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Sample records for intensive organized case-management

  1. The preventing recurrent vascular events and neurological worsening through intensive organized case-management (PREVENTION trial protocol [clinicaltrials.gov identifier: NCT00931788

    Directory of Open Access Journals (Sweden)

    Tsuyuki Ross

    2010-04-01

    Full Text Available Abstract Background Survivors of transient ischemic attack (TIA or stroke are at high risk for recurrent vascular events and aggressive treatment of vascular risk factors can reduce this risk. However, vascular risk factors, especially hypertension and high cholesterol, are not managed optimally even in those patients seen in specialized clinics. This gap between the evidence for secondary prevention of stroke and the clinical reality leads to suboptimal patient outcomes. In this study, we will be testing a pharmacist case manager for delivery of stroke prevention services. We hypothesize this new structure will improve processes of care which in turn should lead to improved outcomes. Methods We will conduct a prospective, randomized, controlled open-label with blinded ascertainment of outcomes (PROBE trial. Treatment allocation will be concealed from the study personnel, and all outcomes will be collected in an independent and blinded manner by observers who have not been involved in the patient's clinical care or trial participation and who are masked to baseline measurements. Patients will be randomized to control or a pharmacist case manager treating vascular risk factors to guideline-recommended target levels. Eligible patients will include all adult patients seen at stroke prevention clinics in Edmonton, Alberta after an ischemic stroke or TIA who have uncontrolled hypertension (defined as systolic blood pressure (BP > 140 mm Hg or dyslipidemia (fasting LDL-cholesterol > 2.00 mmol/L and who are not cognitively impaired or institutionalized. The primary outcome will be the proportion of subjects who attain 'optimal BP and lipid control'(defined as systolic BP Conclusions Nearly one-quarter of those who survive a TIA or minor stroke suffer another vascular event within a year. If our intervention improves the provision of secondary prevention therapies in these patients, the clinical (and financial implications will be enormous.

  2. Veterans Affairs Intensive Case Management for older veterans.

    Science.gov (United States)

    Mohamed, Somaia; Neale, Michael S; Rosenheck, Robert

    2009-08-01

    There is a growing need for information on evidence-based practices that may potentially address needs of elderly people with severe mental illness (SMI), and more specifically on community-based services such as assertive community treatment (ACT). This study examines national evaluation data from fiscal year 2001-2005 from Veterans Affairs Mental Health Intensive Case Management (MHICM) program (N = 5,222), an ACT-based service model, to characterize the age distribution of participants and the distinctive needs, patterns of service delivery, and treatment outcomes for elderly veterans. Altogether, 24.8% of participants were 55-64 years; 7.4% 65-74 years; and 2.8% were older than 75. Veterans over 75 formed a distinct subgroup that had a later age of onset of primarily nonpsychotic illnesses without comorbid substance abuse and had experienced more limited lifetime hospital treatment than younger participants. Older veterans were less symptomatic and more satisfied with their social relationships than younger clients. They mostly live independently or in minimally restrictive housing, but they received less recovery-focused services and more crisis intervention and medical services. They thus do not appear to be young patients with SMI who have aged but rather constitute a distinct group with serious late-onset problems. It is possible that MHICM services keep them in the community and avoid costly nursing home placement while providing a respite service that reduces family burden. These data highlight the unique characteristics of older veterans receiving ACT-like services and the need to focus greater attention on recovery-oriented services as well as community support for this subgroup.

  3. Adaptation of intensive mental health intensive case management to rural communities in the Veterans Health Administration.

    Science.gov (United States)

    Mohamed, Somaia

    2013-03-01

    There has been increasing concern in recent years about the availability of mental health services for people with serious mental illness in rural areas. To meet these needs the Department of Veterans Affairs (VA) implemented the Rural Access Networks for Growth Enhancement (RANGE) program, in 2007, modeled on the Assertive Community Treatment (ACT) model. This study uses VA administrative data from the RANGE program (N = 343) to compare client characteristics at program entry, patterns of service delivery, and outcomes with those of Veterans who received services from the general VA ACT-like program (Mental Health Intensive Case Management (MHICM) (N = 3,077). Veterans in the rural program entered treatment with similar symptom severity, less likelihood of being diagnosed with schizophrenia and having had long-term hospitalization, but significantly higher suicidality index scores and greater likelihood of being dually diagnosed compared with those in the general program. RANGE Veterans live further away from their treatment teams but did not differ significantly in measures of face-to-face treatment intensity. Similar proportions of RANGE and MHICM Veterans were reported to have received rehabilitation services, crisis intervention and substance abuse treatment. The rural programs had higher scores on overall satisfaction with VA mental health care than general programs, slightly poorer outcomes on quality of life and on the suicidality index but no significant difference on other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small specialized case management teams in rural areas.

  4. Two-year outcome of team-based intensive case management for patients with schizophrenia.

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    Aberg-Wistedt, A; Cressell, T; Lidberg, Y; Liljenberg, B; Osby, U

    1995-12-01

    Two-year outcomes of patients with schizophrenic disorders who were assigned to an intensive, team-based case management program and patients who received standard psychiatric services were assessed. The case management model featured increased staff contact time with patients, rehabilitation plans based on patients' expressed needs, and patients' attendance at team meetings where their rehabilitation plan was discussed. Forty patients were randomly assigned to either the case management group or the control group that received standard services. Patients' use of emergency and inpatient services, their quality of life, the size of their social networks, and their relatives' burden of care were assessed at assignment to the study groups and at two-year follow-up. Patients in the case management group had significantly fewer emergency visits compared with the two years before the study, and their relatives reported significantly reduced burden of care associated with relationships with psychiatric services over the two-year period. The size of patients' social networks increased for the case management group and decreased for the control group. A team-based intensive case management model is an effective intervention in the rehabilitation of patients with chronic schizophrenia.

  5. Aspects and Intensity of Pediatric Palliative Case Management Provided by a Hospital-Based Case Management Team: A Comparative Study Between Children With Malignant and Nonmalignant Disease.

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    Jagt-van Kampen, Charissa T; Colenbrander, Derk A; Bosman, Diederik K; Grootenhuis, Martha A; Kars, Marijke C; Schouten-van Meeteren, Antoinette Yn

    2018-01-01

    Anticipating case management is considered crucial in pediatric palliative care. In 2012, our children's university hospital initiated a specialized pediatric palliative care team (PPCT) to deliver inbound and outbound case management for children with life-shortening disease. The aim of this report is to gain insight in the first 9 months of this PPCT. Aspects of care during the first 9 months of the PPCT are presented, and comparison is made between patients with malignant disease (MD) and nonmalignant disease (NMD) in a retrospective study design. Insight in the aspects of care of all patients with a life-shortening disease was retrieved from web-based files and the hour registrations from the PPCT. Forty-three children were supported by the PPCT during the first 9 months: 22 with MD with a median of 50 (1-267) days and 29 minutes (4-615) of case management per patient per day and 21 patients with NMD with a median of 79.5 (5-211) days and 16 minutes of case management per day (6-64). Our data show significantly more interprofessional contacts for patients with MD and more in-hospital contacts for patients with NMD. The median number of admission days per patient was 11 (0-22) for MD (44% for anticancer therapy) and 44 (0-303) for NMD (36% for infectious diseases). This overview of aspects of pediatric palliative case management shows shorter but more intensive case management for MD in comparison with NMD. This insight in palliative case management guides the design of a PPCT.

  6. Reimbursement for pediatric diabetes intensive case management: a model for chronic diseases?

    Science.gov (United States)

    Beck, Joni K; Logan, Kathy J; Hamm, Robert M; Sproat, Scott M; Musser, Kathleen M; Everhart, Patricia D; McDermott, Harrold M; Copeland, Kenneth C

    2004-01-01

    Current reimbursement policies serve as potent disincentives for physicians who provide evaluation and management services exclusively. Such policies threaten nationwide availability of care for personnel-intensive services such as pediatric diabetes. This report describes an approach to improving reimbursement for highly specialized, comprehensive pediatric diabetes management through prospective contracting for services. The objective of this study was to determine whether pediatric diabetes intensive case management services are cost-effective to the payer, the patient, and a pediatric diabetes program. A contract with a third-party payer was created to reimburse for 3 key pediatric diabetes intensive case management components: specialty education, 24/7 telephone access to an educator (and board-certified pediatric endocrinologist as needed), and quarterly educator assessments of self-management skills. Data were collected and analyzed for 15 months after signing the contract. Within the first 15 months after the contract was signed, 22 hospital admissions for diabetic ketoacidosis (DKA) occurred in 16 different patients. After hospitalizations for DKA, all 16 patients were offered participation in the program. All were followed during the subsequent 1 to 15 months of observation. Ten patients elected to participate, and 6 refused participation. Frequency of rehospitalization, emergency department visits, and costs were compared between the 2 groups. Among the 10 participating patients, there was only 1 subsequent DKA admission, whereas among the 6 who refused participation, 5 were rehospitalized for DKA on at least 1 occasion. The 10 patients who participated in the program had greater telephone contact with the team compared with those who did not (16 crisis-management calls vs 0). Costs (education, hospitalization, and emergency department visits) per participating patient were approximately 1350 dollars less than those for nonparticipating patients

  7. Intensive case management for high-risk patients with first-episode psychosis: service model and outcomes.

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    Brewer, Warrick J; Lambert, Timothy J; Witt, Katrina; Dileo, John; Duff, Cameron; Crlenjak, Carol; McGorry, Patrick D; Murphy, Brendan P

    2015-01-01

    The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual. Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15-24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge. Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts. Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis

  8. Expert knowledge elicitation using computer simulation: the organization of frail elderly case management as an illustration.

