEPAGE MODEL FOR PA INCLUDING DRIFT COLLAPSE

    International Nuclear Information System (INIS)

    C. Tsang

    2004-01-01

    The purpose of this report is to document the predictions and analyses performed using the seepage model for performance assessment (SMPA) for both the Topopah Spring middle nonlithophysal (Tptpmn) and lower lithophysal (Tptpll) lithostratigraphic units at Yucca Mountain, Nevada. Look-up tables of seepage flow rates into a drift (and their uncertainty) are generated by performing numerical simulations with the seepage model for many combinations of the three most important seepage-relevant parameters: the fracture permeability, the capillary-strength parameter 1/a, and the percolation flux. The percolation flux values chosen take into account flow focusing effects, which are evaluated based on a flow-focusing model. Moreover, multiple realizations of the underlying stochastic permeability field are conducted. Selected sensitivity studies are performed, including the effects of an alternative drift geometry representing a partially collapsed drift from an independent drift-degradation analysis (BSC 2004 [DIRS 166107]). The intended purpose of the seepage model is to provide results of drift-scale seepage rates under a series of parameters and scenarios in support of the Total System Performance Assessment for License Application (TSPA-LA). The SMPA is intended for the evaluation of drift-scale seepage rates under the full range of parameter values for three parameters found to be key (fracture permeability, the van Genuchten 1/a parameter, and percolation flux) and drift degradation shape scenarios in support of the TSPA-LA during the period of compliance for postclosure performance [Technical Work Plan for: Performance Assessment Unsaturated Zone (BSC 2002 [DIRS 160819], Section I-4-2-1)]. The flow-focusing model in the Topopah Spring welded (TSw) unit is intended to provide an estimate of flow focusing factors (FFFs) that (1) bridge the gap between the mountain-scale and drift-scale models, and (2) account for variability in local percolation flux due to

  6. Critical Care

    Science.gov (United States)

    Critical care helps people with life-threatening injuries and illnesses. It might treat problems such as complications from surgery, ... attention by a team of specially-trained health care providers. Critical care usually takes place in an ...

  7. Site selection

    CERN Multimedia

    CERN PhotoLab

    1968-01-01

    To help resolve the problem of site selection for the proposed 300 GeV machine, the Council selected "three wise men" (left to right, J H Bannier of the Netherlands, A Chavanne of Switzerland and L K Boggild of Denmark).

  8. Benchmark selection

    DEFF Research Database (Denmark)

    Hougaard, Jens Leth; Tvede, Mich

    2002-01-01

    Within a production theoretic framework, this paper considers an axiomatic approach to benchmark selection. It is shown that two simple and weak axioms; efficiency and comprehensive monotonicity characterize a natural family of benchmarks which typically becomes unique. Further axioms are added...... in order to obtain a unique selection...

  9. Core measures for developmentally supportive care in neonatal intensive care units: theory, precedence and practice.

    Science.gov (United States)

    Coughlin, Mary; Gibbins, Sharyn; Hoath, Steven

    2009-10-01

    This paper is a discussion of evidence-based core measures for developmental care in neonatal intensive care units. Inconsistent definition, application and evaluation of developmental care have resulted in criticism of its scientific merit. The key concept guiding data organization in this paper is the United States of America's Joint Commission's concept of 'core measures' for evaluating and accrediting healthcare organizations. This concept is applied to five disease- and procedure-independent measures based on the Universe of Developmental Care model. Electronically accessible, peer reviewed studies on developmental care published in English were culled for data supporting the selected objective core measures between 1978 and 2008. The quality of evidence was based on a structured predetermined format that included three independent reviewers. Systematic reviews and randomized control trials were considered the strongest level of evidence. When unavailable, cohort, case control, consensus statements and qualitative methods were considered the strongest level of evidence for a particular clinical issue. Five core measure sets for evidence-based developmental care were evaluated: (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centred care, and (5) the healing environment. These five categories reflect recurring themes that emerged from the literature review regarding developmentally supportive care and quality caring practices in neonatal populations. This practice model provides clear metrics for nursing actions having an impact on the hospital experience of infant-family dyads. Standardized disease-independent core measures for developmental care establish minimum evidence-based practice expectations and offer an objective basis for cross-institutional comparison of developmental care programmes.

  10. A randomized pilot study of a comprehensive postoperative exercise program compared with usual care following primary total hip arthroplasty in subjects less than 65 years of age: feasibility, selection of outcome measures and timing of assessment.

    Science.gov (United States)

    Beaupre, Lauren A; Masson, Edward C O; Luckhurst, Barbara J; Arafah, Orfan; O'Connor, Gregory J

    2014-06-02

    Total Hip Arthroplasty (THA) is being used more commonly in younger higher demand patients. The purpose of this randomized pilot study was to explore a) feasibility of comprehensive postoperative rehabilitation compared to usual care following primary THA in subjects program (Intervention) or usual postoperative care (Control). Subjects were assessed preoperatively, six-weeks postoperatively (Pre-intervention) and four and 12 months postoperatively (Post-intervention). Self-report measures were the Western Ontario McMaster Osteoarthritis Index (WOMAC) and Rand 36-Item Health Survey (RAND-36). Performance-based measures included lower extremity strength, walking speed and endurance, and gait laboratory assessment. Ten Control and 11 Intervention subjects with an average age of 53.4 (SD9.3) years were randomized. All Intervention subjects completed the program without adverse effects. Although no statistically significantly results were reported, four months postoperatively, Intervention subjects had clinically important differences (CID) in strength compared with Control subjects. Walking endurance, WOMAC and RAND scores improved significantly with no CID noted between groups. Ten (48%) subjects reported a ceiling effect on the WOMAC (9 (43%) subjects on Pain; 1 (5%) subject on Function). No group CID were noted in gait measures. Our recommendations would be that performance-based strength measures should be considered for the primary outcome in this younger cohort. Because of the ceiling effects with WOMAC Pain, a different pain measure is indicated. Other more challenging functional performance-based tests should be considered such as a more prolonged endurance test. There is merit in one-year follow-up as strength improved after four months in both groups.

  11. Improving eye care in the primary health care setting

    Directory of Open Access Journals (Sweden)

    M de Wet

    2000-09-01

    Full Text Available One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO’s providing eye care, decentralisation of services and the establishment of an eye care committee in the region.

  12. Financial Care for Older Adults With Dementia.

    Science.gov (United States)

    Pan, Xi; Lee, Yeonjung; Dye, Cheryl; Roley, Laurie Theriot

    2017-06-01

    This article describes an examination of the sociodemographic characteristics of adult children, particularly Baby Boomer caregivers, who provide financial care to older parents with dementia. The sample including 1,011adult children dementia caregivers aged 50 to 64 years is selected from a nationally representative sample in the 2010 Health and Retirement Study. Exact logistic regression revealed that race, provision of financial assistance to caregiver children, and the number of their children are significantly associated with financial caregiving of parents. Non-White caregivers are more likely to provide financial care to their parents or parents-in-law with dementia; those who have more children and provide financial assistance to their children are less likely to provide financial care to parents with dementia. The current findings present valuable new information on the sociodemographic characteristics of adult children who provide financial assistance to parents with dementia and inform research, programs, and services on dementia caregiving.

  13. Transforming dementia care in an NHS trust.

    Science.gov (United States)

    Robinson, Jennifer; Longden, Jane; Murphy, Jayne

    2015-02-01

    Walsall Healthcare NHS Trust was one of nine trusts selected to take part in the RCN development programme transforming dementia care in hospitals during 2013. The programme aimed to improve the experience of care for people with dementia and their carers in hospital. This article outlines a two-day training programme delivered to staff on two pilot wards with a larger cohort of adults with dementia than other wards in Manor Hospital. A range of staff were trained including nurses, clinical support workers and allied health professionals and also, in a bespoke format, housekeepers, porters and security staff. The programme has led to a noticeable cultural change and significantly improved care and management of patients with cognitive impairment and/or dementia on the two pilot wards. As a result, the training programme has been implemented more widely across the hospital.

  14. Lower Costs, Better Care- Reforming Our Health Care Delivery

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Affordable Care Act includes tools to improve the quality of health care that can also lower costs for taxpayers and patients. This means avoiding costly...

  15. The palliative care needs for those advanced neurology patients on mechanical ventilator support.

    Science.gov (United States)

    Kwok, Tsz Kin

    2017-09-13

    There are mainly two types of needs for the ventilator users with severe neurological diseases: respiratory related needs include mode of ventilation selection, mode of ventilator prescription, maintaining lung recruitment and good airway clearance; non-respiratory related needs include substantial nursing care, adequate nutrition, accessible communication and psychological support. All these are important to maintain the quality of life of these patients.

  16. Selective mutism

    Science.gov (United States)

    ... have a family history of selective mutism, extreme shyness, or anxiety disorders, which may increase their risk ... well Inability to speak in certain social situations Shyness This pattern must be seen for at least ...

  17. Selective Enumeration

    National Research Council Canada - National Science Library

    Damon, Craig

    2000-01-01

    Selective enumeration is an approach to pruning search trees with the goal of preventing the generation of extraneous paths in the search tree, rather than generating paths that will later be pruned...

  18. Informal Care

    NARCIS (Netherlands)

    J.M. Timmermans

    2003-01-01

    Original title: Mantelzorg. Each year, millions of Dutch people care for relatives and friends who are sick, disabled or dying. This report describes those people, the people to whom they provide care and the nature and extent of that care. Caring for someone is found to be a burdensome

  19. Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach

    Directory of Open Access Journals (Sweden)

    Cranley Lisa A

    2012-09-01

    Full Text Available Abstract Background In Canada, healthcare aides (also referred to as nurse aides, personal support workers, nursing assistants are unregulated personnel who provide 70-80% of direct care to residents living in nursing homes. Although they are an integral part of the care team their contributions to the resident care planning process are not always acknowledged in the organization. The purpose of the Safer Care for Older Persons [in residential] Environments (SCOPE project was to evaluate the feasibility of engaging front line staff (primarily healthcare aides to use quality improvement methods to integrate best practices into resident care. This paper describes the process used by teams participating in the SCOPE project to select clinical improvement areas. Methods The study employed a collaborative approach to identify clinical areas and through consensus, teams selected one of three areas. To select the clinical areas we recruited two nursing homes not involved in the SCOPE project and sampled healthcare providers and decision-makers within them. A vote counting method was used to determine the top five ranked clinical areas for improvement. Results Responses received from stakeholder groups included gerontology experts, decision-makers, registered nurses, managers, and healthcare aides. The top ranked areas from highest to lowest were pain/discomfort management, behaviour management, depression, skin integrity, and assistance with eating. Conclusions Involving staff in selecting areas that they perceive as needing improvement may facilitate staff engagement in the quality improvement process.