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    Chiêm, Jean-Christophe; Van Durme, Thérèse; Vandendorpe, Florence; Schmitz, Olivier; Speybroeck, Niko; Cès, Sophie; Macq, Jean

    2014-08-01

    Various elderly case management projects have been implemented in Belgium. This type of long-term health care intervention involves contextual factors and human interactions. These underlying complex mechanisms can be usefully informed with field experts' knowledge, which are hard to make explicit. However, computer simulation has been suggested as one possible method of overcoming the difficulty of articulating such elicited qualitative views. A simulation model of case management was designed using an agent-based methodology, based on the initial qualitative research material. Variables and rules of interaction were formulated into a simple conceptual framework. This model has been implemented and was used as a support for a structured discussion with experts in case management. The rigorous formulation provided by the agent-based methodology clarified the descriptions of the interventions and the problems encountered regarding: the diverse network topologies of health care actors in the project; the adaptation time required by the intervention; the communication between the health care actors; the institutional context; the organization of the care; and the role of the case manager and his or hers personal ability to interpret the informal demands of the frail older person. The simulation model should be seen primarily as a tool for thinking and learning. A number of insights were gained as part of a valuable cognitive process. Computer simulation supporting field experts' elicitation can lead to better-informed decisions in the organization of complex health care interventions. © 2013 John Wiley & Sons, Ltd.

  9. Work Incapacity and Treatment Costs After Severe Accidents: Standard Versus Intensive Case Management in a 6-Year Randomized Controlled Trial.

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    Scholz, Stefan M; Andermatt, Peter; Tobler, Benno L; Spinnler, Dieter

    2016-09-01

    Purpose Case management is widely accepted as an effective method to support medical rehabilitation and vocational reintegration of accident victims with musculoskeletal injuries. This study investigates whether more intensive case management improves outcomes such as work incapacity and treatment costs for severely injured patients. Methods 8,050 patients were randomly allocated either to standard case management (SCM, administered by claims specialists) or intensive case management (ICM, administered by case managers). These study groups differ mainly by caseload, which was approximately 100 cases in SCM and 35 in ICM. The setting is equivalent to a prospective randomized controlled trial. A 6-year follow-up period was chosen in order to encompass both short-term insurance benefits and permanent disability costs. All data were extracted from administrative insurance databases. Results Average work incapacity over the 6-year follow-up, including contributions from daily allowances and permanent losses from disability, was slightly but insignificantly higher under ICM than under SCM (21.6 vs. 21.3 % of pre-accident work capacity). Remaining work incapacity after 6 years of follow-up showed no difference between ICM and SCM (8.9 vs. 8.8 % of pre-accident work incapacity). Treatment costs were 43,500 Swiss Francs (CHF) in ICM compared to 39,800 in SCM (+9.4 %, p = 0.01). The number of care providers involved in ICM was 10.5 compared to 10.0 in ICM (+5.0 %, p accident victims.

  10. Case management for high-intensity service users: towards a relational approach to care co-ordination.

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    McEvoy, Phil; Escott, Diane; Bee, Penny

    2011-01-01

    This study is based on a formative evaluation of a case management service for high-intensity service users in Northern England. The evaluation had three main purposes: (i) to assess the quality of the organisational infrastructure; (ii) to obtain a better understanding of the key influences that played a role in shaping the development of the service; and (iii) to identify potential changes in practice that may help to improve the quality of service provision. The evaluation was informed by Gittell's relational co-ordination theory, which focuses upon cross-boundary working practices that facilitate task integration. The Assessment of Chronic Illness Care Survey was used to assess the organisational infrastructure and qualitative interviews with front line staff were conducted to explore the key influences that shaped the development of the service. A high level of strategic commitment and political support for integrated working was identified. However, the quality of care co-ordination was variable. The most prominent operational factor that appeared to influence the scope and quality of care co-ordination was the pattern of interaction between the case managers and their co-workers. The co-ordination of patient care was much more effective in integrated co-ordination networks. Key features included clearly defined, task focussed, relational workspaces with interactive forums where case managers could engage with co-workers in discussions about the management of interdependent care activities. In dispersed co-ordination networks with fewer relational workspaces, the case managers struggled to work as effectively. The evaluation concluded that the creation of flexible and efficient task focused relational workspaces that are systemically managed and adequately resourced could help to improve the quality of care co-ordination, particularly in dispersed networks. © 2010 Blackwell Publishing Ltd.

  11. Organizing and delivering case management services: lessons from the National Long Term Care Channeling Demonstration.

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    Christianson, J B; Applebaum, R; Carcagno, G; Phillips, B

    1988-01-01

    This article discusses issues relating to the design and internal administration of a case-management agency for community based home care for the elderly. Included in the article are issues relating to screening procedures, assessment and case management activities, cost controls, automated management information systems, and personnel matters. The analysis is based on the experience of the National Long Term Care Demonstration ("Channeling") which established and evaluated ten case management projects nationwide under federal funding.

  12. Case management.

    Science.gov (United States)

    Woodward, Judy; Rice, Eve

    2015-03-01

    Health care in the United States is changing rapidly under pressure from both political and professional stakeholders, and one area on the front line of required change is the discipline of case management. Historically, case management has worked to defragment the health care delivery system for clients and increase access to health care. Case management will have an expanded role resulting from Affordable Care Act initiatives to improve health care. This article includes definitions of case management, current issues related to case management, case management standards of practice, and a case study of the management of pediatric chronic disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Integrating care for frequent users of emergency departments: implementation evaluation of a brief multi-organizational intensive case management intervention.

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    Kahan, Deborah; Leszcz, Molyn; O'Campo, Patricia; Hwang, Stephen W; Wasylenki, Donald A; Kurdyak, Paul; Wise Harris, Deborah; Gozdzik, Agnes; Stergiopoulos, Vicky

    2016-04-27

    Addressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre. Coordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions. To examine barriers and facilitators to early implementation of this multi-organizational intervention, between July and October 2012, 47 stakeholders, including direct service providers, managers and administrators participated in 32 semi-structured qualitative interviews and one focus group exploring their experience with the intervention and factors that helped or hindered successful early implementation. Qualitative data were analyzed using thematic analysis. Stakeholders valued the intervention and its potential to support continuity of care for this population. Service delivery system factors, including organizational capacity and a history of collaborative relationships across the healthcare continuum, and support system factors, such as training and supervision, emerged as key facilitators of program implementation. Operational challenges included early low program referral rates, management of a multi-organizational initiative, variable adherence to the model among participating organizations, and scant access to specialty psychiatric resources. Factors contributing to these challenges included lack of dedicated staff in the ED and limited local system capacity to support this population, and insufficient training and technical assistance available to participating organizations. A multi

  14. Increasing physical activity for veterans in the Mental Health Intensive Case Management Program: A community-based intervention.

    Science.gov (United States)

    Harrold, S Akeya; Libet, Julian; Pope, Charlene; Lauerer, Joy A; Johnson, Emily; Edlund, Barbara J

    2018-04-01

    Individuals with severe mental illness (SMI), experience increased mortality-20 years greater disparity for men and 15 years greater disparity for women-compared to the general population (Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442). Numerous factors contribute to premature mortality in persons with SMI, including suicide and accidental death (Richardson RC, Faulkner G, McDevitt J, Skrinar GS, Hutchinson D, Piette JD. Integrating physical activity into mental health services for persons with serious mental illness. Psychiatr Serv. 2005;56(3):324-331; Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442), but research has shown that adverse health behaviors-including smoking, low rate of physical activity, poor diet, and high alcohol consumption-also significantly contribute to premature deaths (Jones J. Life expectancy in mental illness. Psychiatry Services. 2010. Retrieved from http://psychcentral.com/news/2010/07/13/life-expectancy-in-mental-illness). This quality improvement (QI) project sought to improve health and wellness for veterans in the Mental Health Intensive Case Management Program (MHICM), which is a community-based intensive program for veterans with SMI at risk for decompensation and frequent hospitalizations. At the time of this QI project, the program had 69 veterans who were assessed and treated weekly in their homes. The project introduced a pedometer steps intervention adapted from the VA MOVE! Program-a physical activity and weight management program-with the addition of personalized assistance from trained mental health professionals in the veteran's home environment. Because a large percentage of the veterans in the MHICM program had high blood pressure and increased weight, these outcomes were the focus of this project. Through mental health case management involvement and

  15. Case Management Directors

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    Bankston White, Cheri; Birmingham, Jackie

    2015-01-01

    Purpose and Objectives: Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the “moving parts” of such a complex role. This is Part 2 of a two-part article written for case management directors, particularly new ones. Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes. This article attempts to answer the following questions: Are case management directors prepared for an expanded role that affects departments and organizations outside of their own?How does a case management director manage the transition of care of patients while managing required relationships outside the department?How does the director manage program outcomes in such a complex department? Primary Practice Setting: The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Findings/Conclusions: Part 1 found that case management directors would benefit from further research and documentation of “best practices” related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations

  16. Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study.

    Science.gov (United States)

    Morandi, Stéphane; Silva, Benedetta; Golay, Philippe; Bonsack, Charles

    2017-05-25

    Co-occurring severe mental and substance use disorders are associated with physical, psychological and social complications such as homelessness and unemployment. People with severe mental and substance use disorders are difficult to engage with care. The lack of treatment worsens their health and social conditions and increases treatment costs, as emergency department visits arise. Case management has proved to be effective in promoting engagement with care of people with severe mental and substance use disorders. However, this impact seemed mainly related to the case management model. The Intensive Case Management for Addiction (ICMA) aimed to improve engagement with care of people with severe mental and substance use disorders, insufficiently engaged with standard treatment. This innovative multidisciplinary mobile team programme combined Assertive Community Treatment and Critical Time Intervention methodologies. The aim of the study was to observe the impact of ICMA upon service use, treatment adherence and quality of support networks. Participants' psychosocial and mental functioning, and substance use were also assessed throughout the intervention. The study was observational. Eligible participants were all the people entering the programme during the first year of implementation (April 2014-April 2015). Data were collected through structured questionnaires and medical charts. Assessments were conducted at baseline and at 12 months follow-up or at the end of the programme if completed earlier. McNemar-Bowker's Test, General Linear Model repeated-measures analysis of variance and non-parametric Wilcoxon Signed Rank tests were used for the analysis. A total of 30 participants took part in the study. Results showed a significant reduction in the number of participants visiting the general emergency department compared to baseline. A significantly decreased number of psychiatric emergency department visits was also registered. Moreover, at follow-up participants

  17. A randomized-controlled trial of intensive case management emphasizing the recovery model among patients with severe and enduring mental illness.

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    O'Brien, S; McFarland, J; Kealy, B; Pullela, A; Saunders, J; Cullen, W; Meagher, D

    2012-09-01

    There is increasing interest in the application of recovery principles in mental health services. We studied the implementation of a programme of intensive case management (ICM) emphasizing recovery principles in a community mental health service in Ireland. Eighty service attenders with severe and enduring illness characterized by significant ongoing disability were randomized into (1) a group receiving a programme of ICM and (2) a group receiving treatment as usual (TAU). Groups were compared before and after the programme for general psychopathology using the Brief Psychiatric Rating Scale (BPRS) (clinician rated) and How are You? scale (self-rated). The Functional Analysis of Care Environments (FACE) scale provided assessment of multiple functional domains. The overall group (mean age 44.5 ± 13.2 years; 60% male) had mean total Health of the Nation Outcome Scale (HoNOS) scale scores of 10.5 ± 4.6, with problems in social functioning especially prominent (mean social subscale score 5.0 ± 2.7). The ICM group were younger (p recovery principles resulted in significant improvement across psychopathological and functional domains. Improvements were linked to enhanced engagement with structured daily activities. Recovery-oriented practices can be integrated into existing mental health services and provided alongside traditional models of care.

  18. High Intensity Organic Light-emitting Diodes

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    Qi, Xiangfei

    This thesis is dedicated to the fabrication, modeling, and characterization to achieve high efficiency organic light-emitting diodes (OLEDs) for illumination applications. Compared to conventional lighting sources, OLEDs enabled the direct conversion of electrical energy into light emission and have intrigued the world's lighting designers with the long-lasting, highly efficient illumination. We begin with a brief overview of organic technology, from basic organic semiconductor physics, to its application in optoelectronics, i.e. light-emitting diodes, photovoltaics, photodetectors and thin-film transistors. Due to the importance of phosphorescent materials, we will focus on the photophysics of metal complexes that is central to high efficiency OLED technology, followed by a transient study to examine the radiative decay dynamics in a series of phosphorescent platinum binuclear complexes. The major theme of this thesis is the design and optimization of a novel architecture where individual red, green and blue phosphorescent OLEDs are vertically stacked and electrically interconnected by the compound charge generation layers. We modeled carrier generation from the metal-oxide/doped organic interface based on a thermally assisted tunneling mechanism. The model provides insights to the optimization of a stacked OLED from both electrical and optical point of view. To realize the high intensity white lighting source, the efficient removal of heat is of a particular concern, especially in large-area devices. A fundamental transfer matrix analysis is introduced to predict the thermal properties in the devices. The analysis employs Laplace transforms to determine the response of the system to the combined effects of conduction, convection, and radiation. This perspective of constructing transmission matrices greatly facilitates the calculation of transient coupled heat transfer in a general multi-layer composite. It converts differential equations to algebraic forms, and

  19. Effectiveness of Housing First with Intensive Case Management in an Ethnically Diverse Sample of Homeless Adults with Mental Illness: A Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Vicky Stergiopoulos

    Full Text Available Housing First (HF is being widely disseminated in efforts to end homelessness among homeless adults with psychiatric disabilities. This study evaluates the effectiveness of HF with Intensive Case Management (ICM among ethnically diverse homeless adults in an urban setting. 378 participants were randomized to HF with ICM or treatment-as-usual (TAU in Toronto (Canada, and followed for 24 months. Measures of effectiveness included housing stability, physical (EQ5D-VAS and mental (CSI, GAIN-SS health, social functioning (MCAS, quality of life (QoLI20, and health service use. Two-thirds of the sample (63% was from racialized groups and half (50% were born outside Canada. Over the 24 months of follow-up, HF participants spent a significantly greater percentage of time in stable residences compared to TAU participants (75.1% 95% CI 70.5 to 79.7 vs. 39.3% 95% CI 34.3 to 44.2, respectively. Similarly, community functioning (MCAS improved significantly from baseline in HF compared to TAU participants (change in mean difference = +1.67 95% CI 0.04 to 3.30. There was a significant reduction in the number of days spent experiencing alcohol problems among the HF compared to TAU participants at 24 months (ratio of rate ratios = 0.47 95% CI 0.22 to 0.99 relative to baseline, a reduction of 53%. Although the number of emergency department visits and days in hospital over 24 months did not differ significantly between HF and TAU participants, fewer HF participants compared to TAU participants had 1 or more hospitalizations during this period (70.4% vs. 81.1%, respectively; P=0.044. Compared to non-racialized HF participants, racialized HF participants saw an increase in the amount of money spent on alcohol (change in mean difference = $112.90 95% CI 5.84 to 219.96 and a reduction in physical community integration (ratio of rate ratios = 0.67 95% CI 0.47 to 0.96 from baseline to 24 months. Secondary analyses found a significant reduction in the number of days

  20. Iowa Case Management for Rural Drug Abuse

    Science.gov (United States)

    Hall, James A.; Vaughan Sarrazin, Mary S.; Huber, Diane L.; Vaughn, Thomas; Block, Robert I.; Reedy, Amanda R.; Jang, MiJin

    2009-01-01

    Objective: The purpose of this research was to evaluate the effectiveness of a comprehensive, strengths-based model of case management for clients in drug abuse treatment. Method: 503 volunteers from residential or intensive outpatient treatment were randomly assigned to one of three conditions of Iowa Case Management (ICM) plus treatment as usual…

  1. A randomized controlled open trial of population-based disease and case management in a Medicare Plus Choice health maintenance organization.

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    Martin, David C; Berger, Marc L; Anstatt, David T; Wofford, Jonathan; Warfel, DeAnn; Turpin, Robin S; Cannuscio, Carolyn C; Teutsch, Steven M; Mansheim, Bernard J

    2004-10-01

    The object of this study was to examine the effect of population-based disease management and case management on resource use, self-reported health status, and member satisfaction with and retention in a Medicare Plus Choice health maintenance organization (HMO). Study design consisted of a prospective, randomized controlled open trial of 18 months' duration. Participants were 8504 Medicare beneficiaries aged 65 and older who had been continuously enrolled for at least 12 months in a network model Medicare Plus Choice HMO serving a contiguous nine-county metropolitan area. Members were care managed with an expert clinical information system and frequent telephone contact. Main outcomes included self-reported health status measured by the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), resource use measured by admission rates and bed-days per thousand per year, member satisfaction, and costs measured by paid claims. More favorable outcomes occurred in the intervention group for satisfaction with the health plan (P management and case management led to improved self-reported satisfaction and social function but not to a global net decrease in resource use or improved member retention.

  2. "Tuberculosis Case Management" Training.

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    Knebel, Elisa; Kolodner, Jennifer

    2001-01-01

    The need to isolated health providers with critical knowledge in tuberculosis (TB) case management prompted the development of "Tuberculosis Case Management" CD-ROM. Features include "Learning Center,""Examination Room," and "Library." The combination of audio, video, and graphics allows participants to…

  3. Leadership development and succession planning in case management.

    Science.gov (United States)

    Miodonski, Kathleen; Hines, Patricia

    2013-01-01

    The director of case management is one of health care's leadership positions most frequently in demand. The lack of qualified and effective case management leaders will continue to be an issue for organizations for years to come, influenced by increasing pressures on health care reimbursement and the aging case management workforce. Organizations have an opportunity to create a program to develop future case management leaders from their internal talent. The proposed strategies are designed for the acute care hospital but also have applicability in other health care settings where there are case managers and a need for case management leadership. The business community offers leadership research and leadership development models with relevance to case management. Identifying and developing internal talent for leadership roles has been proven to be effective in preparation for advanced responsibilities, has a positive effect on staff morale, and minimizes the impact of vacant leadership positions during recruitment and onboarding activities. Creating a case management leadership development program for an organization can be an alternative to the process of external recruitment for case management department leaders. Such a program can be undertaken even in today's budget conscious environment by accessing existing resources in an organization in a creative and organized manner. The authors outline an approach for case management leaders to accept responsibility for succession planning and for case managers to accept responsibility for promoting their own career development through creation of a leadership development program.