  20. [Subsequent reoperation obstetric hysterectomy and selective ligation of hypogastric arteries].

    Science.gov (United States)

    López-Vera, E A; Reynosa-Oviedo, Y; Treviño-Báez, J D; Martínez-Salazar, G J; González-Díaz, O A; Cortés-Flores, R

    2016-09-01

    Bleeding in pregnancy, childbirth or postpartum period is an emergency. Selective internal iliac (hypogastric) arteries ligation is a surgical therapy in selected cases of obstetric massive hemorrhage. It had proven to be safe. To evaluate the risk for re-intervention for post-operatory bleeding in patients with obstetric hysterectomy and selective hypogastric arteries ligation. Cross-sectional study including women diagnosed with obstetric hysterectomy with and without selective arterial ligation as a factor to assess the risk of re-intervention, from December 2013 to December 2014, at High Specialty Medical Unit 23 of Gynaecology and Obstetrics, in Monterrey, which is a tertiary care medical center. Those patients with 28 weeks of gestation or more were selected. The postoperative blood loss was quantified by open drainage system (Penrose). We performed 88 hysterectomies in the study period. We included 45 women according to selection criteria. The average was 31.9 ± 5.48 years old. Performing a selective hypogastric arteries ligation may be a protective factor (p<0.05) for re-intervention as a consequence of postoperative bleeding. Selective arterial ligation is a factor that could help to prevent a re-intervention. A continuous training of physicians and residents of Gynecology and Obstetrics is essential to ensure the reduction in morbidity and maternal mortality.

  1. [Improving population mental health by integrating mental health care into primary care].

    Science.gov (United States)

    Menear, Matthew; Gilbert, Michel; Fleury, Marie-Josée

    Objective The objectives of this review were to identify and compare major international initiatives aiming to integrate mental health services in primary care and to summarize the lessons learned for similar integration efforts in the province of Quebec, Canada.Methods We conducted a narrative review of the literature guided by a conceptual framework drawn from the literature on integrated care. We identified relevant initiatives to support primary mental health care integration through Pubmed searches and through previous systematic reviews on this topic. We then selected those initiatives that provided sufficient details on their key characteristics, outcomes, and implementation issues (e.g. barriers, facilitators). We focused our analysis on large-scale initiatives as these offered the most potential for impacts on population mental health. This process resulted in the selection of 20 initiatives that were described in 153 articles and reports. Our synthesis was guided by our conceptual framework, which distinguishes between five types of integration, namely clinical, professional, organizational, systemic and functional integration.Results Of the 20 primary mental health care integration initiatives, 3 targeted youth, 14 targeted adults or multiple age groups, and 3 were targeted towards seniors. Most initiatives aimed to implement collaborative care models for common mental disorders in primary care. Other initiatives focused on co-locating mental health professionals in primary care, supporting the emergence of a diversity of integration projects led by community-based primary care practices, or the merger of primary care and mental health organizations. Most initiatives were based on clinical, professional and functional integration strategies. Across initiatives, a range of positive outcomes were reported, notably to the accessibility and quality of services, the satisfaction of patients and providers, the costs of services, and impacts on patients' health

  2. Prenatal Care: Second Trimester Visits

    Science.gov (United States)

    ... Pregnancy week by week During the second trimester, prenatal care includes routine lab tests and measurements of your ... too. By Mayo Clinic Staff The goal of prenatal care is to ensure that you and your baby ...

  3. Prenatal Care: Third Trimester Visits

    Science.gov (United States)

    ... Pregnancy week by week During the third trimester, prenatal care might include vaginal exams to check the baby's position. By Mayo Clinic Staff Prenatal care is an important part of a healthy pregnancy, ...

  4. Allegheny County Primary Care Access

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The data on health care facilities includes the name and location of all the hospitals and primary care facilities in Allegheny County. The current listing of...

  5. Palliative care and neurology

    Science.gov (United States)

    Boersma, Isabel; Miyasaki, Janis; Kutner, Jean

    2014-01-01

    Palliative care is an approach to the care of patients and families facing progressive and chronic illnesses that focuses on the relief of suffering due to physical symptoms, psychosocial issues, and spiritual distress. As neurologists care for patients with chronic, progressive, life-limiting, and disabling conditions, it is important that they understand and learn to apply the principles of palliative medicine. In this article, we aim to provide a practical starting point in palliative medicine for neurologists by answering the following questions: (1) What is palliative care and what is hospice care? (2) What are the palliative care needs of neurology patients? (3) Do neurology patients have unique palliative care needs? and (4) How can palliative care be integrated into neurology practice? We cover several fundamental palliative care skills relevant to neurologists, including communication of bad news, symptom assessment and management, advance care planning, caregiver assessment, and appropriate referral to hospice and other palliative care services. We conclude by suggesting areas for future educational efforts and research. PMID:24991027

  6. Health system characteristics of quality care delivery: a comparative case study examination of palliative care for cancer patients in four regions in Ontario, Canada.

    Science.gov (United States)

    Sussman, Jonathan; Barbera, Lisa; Bainbridge, Daryl; Howell, Doris; Yang, Jinghao; Husain, Amna; Librach, S Lawrence; Viola, Raymond; Walker, Hugh

    2012-06-01

    A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described. The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths. A comparative case study evaluation was conducted of 'palliative care' in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed. 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services. The four palliative care regional 'systems' examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems.

  7. Integrating rheumatology care in the community: can shared care work?

    Directory of Open Access Journals (Sweden)

    Anita YN Lim

    2015-08-01

    Full Text Available Introduction: Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits. Methods: Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow. Results: About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients and private family physicians independently predicted successful shared care, defined as one cycle of alternating care. Discussion: Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care. Conclusions: Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

  8. Integrating rheumatology care in the community: can shared care work?

    Directory of Open Access Journals (Sweden)

    Anita YN Lim

    2015-08-01

    Full Text Available Introduction: Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, “right siting” aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits.Methods: Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow.Results: About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients and private family physicians independently predicted successful shared care, defined as one cycle of alternating care.Discussion: Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care.Conclusions: Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

  9. Integrating rheumatology care in the community: can shared care work?

    Science.gov (United States)

    Lim, Anita Yn; Tan, Chuen Seng; Low, Bernadette Pl; Lau, Tang Ching; Tan, Tze Lee; Goh, Lee Gan; Teng, Gim Gee

    2015-01-01

    Singapore's rapidly ageing population and chronic disease burden at public hospital specialist clinics herald a silver tsunami. In Singapore, "right siting" aims to manage stable chronic disease in primary care at a lower cost. To improve the quality of rheumatology care, we created shared care between rheumatologist and family physician to reduce hospital visits. Clinical practice improvement methodology was used to structure shared care of stable patients between hospital rheumatologists and eleven community family physicians; one ran a hospital clinic. A case manager coordinated the workflow. About 220 patients entered shared care over 29 months. Patients without hospital subsidies (private patients) and private family physicians independently predicted successful shared care, defined as one cycle of alternating care. Our shared care model incorporated a case manager, systematic workflows, patient selection criteria, willing family physician partners and rheumatologists in the absence of organizational integration. Health care affordability impacts successful shared care. Government subsidy hindered right siting to private primary care. Financing systems in Singapore, at health policy level, must allow transfer of hospital subsidies to primary care, both private and public, to make it more affordable than hospital care. Structural integration will create a seamless continuum between hospital and primary care.

  10. Creation of a synthetic indicator of quality of care as a clinical management standard in primary care.

    Science.gov (United States)

    Coma, Ermengol; Ferran, Manel; Méndez, Leonardo; Iglesias, Begoña; Fina, Francesc; Medina, Manuel

    2013-12-01

    The development of electronic medical records has allowed the creation of new quality indicators in healthcare. Among them, synthetic indicators facilitate global interpretation of results and comparisons between professionals. A healthcare quality standard (EQA, the Catalan acronym for Estàndard de Qualitat Assistencial) was constructed to serve as a synthetic indicator to measure the quality of care provided by primary care professionals in Catalonia (Spain). The project phases were to establish the reference population; select health problems to be included; define, select and deliberate about subindicators; and construct and publish the EQA. Construction of the EQA involved 107 healthcare professionals, and 91 health problems were included. In addition, 133 experts were consulted, who proposed a total of 339 indicators. After systematic paired comparison, 61 indicators were selected to create the synthetic indicator. The EQA is now calculated on a monthly basis for more than 8000 healthcare professionals using an automated process that extracts data from electronic medical records; results are published on a follow-up website. Along with the use of the online EQA results tool, there has been an ongoing improvement in most of the quality of care indicators. Creation of the EQA has proven to be useful for the measurement of the quality of care of primary care services. Also an improvement trend over 5 years is shown across most of the measured indicators. The online version of this article (doi:10.1186/2193-1801-2-51) contains supplementary material, which is available to authorized users.

  11. Tuberculosis care for pregnant women: a systematic review.

    Science.gov (United States)

    Nguyen, Hang Thanh; Pandolfini, Chiara; Chiodini, Peter; Bonati, Maurizio

    2014-11-19

    Tuberculosis (TB) during pregnancy may lead to severe consequences affecting both mother and child. Prenatal care could be a very good opportunity for TB care, especially for women who have limited access to health services. The aim of this review was to gather and evaluate studies on TB care for pregnant women. We used a combination of the terms "tuberculosis" and "pregnancy", limited to human, to search for published articles. Studies reflecting original data and focusing on TB care for pregnant women were included. All references retrieved were collected using the Reference Manager software (Version 11). Thirty five studies were selected for review and their data showed that diagnosis was often delayed because TB symptoms during pregnancy were not typical. TB prophylaxis and anti-TB therapy appeared to be safe and effective for pregnant women and their babies when suitable follow up and early initiation were present, but the compliance rate to TB prophylaxis is still low due to lack of follow up and referral services. TB care practices in the reviewed studies were in line in principle with the WHO International Standards for Tuberculosis Care (ISTC). Integration of TB care within prenatal care would improve TB diagnosis and treatment for pregnant women. To improve the quality of TB care, it is necessary to develop national level guidelines based on the ISTC with detailed guidelines for pregnant women.

  12. Improved wound care product

    DEFF Research Database (Denmark)

    2012-01-01

    The present invention pertains to use of sodium diacetate (NaHAc 2) as an antimicrobial agent against bacteria growing in biofilms. The aspects of the invention include a wound care product comprising sodium diacetate, a kit comprising a wound care product,and a methodof treating an infected wound....

  13. Care, Europeanization and Gender

    DEFF Research Database (Denmark)

    This book adresses the recent underexamined developments concerning care in Europe, including the negotiations about care at the top EU level to that of individual workers. Through a comparative and interdisciplinary approach, this collection examines and further develops current theoretical and ...

  14. Mental health care roles of non-medical primary health and social care services.

    Science.gov (United States)

    Mitchell, Penny

    2009-02-01

    Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

  15. Long-term acute care hospitals and Georgia Medicaid: Utilization, outcomes, and cost

    Directory of Open Access Journals (Sweden)

    Evan S. Cole

    2016-09-01

    Full Text Available Objectives: Because most research on long-term acute care hospitals has focused on Medicare, the objective of this research is to describe the Georgia Medicaid population who received care at a long-term acute care hospital, the type and volume of services provided by these long-term acute care hospitals, and the costs and outcomes of these services. For those with select respiratory conditions, we descriptively compare costs and outcomes to those of patients who received care for the same services in acute care hospitals. Methods: We describe Georgia Medicaid recipients admitted to a long-term acute care hospital between 2011 and 2012. We compare them to a population of Georgia Medicaid recipients admitted to an acute care hospital for one of five respiratory diagnosis-related groups. Measurements used include patient descriptive information, admissions, diagnosis-related groups, length of stay, place of discharge, 90-day episode costs, readmissions, and patient risk scores. Results: We found that long-term acute care hospital admissions for Medicaid patients were fairly low (470 90-day episodes and restricted to complex cases. We also found that the majority of long-term acute care hospital patients were blind or disabled (71.2%. Compared to patients who stayed at an acute care hospital, long-term acute care hospital patients had higher average risk scores (13.1 versus 9.0, lengths of stay (61 versus 38 days, costs (US$143,898 versus US$115,056, but fewer discharges to the community (28.4% versus 51.8%. Conclusion: We found that the Medicaid population seeking care at long-term acute care hospitals is markedly different than the Medicare populations described in other long-term acute care hospital studies. In addition, our study revealed that Medicaid patients receiving select respiratory care at a long-term acute care hospital were distinct from Medicaid patients receiving similar care at an acute care hospital. Our findings suggest that

  16. Selective internal radiation therapy for liver tumours.

    Science.gov (United States)

    Sundram, Francis X; Buscombe, John R

    2017-10-01

    Primary and secondary liver malignancies are common and associated with a poor prognosis. Surgical resection is the treatment of choice; however, many patients have unresectable disease. In these cases, several liver directed therapies are available, including selective internal radiation therapy (SIRT). SIRT is a multidisciplinary treatment involving nuclear medicine, interventional radiology and oncology. High doses of localised internal radiation are selectively delivered to liver tumour tissues, with relative sparing of adjacent normal liver parenchyma. Side effects are minimal and radiation protection measures following treatment are straightforward. In patients who have progressed following chemotherapy, clinical trials demonstrate prolonged liver progression-free survival. SIRT is offered at 10 centres in England via the NHS England Commissioning through Evaluation programme and is approved by the National Institute for Health and Care Excellence for certain liver malignancies. SIRT holds unique promise for personalised treatment of liver tumours. © Royal College of Physicians 2017. All rights reserved.

  17. How to include farmers in the emission trading system?

    OpenAIRE

    Svendsen, Gert Tinggaard

    2011-01-01

    The EU has committed itself to an ambitious 20% reduction of greenhouse gases (GHG) by 2020 compared to the 1990 emissions level. Moreover, the EU goal beyond 2012 is to strengthen, expand and improve climate change initiatives. Therefore, there is a strong need to consider more carefully how to integrate as many sectors as possible in these efforts. Farmers, however, do not trade GHG under the Kyoto agreement. The idea of including farmers in a national emission trading system has been launc...

  18. The Concept of Ethics in the Intensive Care

    Directory of Open Access Journals (Sweden)

    Kutay Alpir

    2010-12-01

    Full Text Available The concept of ethics in the intensive care unit has developed in the last 50 years along with the advancements and regulations in this area of medicine. Especially by the use of life-supportive equipment in the intensive care units and the resulting elongation in the terminal stage of life has led to newly described clinical conditions. These conditions include vegetative state, brain death, dissociated heart death. The current trend aiming to provide the best health care facilities with optimal costs resulted with regulations. The conflicts in the patient-physician relations resulting from these regulations has resolved to some extent by the studies of intensive care unit ethics. The major ethical topics in the intensive care are the usage of autonomy right, the selection of patients to be admitted to the intensive care unit and the limitation of the treatment. The patient selection is optimized by triage and allocation, the limitation of the treatment is done by the means of withdrawal and withhold, and the usage of autonomy right is tried to be solved by proxy, living will and ethics committee regulations. The ethical regulations have found partial solutions to the conflicts. For the ultimate solution much work about the subject has to be done. (Journal of the Turkish Society of Intensive Care 2010; 8: 77-84

  19. A Framework for Including Family Health Spillovers in Economic Evaluation

    Science.gov (United States)

    Al-Janabi, Hareth; van Exel, Job; Brouwer, Werner; Coast, Joanna

    2016-01-01

    Health care interventions may affect the health of patients’ family networks. It has been suggested that these “health spillovers” should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the “health care perspective”). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effects. These multiplier effects express the ratio of total health effects (for patients and their family networks) to patient health effects. One multiplier effect is specified for health benefit generated from providing a new intervention, one for health benefit displaced by funding this intervention. We show that using multiplier effects to internalize health spillovers could change the optimal funding decisions and generate additional health benefits to society. PMID:26377370

  20. A Framework for Including Family Health Spillovers in Economic Evaluation.

    Science.gov (United States)

    Al-Janabi, Hareth; van Exel, Job; Brouwer, Werner; Coast, Joanna

    2016-02-01

    Health care interventions may affect the health of patients' family networks. It has been suggested that these "health spillovers" should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the "health care perspective"). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effects. These multiplier effects express the ratio of total health effects (for patients and their family networks) to patient health effects. One multiplier effect is specified for health benefit generated from providing a new intervention, one for health benefit displaced by funding this intervention. We show that using multiplier effects to internalize health spillovers could change the optimal funding decisions and generate additional health benefits to society. © The Author(s) 2015.

  1. Care management in nursing within emergency care units

    Directory of Open Access Journals (Sweden)

    Roberta Juliane Tono de Oliveira

    2015-12-01

    Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  2. Care management in nursing within emergency care units.

    Science.gov (United States)

    Tono de Oliveira, Roberta Juliane; Vieira Hermida, Patrícia Madalena; da Silva Copelli, Fernanda Hannah; Guedes Dos Santos, José Luís; Lorenzini Erdmann, Alacoque; Regina de Andrade, Selma

    2015-12-01

    Understand the conditions involved in the management of nursing care in emergency care units. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  3. Caring for vulnerable ostomists: learning disabilities and stoma care.

    Science.gov (United States)

    Parker, Michaela

    It is without doubt that people with learning difficulties are considered vulnerable and meeting the healthcare needs of this group in society is now recognised as a challenging task. This case study examines the implications of life with a stoma for one particular man with learning difficulties and reflects on the key issues that have influenced his care: stigma and isolation, general healthcare needs for people with learning disabilities and the association with stoma care, and the provision of care and whose role it is. Key findings include inconsistencies between primary, secondary and social care, resulting in lack of integration and flexibility in provision of care; lack of responsibility for care, with a 'pass the buck' response; lack of knowledge about stoma care in most care settings; and, as a stoma care nurse, the importance of personal instinct, along with persistence in advocating appropriate levels of care for vulnerable ostomists.

  4. Modernizing Agrifood Markets : Including Small Producers in ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Researchers will carry out an analysis of production and market conditions in the fresh fruit and vegetable, dairy and (in one case) beef, and chicken sectors in a selected province or district of each country. Against this baseline data, ... Institution. International Institute for Environment and Development. Pays d' institution.

  5. Health Care in China.

    Science.gov (United States)

    Younger, David S

    2016-11-01

    China has recently emerged as an important global partner. However, like other developing nations, China has experienced dramatic demographic and epidemiologic changes in the past few decades. Population discontent with the health care system has led to major reforms. China's distinctive health care system, including its unique history, vast infrastructure, the speed of health reform, and economic capacity to make important advances in health care, nonetheless, has incomplete insurance coverage for urban and rural dwellers, uneven access, mixed quality of health care, increasing costs, and risk of catastrophic health expenditures. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Indian Health Service: Find Health Care

    Science.gov (United States)

    ... IHS Home for Patients Find Health Care Find Health Care IMPORTANT If you are having a health emergency ... services, continuous nursing services and that provides comprehensive health care including diagnosis and treatment. Health Locations An ambulatory ...

  7. Veterans Medical Care: FY2011 Appropriations

    Science.gov (United States)

    2011-03-21

    traumatic injury protection insurance for servicemembers, and death benefits that cover burial expenses. The Department carries out its programs...prosthetic and orthotic devices, including eyeglasses and hearing aids; home health services, hospice care, palliative care, and institutional respite care

  8. Managed care: mastering the moving parts.

    Science.gov (United States)

    Boyd, Dawn; Finman, Larry

    2010-05-01

    A hospital's success with managed care depends on how thoroughly the hospital understands its interrelated aspects, including: Managed care strategy Contract negotiations. Contract language. Key performance indicators. Modeling. Contract termination provisions. Movement from wholesale to retail health care.