  4. [Case managers experience improved trajectories for cancer patients after implementation of the case manager function].

    Science.gov (United States)

    Axelsen, Karina Rahbek; Nafei, Hanne; Jakobsen, Stine Finne; Gandrup, Per; Knudsen, Janne Lehmann

    2015-06-08

    Case managers are increasingly used to optimize trajectories for patients. This study is based on a questionnaire among case managers in cancer care, aiming at the clarification of the func­tion and its impact on especially patient safety, when handing over the responsibility. The results show a major variation in how the function is organized, the level of competence and the task to be handled. The responsibility has in general been nar­rowed to department level. Overall, the case managers believe that the function has optimized pathways for cancer patients and improved safety, but barriers persist.

  5. The "wins" of change: evaluating the impact of predicted changes on case management practice.

    Science.gov (United States)

    Stanton, Marietta P; Barnett Lammon, Carol Ann

    2008-01-01

    A variety of strategies were employed to identify current and future trends that would impact the practice of case management. Historical review, consultation with case management experts, literature review, and environmental scanning by practicing case managers were strategies employed to determine the impact of current and future trends on case management. The trends identified in this article have implications for case managers in a variety of settings. Case managers participating in the environmental scanning process to evaluate the impact of the identified trends on their organization included representation from acute care, home care, behavioral health, workers' compensation, and private insurance settings. The top 7 trends identified by experts in the field of case management included pay for performance, recovery audit contractors, Medicare demonstration projects, transitions of care, informatics in healthcare and case management, metrics for case management, and the impact of an aging population in case management. Practicing case managers were asked to react to these trends in terms of likelihood of occurrence in their organization and impact of these trends on their case management practice. Case management will ultimately have a higher degree of accountability for its practice if metrics to evaluate and reimbursement for case management become a reality. A multitude of performance measures exist that will be monitored and be tied to reimbursement. To ensure that agencies are accomplishing these performance measures, case management will potentially have a growing importance. Case managers perceive that these trends have a predominantly positive impact on case management.

  6. Improving adolescent pregnancy outcomes and maternal health:a case study of comprehensive case managed services.

    Science.gov (United States)

    Bowman, Elizabeth K; Palley, Howard A

    2003-01-01

    Our findings indicate how health outcomes regarding adolescent pregnancy and maternal and infant health care are intertwined with a case management process that fosters measures that are social in nature-the provision of direct services, as well as the encouragement of informal social supports systems. They also show how case managed services in a small, nongovernmental organization (NGO) with a strong commitment to its clients may provide the spontaneity and caring which results in a "match" between client needs and the delivery of services-and positive outcomes for pregnant women, early maternal health and infant health. The delivery of such case managed services in a manner which is intensive, comprehensive, flexible and integrated contributes significantly to such improved health outcomes.

  7. IT Business Value Model for Information Intensive Organizations

    Directory of Open Access Journals (Sweden)

    Antonio Carlos Gastaud Maçada

    2012-01-01

    Full Text Available Many studies have highlighted the capacity Information Technology (IT has for generating value for organizations. Investments in IT made by organizations have increased each year. Therefore, the purpose of the present study is to analyze the IT Business Value for Information Intensive Organizations (IIO - e.g. banks, insurance companies and securities brokers. The research method consisted of a survey that used and combined the models from Weill and Broadbent (1998 and Gregor, Martin, Fernandez, Stern and Vitale (2006. Data was gathered using an adapted instrument containing 5 dimensions (Strategic, Informational, Transactional, Transformational and Infra-structure with 27 items. The instrument was refined by employing statistical techniques such as Exploratory and Confirmatory Factorial Analysis through Structural Equations (first and second order Model Measurement. The final model is composed of four factors related to IT Business Value: Strategic, Informational, Transactional and Transformational, arranged in 15 items. The dimension Infra-structure was excluded during the model refinement process because it was discovered during interviews that managers were unable to perceive it as a distinct dimension of IT Business Value.

  8. A ten-step process to develop case management plans.

    Science.gov (United States)

    Tahan, Hussein A

    2002-01-01

    The use of case management plans has contained cost and improved quality of care successfully. However, the process of developing these plans remains a great challenge for healthcare executives, in this article, the author presents the answer to this challenge by discussing a 10-step formal process that administrators of patient care services and case managers can adapt to their institutions. It also can be used by interdisciplinary team members as a practical guide to develop a specific case management plan. This process is applicable to any care setting (acute, ambulatory, long term, and home care), diagnosis, or procedure. It is particularly important for those organizations that currently do not have a deliberate and systematic process to develop case management plans and are struggling with how to improve the efficiency and productivity of interdisciplinary teams charged with developing case management plans.

  9. [Case management process identified from experience of nurse case managers].

    Science.gov (United States)

    Park, Eun-Jun; Kim, Chunmi

    2008-12-01

    The purpose of this study was to develop a substantive theory of case management (CM) practice by investigating the experience of nurse case managers caring for Medical Aid enrollees in Korea. A total of 12 nurses were interviewed regarding their own experience in CM practice. Data were recorded and analyzed using grounded theory. Empowerment was the core category of CM for Medical Aid enrollees. The case managers engaged in five phases as follows, phase of inquiring in advance, building a relationship with the client, giving the client critical mind, facilitating positive changes in the client's use of healthcare services, and maintaining relationship bonds. These phases moved gradually and were circular if necessary. Also, they were accelerated or slowed depending on factors including clients' characteristics, case managers' competency level, families' support level, and availability of community resources. This study helps understand what CM practice is and how nurses are performing this innovative CM role. It is recommended that nurse leaders and policy makers integrate empowerment as a core category and the five critical CM phases into future CM programs.

  10. Effectiveness of Case Management for Homeless Persons: A Systematic Review

    Science.gov (United States)

    de Vet, Renée; van Luijtelaar, Maurice J. A.; Brilleslijper-Kater, Sonja N.; Vanderplasschen, Wouter; Beijersbergen, Mariëlle D.

    2013-01-01

    We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness. PMID:23947309

  11. [Structure and functional organization of integrated cardiac intensive care].

    Science.gov (United States)

    Scherillo, Marino; Miceli, Domenico; Tubaro, Marco; Guiducci, Umberto

    2007-05-01

    The early invasive strategy for the treatment of acute coronary syndromes and the increasing number of older and sicker patients requiring prolonged and more complex intensive care have induced many changes in the function of the intensive care units. These changes include the statement that specially trained cardiologists and cardiac nurses who can manage patients with acute cardiac conditions should staff the intensive care units. This document indicates the structure of the units and specific recommendations for the number of beds, monitoring system, respirators, pacemaker/defibrillators and additional equipment.

  12. The impact of staff case manager-case management supervisor relationship on job satisfaction and retention of RN case managers.

    Science.gov (United States)

    Hogan, Tierney D

    2005-01-01

    A positive relationship between staff RN case managers and their case management supervisor significantly impacts job satisfaction and retention in case managers. Literature review supports the premise that staff need to trust their supervisor and that there is a connection between this trust and job satisfaction. Staff case managers need to have a voice at work and feel empowered, and a supervisor's leadership style can influence job satisfaction and retention in their staff.

  13. Case management information systems: how to put the pieces together now and beyond year 2000.

    Science.gov (United States)

    Matthews, Pamela

    2002-01-01

    The case management process is a critical management and operational component in the delivery of customer services across the patient care continuum. Case management has transcended time and will continue to be a viable infrastructure process for successful organizations in the future. A key component of the case management infrastructure is information systems and technology support. Case management challenges include effective deployment and use of systems and technology. As more sophisticated, integrated systems are made available, case managers can use these tools to continue to expand effectively beyond the patient's episodic event to provide greater levels of cradle-to-grave management of healthcare. This article explores methods for defining case management system needs and identifying automation options available to the case manager.

  14. Intensive Ammonia and Methane Oxidation in Organic Liquid Manure Crusts

    DEFF Research Database (Denmark)

    Nielsen, Daniel Aagren; Nielsen, Lars Peter; Schramm, Andreas

    methane oxidizing bacteria (MOB) and are known to accumulate nitrite and nitrate, indicating the presence of ammonia oxidizers (AOB). We have surveyed six manure tanks with organic covers to investigate the prevalence of MOB and AOB and to link the potential activity with physical and chemical aspects...... characterized with respect to O2 availability by in situ profiling with electrochemical microsensors. Results show that oxygen penetration increased from few micrometers up to several centimetres with crust age. AOB and ammonium oxidation are ubiquitously present in well-developed manure crusts whereas MOB were...... also CH4 emission mitigation, an organic surface crust can be effective if populations of MOB and AOB are allowed to build up....

  15. Protease inhibitors: changing the way AIDS case management does business.

    Science.gov (United States)

    Merithew, M A; Davis-Satterla, L

    2000-09-01

    The purpose of the qualitative evaluation study discussed in this article was to examine the AIDS case management model under which five nonprofit AIDS service organizations (ASOs) in Midcity were operating. The study was organized around 40 qualitative interviews with executive directors, directors, and case managers. The finding was that AIDS case management is evolving to accommodate the changing environmental/contextual conditions that have resulted from combination drug therapies (protease inhibitors) introduced in 1996. The agencies are responding to the changes individually rather than as a network, and responses vary among the agencies. Institutional theory, an examination of the interconnectedness of clients, the ASOs, and their environmental context guided the analysis of the findings.