  9. Essential elements of professional nursing environments in Primary Care and their influence on the quality of care.

    Science.gov (United States)

    Gea-Caballero, Vicente; Castro-Sánchez, Enrique; Júarez-Vela, Raúl; Díaz-Herrera, Miguel Ángel; de Miguel-Montoya, Isabel; Martínez-Riera, José Ramón

    Nursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality. We conducted a cross-sectional study in primary care organisations using the Practice Environment Scale - Nursing Work Index tool. We collected sociodemographic variables, scores, and selected the essential items conducive to optimal care. Appropriate parametric and non-parametric statistical tests were used to analyse relations between variables (CI = 95%, error = 5%). One hundred and forty-four nurses participated. The mean total score was 81.6. The results for the five dimensions included in the Practice Environment Scale - Nursing Work Index ranged from 2.25 - 2.92 (Mean). Twelve key items for quality of care were selected; six were positive in the Canary Islands, two were mixed, and four negative. 7/12 items were included in Dimension 2 (fundamentals of nursing). Being a manager was statistically associated with higher scores (p<.000). Years of experience was inversely associated with scores in the 12 items (p<.021). Nursing work environments in primary care settings in the Canary Islands are comparable to others previously studied in Spain. Areas to improve were human resources and participation of nurses in management decisions. Nurse managers must be knowledgeable about their working environments so they can focus on improvements in key dimensions. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  10. Primary Care Physicians' Dementia Care Practices: Evidence of Geographic Variation

    Science.gov (United States)

    Fortinsky, Richard H.; Zlateva, Ianita; Delaney, Colleen; Kleppinger, Alison

    2010-01-01

    Purpose: This article explores primary care physicians' (PCPs) self-reported approaches and barriers to management of patients with dementia, with a focus on comparisons in dementia care practices between PCPs in 2 states. Design and Methods: In this cross-sectional study, questionnaires were mailed to 600 randomly selected licensed PCPs in…

  11. Hospitalizations for ambulatory care sensitive conditions and quality of primary care: their relation with socioeconomic and health care variables in the Madrid regional health service (Spain).

    Science.gov (United States)

    Magán, Purificación; Alberquilla, Angel; Otero, Angel; Ribera, José Manuel

    2011-01-01

    Hospitalizations for ambulatory care sensitive conditions (ACSH) have been proposed as an indirect indicator of the effectiveness and quality of care provided by primary health care. To investigate the association of ACSH rates with population socioeconomic factors and with characteristics of primary health care. Cross-sectional, ecologic study. Using hospital discharge data, ACSH were selected from the list of conditions validated for Spain. All 34 health districts in the Region of Madrid, Spain. Individuals aged 65 years or older residing in the region of Madrid between 2001 and 2003, inclusive. Age- and gender-adjusted ACSH rates in each health district. The adjusted ACSH rate per 1000 population was 35.37 in men and 20.45 in women. In the Poisson regression analysis, an inverse relation was seen between ACSH rates and the socioeconomic variables. Physician workload was the only health care variable with a statistically significant relation (rate ratio of 1.066 [95% CI; 1.041-1.091]). These results were similar in the analyses disaggregated by gender. In the multivariate analyses that included health care variables, none of the health care variables were statistically significant. ACSH may be more closely related with socioeconomic variables than with characteristics of primary care activity. Therefore, other factors outside the health system must be considered to improve health outcomes in the population.

  12. [Selection of treatment modalities in patients with spasticity].

    Science.gov (United States)

    Ota, Tetsuo

    2014-09-01

    Spasticity is the most common abnormality of muscle tone. Typically, oral antispastic drugs, phenol blocks, motor-point blocks, selective dorsal rhizotomies, and selective peripheral neurotomies are used to reduce muscle tone and/or improve ranges of motion. Recently, botulinum toxin injections and intrathecal baclofen have been used as treatment modalities. The selection of the most appropriate treatment modality by doctors treating patients with spasticity is critical. Furthermore, rehabilitation techniques, such as physiotherapy, occupational therapy, therapeutic electrical nerve stimulation, and orthosis, are useful as combination therapy for the treatment of spasticity. The purpose of this study was to outline the various modalities that are currently used for the treatment of spasticity. Regardless of the modality selected, it is imperative that treatment goals are carefully identified. The reduction of spasticity is not an appropriate treatment goal. Appropriate goals include improving gait, activities of daily living, and the quality of life.

  13. Static, Lightweight Includes Resolution for PHP

    NARCIS (Netherlands)

    M.A. Hills (Mark); P. Klint (Paul); J.J. Vinju (Jurgen)

    2014-01-01

    htmlabstractDynamic languages include a number of features that are challenging to model properly in static analysis tools. In PHP, one of these features is the include expression, where an arbitrary expression provides the path of the file to include at runtime. In this paper we present two

  14. Article Including Environmental Barrier Coating System

    Science.gov (United States)

    Lee, Kang N. (Inventor)

    2015-01-01

    An enhanced environmental barrier coating for a silicon containing substrate. The enhanced barrier coating may include a bond coat doped with at least one of an alkali metal oxide and an alkali earth metal oxide. The enhanced barrier coating may include a composite mullite bond coat including BSAS and another distinct second phase oxide applied over said surface.

  15. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; van der Zwan, Jan Maarten; Izarzugaza, Isabel; Jaal, Jana; Treasure, Tom; Foschi, Roberto; Ricardi, Umberto; Groen, Harry; Tavilla, Andrea; Ardanaz, Eva

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  16. Rare thoracic cancers, including peritoneum mesothelioma

    NARCIS (Netherlands)

    Siesling, Sabine; Zwan, J.M.V.D.; Izarzugaza, I.; Jaal, J.; Treasure, T.; Foschi, R.; Ricardi, U.; Groen, H.; Tavilla, A.; Ardanaz, E.

    2012-01-01

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002,

  17. Emergency care of reptiles.

    Science.gov (United States)

    Boyer, T H

    1998-09-01

    Common reptile emergencies are reviewed in this article and the fundamentals of emergency care are provided. Important points include obtaining a complete history and husbandry review, physical examination, diagnostic tests, fluid support, anesthetics, and antibiotics.

  18. Classical mechanics including an introduction to the theory of elasticity

    CERN Document Server

    Hentschke, Reinhard

    2017-01-01

    This textbook teaches classical mechanics as one of the foundations of physics. It describes the mechanical stability and motion in physical systems ranging from the molecular to the galactic scale. Aside from the standard topics of mechanics in the physics curriculum, this book includes an introduction to the theory of elasticity and its use in selected modern engineering applications, e.g. dynamic mechanical analysis of viscoelastic materials. The text also covers many aspects of numerical mechanics, ranging from the solution of ordinary differential equations, including molecular dynamics simulation of many particle systems, to the finite element method. Attendant Mathematica programs or parts thereof are provided in conjunction with selected examples. Numerous links allow the reader to connect to related subjects and research topics. Among others this includes statistical mechanics (separate chapter), quantum mechanics, space flight, galactic dynamics, friction, and vibration spectroscopy. An introductory...

  19. Empowering and caring professionals

    DEFF Research Database (Denmark)

    Hansen, Agnete Meldgaard

    workers negotiate professional identities and understandings of meaningful care work, in the new regime of rehabilitative elderly care – how they manage the ambiguities of a simultaneously empowering and interventionist practice. The paper’s analytical framework draws on an understanding of empowerment......A wave of policies to reform municipal elderly care services is sweeping across Denmark. Under headings such as ‘help for self-help’, ‘everyday rehabilitation’, and ‘re-ablement’, municipalities are working to make their elderly citizens more self-reliant, active and less dependent on municipal...... as a form of advanced liberal government. Also included are perspectives on historically shifting understandings of care and professional care work, that serve as a repertoire of meaning and identity for care workers, who are shown to be actively constructing identities and ‘crafting’ their jobs in relation...

  20. Choosing a health care provider.

    Science.gov (United States)

    Harris, Katherine M; Beeuwkes Buntin, Melinda

    2008-05-01

    In a consumer-driven health care model, consumers, armed with information, would select providers based on quality and cost, thus increasing competition. This synthesis examines the availability of quality information and the evidence of how consumers use such information to choose a provider. Key findings include: information is publicly available from multiple sources regarding hospitals, but not individual doctors. Hospital information is predominantly made available online; but this limits awareness and access. Awareness is low overall, but highest among well-educated, healthy people. Even when consumers are aware of the data available, they rarely use it because they do not find it relevant: they do not foresee needing a hospital soon; are happy with their current provider; or did not find information pertinent to their specific health condition or hospital. While there is some evidence that hospitals that do poorly on public quality scorecards lose market share, there is better evidence that the providers themselves react to the quality scores by addressing care problems. Studies consistently show that consumers value health care quality and want information, but instead they rely on input from friends, family and their personal physicians about the quality of providers.

  1. Characteristics of caring self-efficacy in pediatric nurses: a qualitative study.

    Science.gov (United States)

    Alavi, Azam; Bahrami, Masoud; Zargham-Boroujeni, Ali; Yousefy, Alireza

    2015-07-01

    The present study was conducted to clarify pediatric nurses' characteristics of caring self-efficacy. This study was conducted using a qualitative content analysis approach. The participants included 27 pediatric nurses and clinical instructors, selected purposively. Data were collected using semi-structured interviews and were analyzed using the content analysis method. Data analysis generated four main themes as attributes of a self-efficient pediatric nurse including: (a) professional communications; (b) management of care; (c) altruism; and (d) proficiency. Nursing managers and instructors can use these results to help develop nurses' empowerment and self-efficacy, especially in pediatric care. © 2015, Wiley Periodicals, Inc.

  2. Selective Europeanization

    DEFF Research Database (Denmark)

    Hoch Jovanovic, Tamara; Lynggaard, Kennet

    2014-01-01

    This article investigates the question: why has Danish minority policy shown such remarkable selectiveness with regard to Europeanization? This question is particularly pertinent given that Denmark is typically seen as an otherwise very efficient and keen complier, especially with EU norms and ru...

  3. Selective oxidation

    International Nuclear Information System (INIS)

    Cortes Henao, Luis F.; Castro F, Carlos A.

    2000-01-01

    It is presented a revision and discussion about the characteristics and factors that relate activity and selectivity in the catalytic and not catalytic partial oxidation of methane and the effect of variables as the temperature, pressure and others in the methane conversion to methanol. It thinks about the zeolites use modified for the catalytic oxidation of natural gas

  4. Ventilator-associated pneumonia rates after introducing selective digestive tract decontamination.

    Science.gov (United States)

    Schnabel, Ronny M; Scholte, Johannes B J; Van Der Velden, Kim E H M; Roekaerts, Paul M H J; Bergmans, Dennis C J J

    2015-09-01

    The incidence of ventilator-associated pneumonia (VAP) before and after the introduction of selective oral decontamination (SOD) only and selective digestive tract decontamination (SDD) in a general intensive care population was examined. SOD as standard of care was introduced in December 2010 and SDD, including SOD, in January 2012 for all patients with an expected length of intensive care unit (ICU) stay of at least 48 h. The diagnosis of VAP was based on clinical criteria and quantitative cultures of bronchoalveolar lavage fluid. A total of 4945 mechanically ventilated patients accounting for 37 554 ventilator days in the period from 2005 to 2013 were analyzed. The incidence of VAP per 1000 ventilator days declined significantly from 4.38 ± 1.64 before to 1.64 ± 0.43 after introduction of SOD/SDD (p = 0.007). Implementation of SOD/SDD as standard of care in ICUs may thus be effective in preventing VAP.

  5. Myeloperoxidase selectively binds and selectively kills microbes.

    Science.gov (United States)

    Allen, Robert C; Stephens, Jackson T

    2011-01-01

    Myeloperoxidase (MPO) is reported to selectively bind to bacteria. The present study provides direct evidence of MPO binding selectivity and tests the relationship of selective binding to selective killing. The microbicidal effectiveness of H(2)O(2) and of OCl(-) was compared to that of MPO plus H(2)O(2). Synergistic microbicidal action was investigated by combining Streptococcus sanguinis, a H(2)O(2)-producing microbe showing low MPO binding, with high-MPO-binding Escherichia coli, Staphylococcus aureus, or Pseudomonas aeruginosa without exogenous H(2)O(2), with and without MPO, and with and without erythrocytes (red blood cells [RBCs]). Selectivity of MPO microbicidal action was conventionally measured as the MPO MIC and minimal bactericidal concentration (MBC) for 82 bacteria including E. coli, P. aeruginosa, S. aureus, Enterococcus faecalis, Streptococcus pyogenes, Streptococcus agalactiae, and viridans streptococci. Both H(2)O(2) and OCl(-) destroyed RBCs at submicrobicidal concentrations. Nanomolar concentrations of MPO increased H(2)O(2) microbicidal action 1,000-fold. Streptococci plus MPO produced potent synergistic microbicidal action against all microbes tested, and RBCs caused only a small decrease in potency without erythrocyte damage. MPO directly killed H(2)O(2)-producing S. pyogenes but was ineffective against non-H(2)O(2)-producing E. faecalis. The MPO MICs and MBCs for E. coli, P. aeruginosa, and S. aureus were significantly lower than those for E. faecalis. The streptococcal studies showed much higher MIC/MBC results, but such testing required lysed horse blood-supplemented medium, thus preventing valid comparison of these results to those for the other microbes. E. faecalis MPO binding is reportedly weak compared to binding of E. coli, P. aeruginosa, and S. aureus but strong compared to binding of streptococci. Selective MPO binding results in selective killing.

  6. Altruism, the values dimension of caring self-efficacy concept in Iranian pediatric nurses.

    Science.gov (United States)

    Alavi, Azam; Zargham-Boroujeni, Ali; Yousefy, Alireza; Bahrami, Masoud

    2017-01-01

    Self-efficacy is the most influential among factors affecting nurses' performance. Yet, understanding of the constituent elements of the caring self-efficacy concept was not considered. This study was to introduce altruism as one of the main aspects of caring self-efficacy in pediatric nurses. This is part of a larger study on the concept of caring self-efficacy conducted with qualitative content analysis approach in Iran. Participants included 27 clinical pediatric nurses and instructors, selected purposively. Data were collected using semi-structured interviews and analyzed using conventional content analysis method. Theme "altruism" as one of the main themes extracted from the analysis of the interviews in this study. This theme includes two main categories of "humanistic care" and "caring attitude." This paper introduces altruism as one of the values aspects of caring self-efficacy in pediatric nurses. Efficient nurse with features Humanistic care, through the provision of maternal care and family-centered care and caring attitudes resulting from religious beliefs and loving children to care for the children.

  7. 32 CFR 732.14 - Authorized care.

    Science.gov (United States)

    2010-07-01

    ... 32 National Defense 5 2010-07-01 2010-07-01 false Authorized care. 732.14 Section 732.14 National... CARE Medical and Dental Care From Nonnaval Sources § 732.14 Authorized care. (a) Medical. (1... treatment when directed by COMNAVMEDCOM, are authorized. Such care includes, but is not limited to...

  8. Structural Optimization Including Centrifugal and Coriolis Effects

    Science.gov (United States)

    1988-01-01

    the desired frequency changes with excellent accuracy. MSC/ NASTRAN finite element solution sequences were modified to incorporate rotary effects. DMAP ...properties can be altered by a nonlinear change factor. These manipulations may be done by selective use of the MATMOD DMAP module. In the MSC/ NASTRAN ...Examples were carried out using the general purpose software package MSC/ NASTRAN and ADS (Automated Design Synthesis). "I OTIC copy INSpE TE 6

  9. Implementing Dementia Care Mapping as a practice development tool in dementia care services: a systematic review.

    Science.gov (United States)

    Surr, Claire A; Griffiths, Alys W; Kelley, Rachael

    2018-01-01

    Dementia Care Mapping (DCM) is an observational tool set within a practice development process. Following training in the method, DCM is implemented via a cyclic process of briefing staff, conducting mapping observations, data analysis and report preparation, feedback to staff and action planning. Recent controlled studies of DCM's efficacy have found heterogeneous results, and variability in DCM implementation has been indicated as a potential contributing factor. This review aimed to examine the primary research evidence on the processes and the barriers and facilitators to implementing DCM as a practice development method within formal dementia care settings. PUBMED, PsycINFO, CINAHL, The Cochrane Library-Cochrane reviews, HMIC (Ovid), Web of Science and Social Care Online were searched using the term "Dementia Care Mapping". Inclusion criterion was primary research studies in any formal dementia care settings where DCM was used as a practice development tool and which included discussion/critique of the implementation processes. Assessment of study quality was conducted using the Mixed Methods Appraisal Tool. Twelve papers were included in the review, representing nine research studies. The papers included discussion of various components of the DCM process, including mapper selection and preparation; mapping observations; data analysis, report writing and feedback; and action planning. However, robust evidence on requirements for successful implementation of these components was limited. Barriers and facilitators to mapping were also discussed. The review found some consensus that DCM is more likely to be successfully implemented if the right people are selected to be trained as mappers, with appropriate mapper preparation and ongoing support and with effective leadership for DCM within the implementing organization/unit and in organizations that already have a person-centered culture or ethos. Future development of the DCM tool should consider ways to save on

  10. Palliative Care

    Science.gov (United States)

    ... spiritual beliefs; they can also provide grief counseling massage therapists who promote relaxation, help patients and families ... too. Family members caring for seriously ill children face numerous challenges, and palliative care programs can help ...

  11. Composite Pressure Vessel Including Crack Arresting Barrier

    Science.gov (United States)

    DeLay, Thomas K. (Inventor)

    2013-01-01

    A pressure vessel includes a ported fitting having an annular flange formed on an end thereof and a tank that envelopes the annular flange. A crack arresting barrier is bonded to and forming a lining of the tank within the outer surface thereof. The crack arresting barrier includes a cured resin having a post-curing ductility rating of at least approximately 60% through the cured resin, and further includes randomly-oriented fibers positioned in and throughout the cured resin.

  12. Are English novice nurses prepared to work in primary care setting?

    Science.gov (United States)

    Ali, Parveen Azam; Watson, Roger; Albutt, Gary

    2011-09-01

    This study explored the role of nurses in primary care and nurses' level of preparedness to work in the primary care sector in United Kingdom. The study was conducted in three primary care trusts (PCTs) in the north of England and participants were selected using a modified snowball sampling technique. Data were collected through telephone interviews. Fourteen nurses working at various levels in PCTs were interviewed. Data were analysed using thematic analysis. Participants believed that nurses work in a variety of roles in primary care including care provider, autonomous practitioner, health educator and patient's advocate. With regard to preparedness to work in primary care, a mixed response was identified. Some nurses believed that the pre-registration nursing curriculum generally prepares nurses well for the role; others believed it did not prepare them at all. A common perception was that the pre-registration nursing curriculum is generally acute care focused and does not educate nurses about the structure of the primary care setting. Participants recommended more emphasis on primary care, longer placements in community and primary care, increased involvement of the nurses working in primary care in the pre-registration nursing curriculum and preceptorship and mentorship programmes for novice nurses in primary care. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. Including Organizational Cultural Parameters in Work Processes

    National Research Council Canada - National Science Library

    Handley, Holly A; Heacox, Nancy J

    2004-01-01

    .... In order to represent the organizational impact on the work process, five organizational cultural parameters were identified and included in an algorithm for modeling and simulation of cultural...

  14. Haemophilus influenzae Disease (Including Hib) Symptoms

    Science.gov (United States)

    ... Links Global Hib Vaccination Hib Vaccination Meningitis Pneumonia Sepsis ... Haemophilus influenzae , including H. influenzae type b or Hib, can cause many different kinds of infections . Symptoms depend on ...

  15. Selective Reproduction

    DEFF Research Database (Denmark)

    Svendsen, Mette N.

    2015-01-01

    This article employs a multi-species perspective in investigating how life's worth is negotiated in the field of neonatology in Denmark. It does so by comparing decision-making processes about human infants in the Danish neonatal intensive care unit with those associated with piglets who serve...... as models for the premature infants in research experiments within neonatology. While the comparison is unusual, the article argues that there are parallels across the decision-making processes that shape the lives and deaths of infants and pigs alike. Collectivities or the lack thereof as well...

  16. The European EUCCLID pilot study on care and complications in an unselected sample of people with type 2 diabetes in primary care

    DEFF Research Database (Denmark)

    Gorter, K.J.; Wens, J.; Khunti, K.