  16. Care for the case manager: balancing your wheel of life.

    Science.gov (United States)

    Crowell, D M

    1998-01-01

    The case manager's role in our complex health care system is demanding and draining without some self-reflective attention. The Wheel of Life is a key tool for individuals to assess how well they are leading a fully balanced life. The eight aspects of a balanced life--values, self-care, work, relationships, leisure, relaxation, exercise, and centering--are explained and discussed. A self-reflective activity is presented that encourages readers to assess their current life balance. This focused clarification of personal and professional life will facilitate a more fully balanced life with rewards for case managers as individuals, and for their family, clients, and the health care organization.

  17. Collaborative Infrastructures for Mobilizing Intellectual Resources: assessing intellectual bandwidth in a knowledge intensive organization

    NARCIS (Netherlands)

    R. Verhoef; S. Qureshi (Sadja)

    2004-01-01

    textabstractThe use of intellectual assets of key professionals to provide customized goods and services is seen to be a key characteristic of knowledge intensive organizations. While knowledge management efforts have become popular in organizations that depend on the knowledge and skills of their

  18. The Role of Leadership: The Challenge of Knowledge Management and Learning in Knowledge-Intensive Organizations

    Science.gov (United States)

    Mas-Machuca, Marta

    2014-01-01

    Knowledge and learning are important driving forces for business success and competitiveness, especially in the knowledge-intensive organizations (KIO's) whose core business is to create and sell knowledge (e.g. education, R&D units, and consultancy organizations, among others). Previous works suggested one of the Critical Success Factor (CSF)…

  19. Case Managers on the Front Lines of Ethical Dilemmas: Advocacy, Autonomy, and Preventing Case Manager Burnout.

    Science.gov (United States)

    Sortedahl, Charlotte; Mottern, Nina; Campagna, Vivian

    The purpose of this article is to examine how case managers are routinely confronted by ethical dilemmas within a fragmented health care system and given the reality of financial pressures that influence life-changing decisions. The Code of Professional Conduct for Case Managers (Code), published by the Commission for Case Manager Certification, acknowledges "case managers may often confront ethical dilemmas" (Code 1996, Rev. 2015). The Code and expectations that professional case managers, particularly those who are board certified, will uphold ethical and legal practice apply to case managers in every practice setting across the full continuum of health care. This discussion acknowledges the ethical dilemmas that case managers routinely confront, which empowers them to seek support, guidance, and resources to support ethical practice. In addition, the article seeks to raise awareness of the effects of burnout and moral distress on case managers and others with whom they work closely on interdisciplinary teams.

  20. Case manager satisfaction in public health.

    Science.gov (United States)

    Schutt, Russell K; Fawcett, Jacqueline; Gall, Gail B; Harrow, Brooke; Woodford, Mary Lou

    2010-01-01

    The purpose of this study was to examine correlates of case managers' satisfaction with their work, services, and service network and to identify connections to service performance and service costs. A decentralized public health program that exemplifies the trend toward more diverse clients and networked services. A mixed method design with 34 case managers. As hypothesized, the case managers' experiences with clients and the service network, and their service effectiveness, were associated with their satisfaction with their jobs and the services they provide. Satisfaction was also positively associated with more timely service delivery. These associations were explained in part by case managers' education and training. Case managers can achieve high levels of job and service satisfaction in outreach programs serving a diverse client population in a decentralized service network. Case managers' job and service satisfaction improves with reduced service problems and service delays and when case managers can devise work-arounds for persistent service problems. Using advanced practice nurses (APN) and providing more on-the-job training may increase case manager satisfaction with their jobs and the services they provide. Special efforts may be needed to prevent a decline in job satisfaction with years of experience.

  1. The Effect Of Intensive Keramba On The Presence Of Parasite Organisms In Rivers Of Lingsar Area

    Directory of Open Access Journals (Sweden)

    Supriadi Supriadi

    2015-04-01

    Full Text Available The application of intensive keramba in rivers could affect the presence of parasite organisms throughout  the river downstream. The aims of this research are to find out the diversity of parasite species and the effect of intensive aquaculture method developed by the community on the presence of various parasitic organisms, particularly in the downstream area. A total of 65 Tilapia fish samples (O. niloticus that was collected from 3 areas ( 15 samples from upstream, 25 samples in keramba and 25 samples from downstream areas have been examined  in the laboratory of Faculty of Mathematic and Natural Science, University of Mataram. Methods employed  to identify parasites that  infected fish samples are native method and flotation method. This research has identified 7 species of parasites which were divided into 2 groups: ectoparasites (Trichodina sp., Amylodinium sp., Oogonium sp., Dactylogirus sp., Trematode and endoparasites (Entamoeba sp. dan Camallanus sp.. Diversity index calculation  indicated that parasite organisms in upstream area were lower in number than that in the downstream and intensive karamba area (H’= (0,825; 1,596 dan 1.324 respectively.  These data has showed there was a difference in species diversity and evenness index of parasite organisms in the upstream, downstream and intensive keramba area. In conclusion, there was significant influence of the application of intensive keramba on the appearance of various parasite organisms that could affect the sustainability of  fish aquaculture.

  2. Applying e-health to case management.

    Science.gov (United States)

    Adams, J M

    2000-01-01

    The healthcare industry is only beginning to understand e-health. E-health can be defined as the use of technology to directly improve healthcare delivery-affording patients the opportunity to participate in their own healthcare management, provider, and institution. The market is changing rapidly, and innovations, partnerships, and mergers are taking place daily. For healthcare institutions, setting a long-term, yet adaptable e-health strategy is of vital importance for the continued success of the organization. For clinicians, an understanding of and familiarity with technologies can significantly improve workflow, organization, and patient interaction. For the patient, technology can be leveraged as a means to take initiative and responsibility for his/her own health. This article defines e-health and explains the implications and benefits of e-health to nurses and their patients. The article also identifies unique opportunities e-health/e-commerce can provide case managers in promoting patient connectivity, care management, and economy in cost of care.

  3. The impact of leadership, management and power in an international knowledge-intensive organization

    Directory of Open Access Journals (Sweden)

    Senni Kirjavainen

    Full Text Available The shift to knowledge economies and the boom of knowledge-intensive organizations with their expert employees pose new challenges for leadership and management of development work. What is the appropriate amount and form of managerial control that is needed in knowledge-intensive development work? This paper focuses on illuminating the kind of leadership and management efforts that either support or hinder advancing development projects. The results highlight the paradoxical role of power and control, and reveal that employees need freedom and yet strong guidance and managerial commitment to develop work in order to stay motivated. Implications for leading knowledge-intensive development are discussed.

  4. Intensive care nurses' perceptions of their professional competence in the organ donor process: a national survey.

    Science.gov (United States)

    Meyer, Käthe; Bjørk, Ida Torunn; Eide, Hilde

    2012-01-01

    This paper is a report of a study that explored Norwegian intensive care nurses' perceptions of their professional competence to identify educational needs in the organ donor process. Intensive care professionals are requested to consider organ donation each time they care for patients with severe cerebral lesion to ensure donor organs for transplantation. The donor process challenges intensive care nurses' professional competence. Nurses' knowledge and experience may influence their professional competence in caring for organ donors and their relatives. METHODS.: A cross-sectional survey was conducted in all 28 Norwegian donor hospitals between October 2008 and January 2009. Intensive care nurses (N = 801) were invited to participate and the response rate was 71·4%. Dimensions of professional competence, learning needs and contextual and demographic variables were explored. Data were analysed using descriptive and inferential statistics. Few intensive care nurses had extensive experience of or competence and training in organ donation. Nurses working at university hospitals had more experience, but lesser training than nurses in local hospitals. Experience of donor acquisition had an impact on intensive care nurses' perceptions of their professional competence in the donor process. Discussions on the ward and educational input were seen as important for the further development of professional competence. Training provided by experienced colleagues and a culture that encourages discussion about aspects of the donor process can develop nurses' professional competence and communally defined professional practice. Educational input that cultivates various types of knowledge can be beneficial in organ donation. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

  5. Clinical review: Moral assumptions and the process of organ donation in the intensive care unit

    OpenAIRE

    Streat, Stephen

    2004-01-01

    The objective of the present article is to review moral assumptions underlying organ donation in the intensive care unit. Data sources used include personal experience, and a Medline search and a non-Medline search of relevant English-language literature. The study selection included articles concerning organ donation. All data were extracted and analysed by the author. In terms of data synthesis, a rational, utilitarian moral perspective dominates, and has captured and circumscribed, the lan...

  6. Case management: developing practice through action research.

    Science.gov (United States)

    Smith, Annetta; Mackay, Seonaid; McCulloch, Kathleen

    2013-09-01

    This article is a report of an action research study carried out with community nurses to help develop case management within their practice. Using action research principles, nurses reviewed and analysed their current practice and developed recommendations for further embedding case management as a means of supporting patients with complex care needs in their own homes. Findings indicate that a number of factors can influence the community nurse's ability to implement case management. These factors include approaches to case finding, availability of resources and interprofessional working. Important considerations for nurses were the influence of the context of care, the geographical location and the health needs of the local patient population, which meant that case management may need to be adapted to meet local circumstances.

  7. Intelligent Learning Infrastructure for Knowledge Intensive Organizations: A Semantic Web Perspective

    Science.gov (United States)

    Lytras, Miltiadis, Ed.; Naeve, Ambjorn, Ed.