    2010-01-01

    ) in Primary Care (EUCCLID) in 12 European countries. METHOD: One rural and one urban practice from each country participated. The central coordinating centre randomly selected five patients from each practice. Patient characteristics were assessed including medical history, anthropometric measures, quality...... selection of people with T2DM is feasible. There are large differences in indicators of metabolic control and wellbeing between countries Udgivelsesdato: 2010/4...

  17. The Influence of Group Versus Individual Prenatal Care on Phase of Labor at Hospital Admission.

    Science.gov (United States)

    Tilden, Ellen L; Emeis, Cathy L; Caughey, Aaron B; Weinstein, Sarah R; Futernick, Sarah B; Lee, Christopher S

    2016-07-01

    Group prenatal care, an alternate model of prenatal care delivery, has been associated with various improved perinatal outcomes in comparison to standard, individual prenatal care. One important maternity care process measure that has not been explored among women who receive group prenatal care versus standard prenatal care is the phase of labor (latent vs active) at hospital admission. A retrospective case-control study was conducted comparing 150 women who selected group prenatal care with certified nurse-midwives (CNMs) versus 225 women who chose standard prenatal care with CNMs. Analyses performed included descriptive statistics to compare groups and multivariate regression to evaluate the contribution of key covariates potentially influencing outcomes. Propensity scores were calculated and included in regression models. Women within this sample who received group prenatal care were more likely to be in active labor (≥ 4 cm of cervical dilatation) at hospital admission (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.03-2.99; P = .049) and were admitted to the hospital with significantly greater cervical dilatation (mean [standard deviation, SD] 5.7 [2.5] cm vs. 5.1 [2.3] cm, P = .005) compared with women who received standard prenatal care, controlling for potential confounding variables and propensity for group versus individual care selection. Group prenatal care may be an effective and safe intervention for decreasing latent labor hospital admission among low-risk women. Neither group prenatal care nor active labor hospital admission was associated with increased morbidity. © 2016 by the American College of Nurse-Midwives.

  18. Maternity Care Update: Postpartum Care.

    Science.gov (United States)

    Smith, Andrew; Barr, Wendy B; Bassett-Novoa, Erin; LeFevre, Nicholas

    2018-04-01

    Family physicians are uniquely situated to play a major role in postpartum care. Postpartum issues that should be monitored and addressed include reproductive and contraceptive planning, breastfeeding counseling and support, and maternal mental health. All women should be screened for postpartum depression using a validated tool at the postpartum visit and/or at well-child visits. Patients with positive screening results should be offered support and treatment. Women are more likely to breastfeed if they are provided with breastfeeding support and counseling routinely during the prenatal and postpartum periods. All women should be asked about their reproductive life plans, counseled about potential risks associated with short and prolonged interpregnancy intervals, and offered contraception. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  19. Selective Optimization

    Science.gov (United States)

    2015-07-06

    vehicle routing [11], [6], probabilistic traveling salesman problems [9], location problems [10], and generalized assignment [1], among others. Next we...Mercure, A priori optimization of the probabilistic traveling salesman problem , Operations research 42 (1994), 543–549. [10] G. Laporte, F.V. Louveaux...standard mixed-integer programming (MIP) formulations of selective optimization problems . While such formulations can be attacked by commercial

  20. Genomic selection in plant breeding.

    Science.gov (United States)

    Newell, Mark A; Jannink, Jean-Luc

    2014-01-01

    Genomic selection (GS) is a method to predict the genetic value of selection candidates based on the genomic estimated breeding value (GEBV) predicted from high-density markers positioned throughout the genome. Unlike marker-assisted selection, the GEBV is based on all markers including both minor and major marker effects. Thus, the GEBV may capture more of the genetic variation for the particular trait under selection.

  1. Ion-selective electrode reviews

    CERN Document Server

    Thomas, J D R

    1985-01-01

    Ion-Selective Electrode Reviews, Volume 7 is a collection of papers that covers the applications of electrochemical sensors, along with the versatility of ion-selective electrodes. The coverage of the text includes solid contact in membrane ion-selective electrodes; immobilized enzyme probes for determining inhibitors; potentiometric titrations based on ion-pair formation; and application of ion-selective electrodes in soil science, kinetics, and kinetic analysis. The text will be of great use to chemists and chemical engineers.

  2. Evaluation of employees in public day care centers knowledge about breastfeeding and complementary feeding

    OpenAIRE

    Souza, Joelânia Pires de O.; Prudente, Amanda Moura; Silva, Dyene Aparecida; Pereira, Leandro Alves; Rinaldi, Ana Elisa M.

    2013-01-01

    OBJECTIVE: To evaluate the knowledge of public day care centers employees about breastfeeding and complementary feeding. METHODS: A cross-sectional study was conducted in 15 public day care centers randomly selected in the city of Uberlandia, Southeast Brazil. A questionnaire applied to school principals, teachers, educators and general services assistants (GSA) included demographic and socioeconomic variables and questions about knowledge on breastfeeding, complementary feeding besides ...

  3. Characterization of Campylobacter phages including analysis of host range by selected Campylobacter Penner serotypes

    DEFF Research Database (Denmark)

    Hansen, Vinni; Rosenquist, Hanne; Baggesen, Dorte Lau

    2007-01-01

    size undeterminable in PFGE. The categorization of the phages correlated with the host range patterns displayed by the phages. Six phages were subjected to transmission electron microscopy (TEM). They all belonged to the family of Myoviridae. Conclusion: We have characterized and identified the host......Background: The predominant food borne pathogen in the western world today is Campylobacter. Campylobacter specific bacteriophages (phages) have been proposed as an alternative agent for reducing the burden of Campylobacter in broilers. One concern in relation to phage biocontrol is the narrow host...

  4. Floating point only SIMD instruction set architecture including compare, select, Boolean, and alignment operations

    Science.gov (United States)

    Gschwind, Michael K [Chappaqua, NY

    2011-03-01

    Mechanisms for implementing a floating point only single instruction multiple data instruction set architecture are provided. A processor is provided that comprises an issue unit, an execution unit coupled to the issue unit, and a vector register file coupled to the execution unit. The execution unit has logic that implements a floating point (FP) only single instruction multiple data (SIMD) instruction set architecture (ISA). The floating point vector registers of the vector register file store both scalar and floating point values as vectors having a plurality of vector elements. The processor may be part of a data processing system.

  5. Threats to Aircraft Structural Safety Including a Compendium of Selected Structural Accidents/Incidents

    Science.gov (United States)

    2010-03-01

    Photos Illustrating Rivet Damage on 747SR Rear Pressure Bulkhead C10 C13 Photo of Boeing 747-200 C11 C14 Crack Location under Edge of Repair...Association AIB Accident Investigation Board AIDS Accident/Incident Data System API Armor Piercing Incendiary ASIP Aircraft Structural...transport aircraft be designed to be fail-safe in spite of the fact that some manufacturers have such self imposed design requirements. The lack of such a

  6. Quick selection of industrial heat pump types including the impact of thermodynamic losses

    International Nuclear Information System (INIS)

    Bor, D.M. van de; Infante Ferreira, C.A.

    2013-01-01

    Making a rough performance estimate for conventional vapor compression and vapor recompression heat pumps is straight forward: Dividing the Carnot efficiency by 2 results in a reasonable estimate. Still, actual performance of heat pumps could easily vary to a large extent. With new and innovative heat pumps the discrepancies between the rough estimate and actual performance might be even larger as the Carnot efficiency is not the upper limit anymore due to the use of temperature glides. Lack of a simple method to determine the approximate performance of a heat pump will hinder the implementation of these novel types in industry. In this study a performance map is presented and it is shown that, for mechanical heat pumps, making use of the available temperature glide increases performance and reduces the payback period. While at low glides heat driven absorption heat pumps and vapor (re)compression heat pumps show the smallest payback times, mechanical heat pumps with large glides show to be more effective at higher temperature lifts when temperature glides are available. Due to improved performance, these mechanical heat pumps are able to achieve better economical results over their technical life time although they require higher initial investment. - Highlights: • A method is proposed for simple estimation of industrial heat pump performance. • Estimation of economic performance of industrial heat pumps. • No detailed knowledge about heat pumps, working fluids or process required

  7. External Contamination Environment at ISS Included: Selected Results from Payloads Contamination Mapping Delivery 3 Package

    Science.gov (United States)

    Olsen, Randy; Huang, Alvin; Steagall, Courtney; Kohl, Nathaniel; Koontz, Steve; Worthy, Erica

    2017-01-01

    The International Space Station is the largest and most complex on-orbit platform for space science utilization in low Earth orbit. Multiple sites for external payloads, with exposure to the associated natural and induced environments, are available to support a variety of space science utilization objectives. Contamination is one of the induced environments that can impact performance, mission success and science utilization on the vehicle. The ISS has been designed, built and integrated with strict contamination requirements to provide low levels of induced contamination on external payload assets.

  8. Community Care for People with Complex Care Needs: Bridging the Gap between Health and Social Care

    Directory of Open Access Journals (Sweden)

    Kerry Kuluski

    2017-07-01

    Full Text Available Introduction: A growing number of people are living with complex care needs characterized by multimorbidity, mental health challenges and social deprivation. Required is the integration of health and social care, beyond traditional health care services to address social determinants. This study investigates key care components to support complex patients and their families in the community. Methods: Expert panel focus groups with 24 care providers, working in health and social care sectors across Toronto, Ontario, Canada were conducted. Patient vignettes illustrating significant health and social care needs were presented to participants. The vignettes prompted discussions on i how best to meet complex care needs in the community and ii the barriers to delivering care to this population.  Results: Categories to support care needs of complex patients and their families included i relationships as the foundation for care, ii desired processes and structures of care, and iii barriers and workarounds for desired care.  Discussion and Conclusions: Meeting the needs of the population who require health and social care requires time to develop authentic relationships, broadening the membership of the care team, communicating across sectors, co-locating health and social care, and addressing the barriers that prevent providers from engaging in these required practices.