    2005-01-01

    In the context of Knowledge Society, the convergence of knowledge and learning management is a critical milestone. "Intelligent Learning Infrastructure for Knowledge Intensive Organizations: A Semantic Web Perspective" provides state-of-the art knowledge through a balanced theoretical and technological discussion. The semantic web perspective…

  8. Case Management for Individuals with Mental Retardation. ARC Facts.

    Science.gov (United States)

    Association for Retarded Citizens, Arlington, TX.

    A question-and-answer format is used in this fact sheet to provide information on case management for individuals with mental retardation. The fact sheet describes the major components of a case management system, the role of the case manager, the individual's or family's role in case management, providers of case management services and systems…

  9. A new influence model of low intensive ionizing radiation on organism

    International Nuclear Information System (INIS)

    Bulanova, K.Ya.; Lobanok, L.M.; Berdnikov, M.V.; Ignatenko, A.O.; Konoplya, E.F.

    2006-01-01

    The data and facts about the influence of ionizing radiation in small doses and low intensity on cardiovascular system and blood sells of experimental animals are given in the article. The ideas about its signal perception are used to illustrate and explain the mechanisms of low intensive physical nature factors influencing on organism. The leading role of quantitative information change in the process of forming physiological and pathologic influence of radiation on organism is supposed. The influence of X-ray small doses emission on human organism was analyzed on the basis of entropy calculation with the help of mathematical conversion characteristic of finger-tips luminosity. This method helped us to understand that the amount of information in the system was changed during post-radiation period. (authors)

  10. Paediatric cardiac intensive care unit: current setting and organization in 2010.

    Science.gov (United States)

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

    2010-10-01

    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  11. Nurse Case Managers' Experiences on Case Management for Long-term Hospitalization in Korea

    OpenAIRE

    Jinjoo Oh, Ph.D., RN, GNP; Seieun Oh, Ph.D., RN

    2017-01-01

    Purpose: The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for ...

  12. Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part I.

    Science.gov (United States)

    O'Donnell, Lolita T

    2007-01-01

    To describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute hospital setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice in case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between their obligations to the

  13. Ethical dilemmas among nurses as they transition to hospital case management: implications for organizational ethics, part II.

    Science.gov (United States)

    O'Donnell, Lolita T

    2007-01-01

    The purpose of this study was to describe the experiences of ethical concerns by clinical nurses as they transitioned into their new role in hospital case management. Through this study, an attempt was made to explore experiences of ethical concerns and identify the implications for organizational ethics. In this study, nurse case managers practicing in the acute care setting, military, not-for-profit community, and teaching hospitals were interviewed. The majority of the nurse case manager participants were engaged in hospital discharge planning and utilization review activities. An interpretive phenomenological approach was used to identify the themes inherent in ethical concerns and articulate them within the context of hospital nurse case management. Fifteen participants were interviewed to obtain a qualitative description of the nurse case managers' lived experiences of ethical dilemmas and how they were resolved. Nurse case managers' perceptions of solutions/options to resolve such ethical dilemmas were explored. As nurses transition into the expanded role of case management in the present healthcare delivery system, they frequently face situations demanding ethical choices and judgments to accommodate diverse patient interests and needs. These ethical decisions required in daily practice of case management represent ethical dilemmas to nurses. The insights derived from the analysis of the interviews have implications for nursing practice, education, policy, ethics, and research; recommendations for organizations employing nurse case managers in terms of recruitment, orientation, training, and continued need for educational support are identified. 1. The clinical decisions required in daily practice of case management represented challenges to the nurses. This highlights the critical role of adequate educational orientation to case management for beginning case managers. 2. Nurse case managers should be cognizant of the "disconnect" that could occur between

  14. Nurse Case Managers' Experiences on Case Management for Long-term Hospitalization in Korea

    Directory of Open Access Journals (Sweden)

    Jinjoo Oh, Ph.D., RN, GNP

    2017-12-01

    Full Text Available Purpose: The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for successful case management. Methods: Thematic analysis was employed to analyze the data. Medical Aid case managers with 3 or more years of case management experience were recruited from urban, suburban, and rural regions. Data were collected through in-depth interviews: 12 nurse case managers participated in focus group interviews and 11 participated in individual one-on-one interviews. Results: Four major themes emerged: on-site obstacles that hinder work progress; going in an opposite direction; ambiguous position of case managers; and work-related emotions. Eleven subthemes were discovered: chasing potential candidates; becoming an enemy; discharging patients who have nowhere to go; welfare-centered national policies increasing medical costs; Medical Aid Program that encourages hospitalization; misuse of hospitalization; feeling limited; working without authority; fulfilling the expected role; fretting about social criticism; and feeling neglected and unprotected. Conclusion: The findings highlight the complexity and ambiguity of the issues faced by case managers. Successful management of Medical Aid resources requires the orchestrated efforts and collaboration of multiple stakeholders. More systematized support and resources for nurse case managers are essential to fully implement this nursing innovation in Korea. Keywords: case management, focus groups, hospitalization, qualitative research, vulnerable populations

  15. Organic farming benefits local plant diversity in vineyard farms located in intensive agricultural landscapes.

    Science.gov (United States)

    Nascimbene, Juri; Marini, Lorenzo; Paoletti, Maurizio G

    2012-05-01

    The majority of research on organic farming has considered arable and grassland farming systems in Central and Northern Europe, whilst only a few studies have been carried out in Mediterranean agro-systems, such as vineyards, despite their economic importance. The main aim of the study was to test whether organic farming enhances local plant species richness in both crop and non-crop areas of vineyard farms located in intensive conventional landscapes. Nine conventional and nine organic farms were selected in an intensively cultivated region (i.e. no gradient in landscape composition) in northern Italy. In each farm, vascular plants were sampled in one vineyard and in two non-crop linear habitats, grass strips and hedgerows, adjacent to vineyards and therefore potentially influenced by farming. We used linear mixed models to test the effect of farming, and species longevity (annual vs. perennial) separately for the three habitat types. In our intensive agricultural landscapes organic farming promoted local plant species richness in vineyard fields, and grassland strips while we found no effect for linear hedgerows. Differences in species richness were not associated to differences in species composition, indicating that similar plant communities were hosted in vineyard farms independently of the management type. This negative effect of conventional farming was probably due to the use of herbicides, while mechanical operations and mowing regime did not differ between organic and conventional farms. In grassland strips, and only marginally in vineyards, we found that the positive effect of organic farming was more pronounced for perennial than annual species.

  16. "Since I have my case manager, I am back to life" case management in Croatia.

    Science.gov (United States)

    Gruber, Ema N; Ivezić-Strkalj, Sladana; Agius, Mark; Martić-Biocina, Sanja

    2008-03-01

    The authors present a case report of a patient who was treated by a case manager, a member of a Croatian Community Mental Health (CMH) Team, following the recommendations of WHO 2004 as well as the IRIS guidelines and the Basic Standards for Management of Patients with Serious Mental Illness in the Community (Agius 2005) and using the elements of Clinical case management (Muser 1998), Assertive community treatment model (Burns 1995, Scott 1995, Wolfsan 1990), the personal strength model (Rapp 1988) and Rehabilitation model (Anthony 1993). In order to emphasize the importance of the therapist-patient relationship in the treatment of chronic schizophrenic patients (Ivezic 2001) and creating the group atmosphere a Croatian model of case management is created where the patient's needs and risks are assessed by a multidisciplinary team which also conducts the recommended psychosocial interventions plan. The majority of interventions are conducted in groups. The case manager develops a confident relationship with a patient, nourishes the positive transference and aids the delivery of the treatment. The main goals of the interventions are empowerment of the patient, improvement of his abilities and decreasing of disabilities. The case manager also carries out a full assessment of the needs of the patient's family so that the family or carers are also included in the treatment or support if necessary (Gruber 2006). A case report of a patient and the work of her case manager as well as the case manager's diary (Gruber 2007) and the Croatian model of case management is presented in this article.

  17. Sequential Organ Failure Assessment Score for Evaluating Organ Failure and Outcome of Severe Maternal Morbidity in Obstetric Intensive Care

    Directory of Open Access Journals (Sweden)

    Antonio Oliveira-Neto

    2012-01-01

    Full Text Available Objective. To evaluate the performance of Sequential Organ Failure Assessment (SOFA score in cases of severe maternal morbidity (SMM. Design. Retrospective study of diagnostic validation. Setting. An obstetric intensive care unit (ICU in Brazil. Population. 673 women with SMM. Main Outcome Measures. mortality and SOFA score. Methods. Organ failure was evaluated according to maximum score for each one of its six components. The total maximum SOFA score was calculated using the poorest result of each component, reflecting the maximum degree of alteration in systemic organ function. Results. highest total maximum SOFA score was associated with mortality, 12.06 ± 5.47 for women who died and 1.87 ± 2.56 for survivors. There was also a significant correlation between the number of failing organs and maternal mortality, ranging from 0.2% (no failure to 85.7% (≥3 organs. Analysis of the area under the receiver operating characteristic (ROC curve (AUC confirmed the excellent performance of total maximum SOFA score for cases of SMM (AUC = 0.958. Conclusions. Total maximum SOFA score proved to be an effective tool for evaluating severity and estimating prognosis in cases of SMM. Maximum SOFA score may be used to conceptually define and stratify the degree of severity in cases of SMM.

  18. Nurse Case Managers' Experiences on Case Management for Long-term Hospitalization in Korea.

    Science.gov (United States)

    Oh, Jinjoo; Oh, Seieun

    2017-12-01

    The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for successful case management. Thematic analysis was employed to analyze the data. Medical Aid case managers with 3 or more years of case management experience were recruited from urban, suburban, and rural regions. Data were collected through in-depth interviews: 12 nurse case managers participated in focus group interviews and 11 participated in individual one-on-one interviews. Four major themes emerged: on-site obstacles that hinder work progress; going in an opposite direction; ambiguous position of case managers; and work-related emotions. Eleven subthemes were discovered: chasing potential candidates; becoming an enemy; discharging patients who have nowhere to go; welfare-centered national policies increasing medical costs; Medical Aid Program that encourages hospitalization; misuse of hospitalization; feeling limited; working without authority; fulfilling the expected role; fretting about social criticism; and feeling neglected and unprotected. The findings highlight the complexity and ambiguity of the issues faced by case managers. Successful management of Medical Aid resources requires the orchestrated efforts and collaboration of multiple stakeholders. More systematized support and resources for nurse case managers are essential to fully implement this nursing innovation in Korea. Copyright © 2017. Published by Elsevier B.V.

  19. Organ and tissue donation in a regional paediatric intensive care unit: evaluation of practice.

    Science.gov (United States)

    Carone, Laura; Alurkar, Shrirang; Kigozi, Phoebe; Vyas, Harish

    2018-05-01

    Approximately 2% of those on the organ transplant list in the UK are children. Early identification of donors and referral to organ donation teams (ODT) has proven to increase both the success rate of gaining consent and the number of organs actually retrieved. To evaluate the practice relating to organ donation for children receiving end-of-life care on a paediatric intensive care unit (PICU) measured against the National Guidelines. All children 0-18 who received their end-of-life care and died on the PICU. A retrospective cohort study of organ donation patterns including referral, approach, consent and donation. This involved a review of case notes on PICU between the years 2009 and 2014. One hundred five deaths were identified and 100 notes were examined and data analysed to ascertain if religion, age and length of stay on PICU impacted on practice. Eighty-six children met the early identification criteria for potential donors, 40 (46.5%) children were referred to the ODT and 33 (38.3%) families were approached regarding donation. Twenty-one (24.4%) families consented to donation. Seventeen donations took place with a total of 41 sets of organs/tissues retrieved. Despite the majority of children meeting early identification for potential donors, many were not being referred. All children on end-of-life care should be referred for potential organ donation. Organ donation needs to be seen as a priority for hospitals as a part of routine end-of-life care to help increase referral rates and give families the opportunity to donate. Many paediatric deaths are not referred for consideration of organ donation, despite guidelines stating that this process should be standard of care. Further optimization of referral rates may aid in increasing the number of organs available for donation. What is Known: • Shortage of organs continues to be a national problem. • NICE guidelines state that all patients who are on end-of-life care should have the option of organ donation

  20. Predicting the effects of organ motion on the dose delivered by dynamic intensity modulation

    International Nuclear Information System (INIS)

    Yu, C.X.; Jaffray, David; Martinez, A.A.; Wong, J.W.

    1997-01-01

    Purpose: Computer-optimized treatment plans, aimed to enhance tumor control and reduce normal tissue complication, generally require non-uniform beam intensities. One of the techniques for delivering intensity-modulated beams is the use of dynamic multileaf collimation, where the beam aperture and field shape change during irradiation. When intensity-modulated beams are delivered with dynamic collimation, intra-treatment organ motion may not only cause geometric misses at the field boundaries but also create hot and cold spots in the target. The mechanism for producing such effects has not been well understood. This study analyzes the dosimetric effects of intra-treatment organ motion on dynamic intensity modulation. A numerical method is developed for predicting the intensity distributions in a moving target before dose is delivered with dynamic intensity modulation. Material and Methods: In the numerical algorithm, the change in position and shape of the beam aperture with time were modeled as a three-dimensional 'tunnel', with the shape of the field aperture described in the x-y plane and its temporal position shown in the z-dimension. A point in the target had to be in the tunnel in order to receive irradiation and the dose to the point was proportional to the amount of time that this point stayed in the tunnel. Since each point in the target were analyzed separately, non-rigid body variations could easily be handled. The dependency of the dose variations on all parameters involved, including the speed of collimator motion, the frequency and amplitude of the target motion, and the size of the field segments, was analyzed. The algorithm was verified by irradiating moving phantoms with beams of dynamically modulated intensities. Predictions were also made for a treatment of a thoracic tumor using a dynamic wedge. The changes of target position with time were based on the MRI images of the chest region acquired using fast MRI scans in a cine fashion for a duration

  1. 75 FR 27375 - Postal Rate Case Management

    Science.gov (United States)

    2010-05-14

    ... POSTAL REGULATORY COMMISSION [Docket No. PI2010-3; Order No. 456] Postal Rate Case Management AGENCY: Postal Regulatory Commission. ACTION: Notice. SUMMARY: The Commission is seeking comments relevant to management of an anticipated exigent postal rate case. It has scheduled a technical conference...

  2. Characteristics of airborne micro-organisms in a neurological intensive care unit: Results from China.

    Science.gov (United States)

    Yu, Yao; Yin, Sufeng; Kuan, Yi; Xu, Yingjun; Gao, Xuguang

    2015-06-01

    To describe the characteristics of airborne micro-organisms in the environment in a Chinese neurological intensive care unit (NICU). This prospective study monitored the air environment in two wards (large and small) of an NICU in a tertiary hospital in China for 12 months, using an LWC-1 centrifugal air sampler. Airborne micro-organisms were identified using standard microbiology techniques. The mean ± SD number of airborne bacteria was significantly higher in the large ward than in the small ward (200 ± 51 colony-forming units [CFU]/m(3) versus 110 ± 40 CFU/m(3), respectively). In the large ward only, the mean number of airborne bacteria in the autumn was significantly higher than in any of the other three seasons. A total of 279 airborne micro-organisms were identified (large ward: 195; small ward: 84). There was no significant difference in the type and distribution of airborne micro-organisms between the large and small wards. The majority of airborne micro-organisms were Gram-positive cocci in both wards. These findings suggest that the number of airborne micro-organisms was related to the number of patients on the NICU ward. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  3. Intensive vs. free-range organic beef. A preference study through consumer liking and conjoint analysis.

    Science.gov (United States)

    García-Torres, S; López-Gajardo, A; Mesías, F J

    2016-04-01

    This paper evaluates consumer liking and preferences towards organic beef from two production systems allowed by EU regulation: i) free-range and ii) intensive (fattened in feed-lot with organic feedstuff) as compared with conventionally produced beef. Data were obtained in April-May 2014 with a sample of 150 regular beef consumers who completed two tasks: firstly a sensory test where consumers tasted and rated the meats and secondly a conjoint analysis to study beef purchasing preferences. Willingness-to-pay for the different meats was also calculated from conjoint results. Results show that consumers preferred organic-from-concentrate beef at sensory level while organic beef from animals fed on grass was preferred when process characteristics (i.e. farming system) or attributes perceived at the point of purchase (i.e. colour) were evaluated. It was also found that the price-premium for organic beef is over 40%, with organic-fed-on grass beef preferred slightly over that fed-on-concentrate. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Time management for case managers--so much work, so little time.

    Science.gov (United States)

    Cesta, Toni

    2014-08-01

    The world of a case manager is a busy one, and you may not have all the resources you need each and every day. If you can maintain a routine it will make the workload more manageable for you and will allow room for those surprises that invariably happen. Whether you are a new or a seasoned case manager, organizing your workload can always help smooth out the rough edges in anyone's hectic day!

  5. Intensity of the production organisation in organic and conventional dairy farms

    Directory of Open Access Journals (Sweden)

    Urszula Malaga-Toboła

    2013-03-01

    Full Text Available This paper presents a comparative analysis of the intensity of the production organization between dairy farms conducting agricultural activity in organic and conventional production systems. Study groups of farms were located in the southern (fifteen organic farms, central and eastern part of Poland (fifteen conventional farms. The study was conducted in the form of a directed interview in the marketing year 2010/2011. Area, structure of land use and crop, livestock and the size of plant and animal in the production global and commodity were specified. The analysis showed a lot of differences between the two systems of production, from the area of farm and structure of land use and finally the production outputs. Basic statistical analysis was also conducted. It showed a significant negative correlation between the area of agricultural land and a positive correlation between the livestock and intensity of organisation of production. However, the correlation coefficients between the studied variables in the analysed farm groups differed from each other.