  9. Lead acid batteries simulation including experimental validation

    Energy Technology Data Exchange (ETDEWEB)

    Achaibou, N.; Malek, A. [Division Energie Solaire Photovoltaique, Centre de Developpement des Energies Renouvelables, B.P. 62, Route de l' Observatoire, Bouzareah, Alger (Algeria); Haddadi, M. [Laboratoire de Dispositif de Communication et de Conversion Photovoltaique Ecole Nationale Polytechnique, Rue Hassen Badi, El Harrach, Alger (Algeria)

    2008-12-01

    The storage of energy in batteries is a cause of the failure and loss of reliability in PV systems. The battery behavior has been largely described in the literature by many authors; the selected models are of Monegon and CIEMAT. This paper reviews the two general lead acid battery models and their agreement with experimental data. In order to validate these models, the behavior of different battery cycling currents has been simulated. Results obtained have been compared to real data. The CIEMAT model presents a good performance compared to Monegon's model. (author)

  10. The effect of foster care placement on paternal welfare dependency

    DEFF Research Database (Denmark)

    Fallesen, Peter

    The arrival of a child profoundly alters the life-course for men. Yet, children could change men's lives not only by arriving in them, but also by departing from them. In this article, I test how one such departure-foster care placement-affects men's labor market attachment, and in so doing I...... provide a novel parallel to existing research on how fatherhood affects men, which focuses almost exclusively on a child's arrival. Using population panel data from Denmark that include all first time fathers whose children were placed in foster care from 1995-2005, I find that having a child placed...... in foster care is associated with up to a 12 percentage point increase in welfare dependency. This result persists in analyses that control for individual and family level fixed effects, unobserved heterogeneity, and selection into having a child placed in foster care....

  11. Managing cancer-related pain in critical care settings.

    Science.gov (United States)

    Dolan, Elisabeth A; Paice, Judith A; Wile, Sally

    2011-01-01

    Pain is a common symptom experienced by individuals who are in treatment for cancer and becomes more prevalent for those with more advanced stages of malignancy. Critical care nurses are essential in the management of cancer-related pain, which is a challenging problem when individuals who have a cancer diagnosis are admitted to the intensive care unit for emergent conditions. Regular, thorough, and patient-appropriate assessments by experienced critical care nurses guide selection of treatment modalities, including pharmacologic and nonpharmacologic techniques. In addition, existential pain necessitates spiritual care intervention, and involvement of other appropriate interdisciplinary team members can result in improved management of all types of pain experienced by critically ill individuals with cancer.

  12. Gender bias in child care and child health: global patterns.

    Science.gov (United States)

    Khera, Rohan; Jain, Snigdha; Lodha, Rakesh; Ramakrishnan, Sivasubramanian

    2014-04-01

    Gender-based discrimination is reported across the spectrum of paediatric healthcare including emergency, inpatient, outpatient and preventive care and is mostly reported from South Asia and China with sporadic reports from Africa and South America. Biases against young girls have been documented even in immunisation percentage, home food allocation, seeking medical care for childhood ailments and percentage of household healthcare expenditures allocated to them. Such gender discrimination in access to medical care is likely to have an influence on the overall health of female children. Over the last five decades, the under-5 sex ratios are worsening in India with declining number of girls. Deliberate parental neglect of girls' essential and life-saving medical care is also an important contributing factor apart from sex-selective abortions to the declining gender ratios. Corrective measures and focused action are needed.

  13. Patient safety in primary health care: a systematic review

    Directory of Open Access Journals (Sweden)

    Simone Grativol Marchon

    2014-09-01

    Full Text Available The aim of this study was to identify methodologies to evaluate incidents in primary health care, types of incidents, contributing factors, and solutions to make primary care safer. A systematic literature review was performed in the following databases: PubMed, Scopus, LILACS, SciELO, and Capes, from 2007 to 2012, in Portuguese, English, and Spanish. Thirty-three articles were selected: 26% on retrospective studies, 44% on prospective studies, including focus groups, questionnaires, and interviews, and 30% on cross-sectional studies. The most frequently used method was incident analysis from incident reporting systems (45%. The most frequent types of incidents in primary care were related to medication and diagnosis. The most relevant contributing factors were communication failures among member of the healthcare team. Research methods on patient safety in primary care are adequate and replicable, and they will likely be used more widely, thereby providing better knowledge on safety in this setting.

  14. Reporting characteristics of cancer pain: A systematic review and quantitative analysis of research publications in palliative care journals

    Directory of Open Access Journals (Sweden)

    Senthil P Kumar

    2011-01-01

    Full Text Available Objective: A common disorder requiring symptom palliation in palliative and end-of-life care is cancer. Cancer pain is recognized as a global health burden. This paper sought to systematically examine the extent to which there is an adequate scientific research base on cancer pain and its reporting characteristics in the palliative care journal literature. Materials and Methods: Search conducted in MEDLINE and CINAHL sought to locate all studies published in 19 palliative/ hospice/ supportive/ end-of-life care journals from 2009 to 2010. The journals included were: American Journal of Hospice and Palliative Care, BMC Palliative Care, Current Opinion in Supportive and Palliative Care, End of Life Care Journal, European Journal of Palliative Care, Hospice Management Advisor, Indian Journal of Palliative Care, International Journal of Palliative Nursing, Internet Journal of Pain Symptom Control and Palliative Care, Journal of Pain and Palliative Care Pharmacotherapy, Journal of Palliative Care, Journal of Palliative Medicine, Journal of Social Work in End-of-life and Palliative Care, Journal of Supportive Oncology, Palliative Medicine, Palliative and Supportive Care, and Supportive Care in Cancer. Journal contents were searched to identify studies that included cancer pain in abstract. Results: During the years 2009 and 2010, of the selected 1,569 articles published in the journals reviewed, only 5.86% (92 articles were on cancer pain. Conclusion: While researchers in the field of palliative care have studied cancer pain, the total percentage for studies is still a low 5.86%. To move the field of palliative care forward so that appropriate guidelines for cancer pain management can be developed, it is critical that more research be reported upon which to base cancer pain therapy in an evidence-based palliative care model.

  15. Reporting Characteristics of Cancer Pain: A Systematic Review and Quantitative Analysis of Research Publications in Palliative Care Journals

    Science.gov (United States)

    Kumar, Senthil P

    2011-01-01

    Objective: A common disorder requiring symptom palliation in palliative and end-of-life care is cancer. Cancer pain is recognized as a global health burden. This paper sought to systematically examine the extent to which there is an adequate scientific research base on cancer pain and its reporting characteristics in the palliative care journal literature. Materials and Methods: Search conducted in MEDLINE and CINAHL sought to locate all studies published in 19 palliative/ hospice/ supportive/ end-of-life care journals from 2009 to 2010. The journals included were: American Journal of Hospice and Palliative Care, BMC Palliative Care, Current Opinion in Supportive and Palliative Care, End of Life Care Journal, European Journal of Palliative Care, Hospice Management Advisor, Indian Journal of Palliative Care, International Journal of Palliative Nursing, Internet Journal of Pain Symptom Control and Palliative Care, Journal of Pain and Palliative Care Pharmacotherapy, Journal of Palliative Care, Journal of Palliative Medicine, Journal of Social Work in End-of-life and Palliative Care, Journal of Supportive Oncology, Palliative Medicine, Palliative and Supportive Care, and Supportive Care in Cancer. Journal contents were searched to identify studies that included cancer pain in abstract. Results: During the years 2009 and 2010, of the selected 1,569 articles published in the journals reviewed, only 5.86% (92 articles) were on cancer pain. Conclusion: While researchers in the field of palliative care have studied cancer pain, the total percentage for studies is still a low 5.86%. To move the field of palliative care forward so that appropriate guidelines for cancer pain management can be developed, it is critical that more research be reported upon which to base cancer pain therapy in an evidence-based palliative care model. PMID:21633623

  16. Virtual care

    DEFF Research Database (Denmark)

    Kamp, Annette; Aaløkke Ballegaard, Stinne

    of retrenchment, promising better quality, empowerment of citizens and work that is smarter and more qualified. Through ethnographic field studies we study the introduction of virtual home care in Danish elderly care, focusing on the implications for relational work and care relations. Virtual home care entails...... and professionals, and they instigate change in organization and professional identities. Studies, which more specifically deal with telecare, stress how virtualization alters the character of the observations care workers are able to make, and how the validity of the patients’ own measurements and observations...... point out how issues of trust and surveillance, which are always negotiated in care relations, are in fact accentuated in this kind of virtual care work. Moreover, we stress that the contemporary institutional context, organization and time schedules have a vast impact on the practices developed....

  17. Interprofessional care in intensive care settings and the factors that impact it: results from a scoping review of ethnographic studies.

    Science.gov (United States)

    Paradis, Elise; Leslie, Myles; Gropper, Michael A; Aboumatar, Hanan J; Kitto, Simon; Reeves, Scott

    2013-12-01

    At the heart of safe cultures are effective interactions within and between interprofessional teams. Critical care clinicians see severely ill patients who require coordinated interprofessional care. In this scoping review, we asked: "What do we know about processes, relationships, organizational and contextual factors that shape the ability of clinicians to deliver interprofessional care in adult ICUs?" Using the 5-stage process established by Levac et al. (2010), we reviewed 981 abstracts to identify ethnographic articles that shed light on interprofessional care in the intensive care unit. The quality of selected articles is assessed using best practices in ethnographic research; their main insights evaluated in light of an interprofessional framework developed by Reeves et al (Interprofessional Teamwork for Health and Social Care. San Francisco, CA: Wiley-Blackwell; 2010). Overall, studies were of mixed quality, with an average (SD) score of 5.8 out of 10 (1.77). Insights into intensive care unit cultures include the importance of paying attention to workflow, the nefarious impact of hierarchical relationships, the mixed responses to protocols imposed from the top down, and a general undertheorization of sex and race. This review highlights several lessons for safe cultures and argues that more needs to be known about the context of critical care if quality and safety interventions are to succeed. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. How technology in care at home affects patient self-care and self-management: a scoping review.

    Science.gov (United States)

    Peeters, José M; Wiegers, Therese A; Friele, Roland D

    2013-10-29

    The use of technology in care at home has potential benefits such as improved quality of care. This includes greater focus on the patients' role in managing their health and increased patient involvement in the care process. The objective of this scoping review is to analyse the existing evidence for effects of technology in home-based care on patients' self-care and self-management. Using suitable search terms we searched the databases of Pubmed, Embase, Cochrane Library, Cinahl, Picarta and NIVEL dating from 2002 to 2012. Thirty-three studies (six review studies and twenty-seven individual studies) were selected. Effects were extracted from each study and were classified. In almost all the studies, the concepts self-care and self-management are not clearly defined or operationalized. Therefore, based on a meta-analysis, we made a new classification of outcome measures, with hierarchical levels: (1) competence (2) illness-management (3) independence (social participation, autonomy). In general, patient outcomes appear to be positive or promising, but most studies were pilot studies. We did not find strong evidence that technology in care at home has (a positive) effect on patient self-care and self-management according to the above classification. Future research is needed to clarify how technology can be used to maximize its benefits.

  19. Major publications in the critical care pharmacotherapy literature in 2015.

    Science.gov (United States)

    Wong, Adrian; Erdman, Michael; Hammond, Drayton A; Holt, Tara; Holzhausen, Jenna M; Horng, Michelle; Huang, Lori Lynn; Jarvis, Jennifer; Kram, Bridgette; Kram, Shawn; Lesch, Christine; Mercer, Jessica; Rech, Megan A; Rivosecchi, Ryan; Stump, Brian; Teevan, Colleen; Day, Sarah

    2017-03-01

    Recently published practice guidelines and research reports on pharmacotherapy in critical care patient populations are summarized. The Critical Care Pharmacotherapy Literature Update (CCPLU) Group is composed of over 50 experienced critical care pharmacists who evaluate 31 peer-reviewed journals monthly to identify literature pertaining to pharmacotherapy in critical care populations. Articles are chosen for summarization in a monthly CCPLU Group publication on the basis of applicability and relevance to clinical practice and strength of study design. From January to December 2015, a total of 121 articles were summarized; of these, 3 articles presenting clinical practice guidelines and 12 articles presenting original research findings were objectively selected for inclusion in this review based on their potential to change or reinforce current evidence-based practice. The reviewed guidelines address the management of intracranial hemorrhage (ICH), adult advanced cardiac life support (ACLS) and post-cardiac arrest care, and the management of supraventricular tachycardia (SVT). The reviewed research reports address topics such as nutrition in critically ill adults, administration of β-lactams for severe sepsis, anticoagulant selection in the context of continuous renal replacement therapy, early goal-directed therapy in septic shock, magnesium use for neuroprotection in acute stroke, and progesterone use in patients with traumatic brain injury. Important recent additions to the critical care pharmacy literature include updated joint clinical practice guidelines on the management of spontaneous ICH, ACLS, and SVT. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  20. Artificial intelligence applications in the intensive care unit.

    Science.gov (United States)

    Hanson, C W; Marshall, B E

    2001-02-01

    To review the history and current applications of artificial intelligence in the intensive care unit. The MEDLINE database, bibliographies of selected articles, and current texts on the subject. The studies that were selected for review used artificial intelligence tools for a variety of intensive care applications, including direct patient care and retrospective database analysis. All literature relevant to the topic was reviewed. Although some of the earliest artificial intelligence (AI) applications were medically oriented, AI has not been widely accepted in medicine. Despite this, patient demographic, clinical, and billing data are increasingly available in an electronic format and therefore susceptible to analysis by intelligent software. Individual AI tools are specifically suited to different tasks, such as waveform analysis or device control. The intensive care environment is particularly suited to the implementation of AI tools because of the wealth of available data and the inherent opportunities for increased efficiency in inpatient care. A variety of new AI tools have become available in recent years that can function as intelligent assistants to clinicians, constantly monitoring electronic data streams for important trends, or adjusting the settings of bedside devices. The integration of these tools into the intensive care unit can be expected to reduce costs and improve patient outcomes.

  1. The surgery of peripheral nerves (including tumors)

    DEFF Research Database (Denmark)

    Fugleholm, Kåre

    2013-01-01

    Surgical pathology of the peripheral nervous system includes traumatic injury, entrapment syndromes, and tumors. The recent significant advances in the understanding of the pathophysiology and cellular biology of peripheral nerve degeneration and regeneration has yet to be translated into improved...

  2. Including Indigenous Minorities in Decision-Making

    DEFF Research Database (Denmark)

    Pristed Nielsen, Helene

    Based on theories of public sphere participation and deliberative democracy, this book presents empirical results from a study of experiences with including Aboriginal and Maori groups in political decision-making in respectively Western Australia and New Zealand...

  3. Lung Disease Including Asthma and Adult Vaccination

    Science.gov (United States)

    ... Diseases Resources Lung Disease including Asthma and Adult Vaccination Language: English (US) Español (Spanish) Recommend on Facebook ... more about health insurance options. Learn about adult vaccination and other health conditions Asplenia Diabetes Heart Disease, ...

  4. Births and deaths including fetal deaths

    Data.gov (United States)

    U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...

  5. Barriers and Enablers to Integrating Mental Health into Primary Care: A Policy Analysis.

    Science.gov (United States)

    Durbin, Anna; Durbin, Janet; Hensel, Jennifer M; Deber, Raisa

    2016-01-01

    Integrating care for physical health and behavioural health (mental health and addictions) has been a longstanding challenge, although research supports the clinical and cost effectiveness of integrated care for many clients. In one such model, primary care (PC) physicians work with specialist physicians and non-physician providers (NPPs) to provide mental health and addictions care in PC settings. This Ontario, Canada-focused policy analysis draws on research evidence to examine potential barriers and enablers to this model of integrated care, focusing on mental health. Funding challenges pertain to incentivizing PC physicians to select patients with mental illness, include NPPs on the treatment team, and collaborate with specialist providers. Legal/regulatory challenges pertain to NPP scopes of practice for prescribing and counselling. Integrated care also requires revising the role of the physician and distribution of functions among the team. Policy support to integrate addictions treatment in PC may face similar challenges but requires further exploration.

  6. Insights and advances in multidisciplinary critical care: a review of recent research.

    Science.gov (United States)

    Blot, Stijn; Afonso, Elsa; Labeau, Sonia

    2014-01-01

    The intensive care unit is a work environment where superior dedication is pivotal to optimize patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the abundance of research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovations in the field. This article broadly summarizes new developments in multidisciplinary intensive care, providing elementary information about advanced insights in the field by briefly describing selected articles bundled in specific topics. Issues considered include cardiovascular care, monitoring, mechanical ventilation, infection and sepsis, nutrition, education, patient safety, pain assessment and control, delirium, mental health, ethics, and outcomes research.

  7. Instruments Measuring Integrated Care: A Systematic Review of Measurement Properties

    Science.gov (United States)

    BAUTISTA, MARY ANN C.; NURJONO, MILAWATY; DESSERS, EZRA; VRIJHOEF, HUBERTUS JM

    2016-01-01

    Policy Points: Investigations on systematic methodologies for measuring integrated care should coincide with the growing interest in this field of research.A systematic review of instruments provides insights into integrated care measurement, including setting the research agenda for validating available instruments and informing the decision to develop new ones.This study is the first systematic review of instruments measuring integrated care with an evidence synthesis of the measurement properties.We found 209 index instruments measuring different constructs related to integrated care; the strength of evidence on the adequacy of the majority of their measurement properties remained largely unassessed. Context Integrated care is an important strategy for increasing health system performance. Despite its growing significance, detailed evidence on the measurement properties of integrated care instruments remains vague and limited. Our systematic review aims to provide evidence on the state of the art in measuring integrated care. Methods Our comprehensive systematic review framework builds on the Rainbow Model for Integrated Care (RMIC). We searched MEDLINE/PubMed for published articles on the measurement properties of instruments measuring integrated care and identified eligible articles using a standard set of selection criteria. We assessed the methodological quality of every validation study reported using the COSMIN checklist and extracted data on study and instrument characteristics. We also evaluated the measurement properties of each examined instrument per validation study and provided a best evidence synthesis on the adequacy of measurement properties of the index instruments. Findings From the 300 eligible articles, we assessed the methodological quality of 379 validation studies from which we identified 209 index instruments measuring integrated care constructs. The majority of studies reported on instruments measuring constructs related to care

  8. Astronaut medical selection during the shuttle era: 1981-2011.

    Science.gov (United States)

    Johnston, Smith L; Blue, Rebecca S; Jennings, Richard T; Tarver, William J; Gray, Gary W

    2014-08-01

    U.S. astronauts undergo extensive job-related screening and medical examinations prior to selection in order to identify candidates optimally suited for careers in spaceflight. Screening medical standards evolved over many years and after extensive spaceflight experience. These standards assess health-related risks for each astronaut candidate, minimizing the potential for medical impact on future mission success. This document discusses the evolution of the Shuttle-era medical selection standards and the most common reasons for medical dis-qualification of applicants. Data for astronaut candidate finalists were compiled from medical records and NASA archives from the period of 1978 to 2004 and were retrospectively reviewed for medically disqualifying conditions. During Shuttle selection cycles, a total of 372 applicants were disqualified due to 425 medical concerns. The most common disqualifying conditions included visual, cardiovascular, psychiatric, and behavioral disorders. During this time period, three major expert panel reviews resulted in refinements and alterations to selection standards for future cycles. Shuttle-era screening, testing, and specialist evaluations evolved through periodic expert reviews, evidence-based medicine, and astronaut medical care experience. The Shuttle medical program contributed to the development and implementation of NASA and international standards, longitudinal data collection, improved medical care, and occupational surveillance models. The lessons learned from the Shuttle program serve as the basis for medical selection for the ISS, exploration-class missions, and for those expected to participate in commercial spaceflight.

  9. Caring for Dying Patients in the Nursing Home: Voices From Frontline Nursing Home Staff

    Science.gov (United States)

    Cagle, John G.; Unroe, Kathleen T.; Bunting, Morgan; Bernard, Brittany L.; Miller, Susan C.

    2017-01-01

    Context Nursing homes are an important site for end-of-life care, yet little is known about the perspectives of the frontline staff who provide a majority of this care. Objective To describe, from the staff perspective, positive/negative experiences related to caring for dying residents. Methods Qualitative analysis using survey data from staff working in 52 Indiana nursing homes. Results A total of 707 frontline staff who provide nursing, nurse aide, and social work services responded to open-ended prompts. Study data included responses to open-ended prompts asking participants to describe one positive experience and one negative experience caring for a dying patient. A thematic content analysis was conducted using the constant-comparative method. Respondents were largely female (93%), white (78%), 31–50 years (42%), and 53% had >5 years of nursing home work experience. Experiences were described from three perspectives: 1) first-hand experiences, 2) observed experiences of dying patients, and 3) observed experiences of family members. Se