  6. Prokaryotic Diversity in the Rhizosphere of Organic, Intensive, and Transitional Coffee Farms in Brazil.

    Science.gov (United States)

    Caldwell, Adam Collins; Silva, Lívia Carneiro Fidéles; da Silva, Cynthia Canêdo; Ouverney, Cleber Costa

    2015-01-01

    Despite a continuous rise in consumption of coffee over the past 60 years and recent studies showing positive benefits linked to human health, intensive coffee farming practices have been associated with environmental damage, risks to human health, and reductions in biodiversity. In contrast, organic farming has become an increasingly popular alternative, with both environmental and health benefits. This study aimed to characterize and determine the differences in the prokaryotic soil microbiology of three Brazilian coffee farms: one practicing intensive farming, one practicing organic farming, and one undergoing a transition from intensive to organic practices. Soil samples were collected from 20 coffee plant rhizospheres (soil directly influenced by the plant root exudates) and 10 control sites (soil 5 m away from the coffee plantation) at each of the three farms for a total of 90 samples. Profiling of 16S rRNA gene V4 regions revealed high levels of prokaryotic diversity in all three farms, with thousands of species level operational taxonomic units identified in each farm. Additionally, a statistically significant difference was found between each farm's coffee rhizosphere microbiome, as well as between coffee rhizosphere soils and control soils. Two groups of prokaryotes associated with the nitrogen cycle, the archaeal genus Candidatus Nitrososphaera and the bacterial order Rhizobiales were found to be abundant and statistically different in composition between the three farms and in inverse relationship to each other. Many of the nitrogen-fixing genera known to enhance plant growth were found in low numbers (e.g. Rhizobium, Agrobacter, Acetobacter, Rhodospirillum, Azospirillum), but the families in which they belong had some of the highest relative abundance in the dataset, suggesting many new groups may exist in these samples that can be further studied as potential plant growth-promoting bacteria to improve coffee production while diminishing negative

  7. Self-organization of high intensity laser pulses propagating in gases

    International Nuclear Information System (INIS)

    Koga, James

    2001-01-01

    In recent years the development of high intensity short pulse lasers has opened up wide fields of science which had previously been difficult to study. Recent experiments of short pulse lasers propagating in air have shown that these laser pulses can propagate over very long distances (up to 12 km) with little or no distortion of the pulse. Here we present a model of this propagation using a modified version of the self-organized criticality model developed for sandpiles by Bak, Tang, and Weisenfeld. The additions to the sandpile model include the formation of plasma which acts as a threshold diffusion term and self-focusing by the nonlinear index of refraction which acts as a continuous inverse diffusion. Results of this simple model indicate that a strongly self-focusing laser pulse shows self-organized critical behavior. (author)

  8. Soil Organic Matter Stability and Soil Carbon Storage with Changes in Land Use Intensity in Uganda

    Science.gov (United States)

    Tiemann, L. K.; Grandy, S.; Hartter, J.

    2014-12-01

    As the foundation of soil fertility, soil organic matter (SOM) formation and break-down is a critical factor of agroecosystem sustainability. In tropical systems where soils are quickly weathered, the link between SOM and soil fertility is particularly strong; however, the mechanisms controlling the stabilization and destabilization of SOM are not well characterized in tropical soils. In western Uganda, we collected soil samples under different levels of land use intensity including maize fields, banana plantations and inside an un-cultivated native tropical forest, Kibale National Park (KNP). To better understand the link between land use intensity and SOM stability we measured total soil C and N, and respiration rates during a 369 d soil incubation. In addition, we separated soils into particle size fractions, and mineral adsorbed SOM in the silt (2-50 μm ) and clay (fractions was dissociated, purified and chemically characterized via pyrolysis-GC/MS. Cultivated soil C and N have declined by 22 and 48%, respectively, in comparison to uncultivated KNP soils. Incubation data indicate that over the last decade, relatively accessible and labile soil organic carbon (SOC) pools have been depleted by 55-59% in cultivated soils. As a result of this depletion, the chemical composition of SOM has been altered such that clay and silt associated SOM differed significantly between agricultural fields and KNP. In particular, nitrogen containing compounds were in lower abundance in agricultural compared to KNP soils. This suggests that N depletion due to agriculture has advanced to pools of mineral associated organic N that are typically protected from break-down. In areas where land use intensity is relatively greater, increases in polysaccharides and lipids in maize fields compared to KNP indicate increases in microbial residues and decomposition by-products as microbes mine SOM for organic N. Chemical characterization of post-incubation SOM will help us better understand

  9. [The case manager--from words to deeds?].

    Science.gov (United States)

    Lindegaard, Birthe Rosenkrantz; Qvist, Peter

    2010-04-19

    Allocation of a case manager is now mandatory for both in- and outpatients in Denmark. Case manager allocation is reported quarterly to the regions and results are generally satisfying. Knowledge about fulfillment of the case manager role is, however, sparse. This study aims to examine the degree of fulfillment of the case manager role for a sample of inpatients. Two medical and two surgical wards participated. Patients were interviewed in relation to discharge while staff assigned as case managers completed a survey. Both patients and case managers answered questions regarding the defined roles as case managers: Planning/coordination, continuous information and discharge planning. 107 of 125 eligible patients were interviewed. Only 25 declared themselves informed about the allocation of a case manager. The patients' assessment of the service provided by the staff in relation to case manager tasks was generally good, but the services were seldom provided by the named case manager. 22% of patients did not experience continuous information, while only 13% did not experience a generally coherent stay in hospital. 110 case managers completed the survey. Less than half felt themselves well informed about the case manager role. Only a few case managers feel that they succeed in fulfilling the role, particularly regarding the participation in discharge planning. There seems to be a need for a targeted effort to improve the conditions for case managers in Danish hospitals in order to meet the intentions of this initiative.

  10. Case management redesign in an urban facility.

    Science.gov (United States)

    Almaden, Stefany; Freshman, Brenda; Quaye, Beverly

    2011-01-01

    To explore strategies for improving patient throughput and to redesign case management processes to facilitate level of care transitions and safe discharges. Large Urban Medical Center in South Los Angeles County, with 384 licensed beds that services poor, underserved communities. Both qualitative and quantitative methods were applied. Combined theoretical frameworks were used for needs assessment, intervention strategies, and change management. Observations, interviews, surveys, and database extraction methods were used. The sample consisted of case management staff members and several other staff from nursing, social work, and emergency department staff. Postintervention measures indicated improvement in reimbursements for services, reduction in length of stay, increased productivity, improved patients' access to care, and avoiding unnecessary readmission or emergency department visits. Effective change management strategies must consider multiple factors that influence daily operations and service delivery. Creating accountability by using performance measures associated with patient transitions is highlighted by the case study results. The authors developed a process model to assist in identifying and tracking outcome measures related to patient throughput, front-end assessments, and effective patient care transitions. This model can be used in future research to further investigate best case management practices.

  11. Motion compensation with skin contact control for high intensity focused ultrasound surgery in moving organs

    Science.gov (United States)

    Diodato, A.; Cafarelli, A.; Schiappacasse, A.; Tognarelli, S.; Ciuti, G.; Menciassi, A.

    2018-02-01

    High intensity focused ultrasound (HIFU) is an emerging therapeutic solution that enables non-invasive treatment of several pathologies, mainly in oncology. On the other hand, accurate targeting of moving abdominal organs (e.g. liver, kidney, pancreas) is still an open challenge. This paper proposes a novel method to compensate the physiological respiratory motion of organs during HIFU procedures, by exploiting a robotic platform for ultrasound-guided HIFU surgery provided with a therapeutic annular phased array transducer. The proposed method enables us to keep the same contact point between the transducer and the patient’s skin during the whole procedure, thus minimizing the modification of the acoustic window during the breathing phases. The motion of the target point is compensated through the rotation of the transducer around a virtual pivot point, while the focal depth is continuously adjusted thanks to the axial electronically steering capabilities of the HIFU transducer. The feasibility of the angular motion compensation strategy has been demonstrated in a simulated respiratory-induced organ motion environment. Based on the experimental results, the proposed method appears to be significantly accurate (i.e. the maximum compensation error is always under 1 mm), thus paving the way for the potential use of this technique for in vivo treatment of moving organs, and therefore enabling a wide use of HIFU in clinics.

  12. Transformational leadership: the development of a model of nursing case management by the army nurse corps.

    Science.gov (United States)

    Hocker, Susan M; Trofino, Joan

    2003-01-01

    Management philosophy and culture of any organization must match the nursing professions' core value of caring. Organizational conflict symptomology includes communication barriers and widely differing values. Employment of accountability based systems and bringing nurses into governance prevents conflict and improves job satisfaction. This article identifies the barriers to case management program development and discusses strategies for its successful implementation. Today's most successful organizations will implement an institution-wide commitment to a culture within which excellence flourishes. Creative staffing models and professional practice partnerships such as nursing case management will be supported and encouraged by executive leadership; they work as a team and will be jointly accountable for positive outcomes The United States Army Nurse Corps has the framework necessary to develop a premiere nursing organization. Case management departments may adopt these techniques to improve working relationships and leadership capacity within their organizations.

  13. Modeling Coupled Landscape Evolution and Soil Organic Carbon Dynamics in Intensively Management Landscapes

    Science.gov (United States)

    Yan, Q.; Kumar, P.

    2017-12-01

    Soil is the largest reservoir of carbon in the biosphere but in agricultural areas it is going through rapid erosion due disturbance arising from crop harvest, tillage, and tile drainage. Identifying whether the production of soil organic carbon (SOC) from the crops can compensate for the loss due to erosion is critical to ensure our food security and adapt to climate change. In the U.S. Midwest where large areas of land are intensively managed for agriculture practices, predicting soil quantity and quality are critical for maintaining crop yield and other Critical Zone services. This work focuses on modeling the coupled landscape evolutions soil organic carbon dynamics in agricultural fields. It couples landscape evolution, surface water runoff, organic matter transformation, and soil moisture dynamics to understand organic carbon gain and loss due to natural forcing and farming practices, such as fertilizer application and tillage. A distinctive feature of the model is the coupling of surface ad subsurface processes that predicts both surficial changes and transport along with the vertical transport and dynamics. Our results show that landscape evolution and farming practices play dominant roles in soil organic carbon (SOC) dynamics both above- and below-ground. Contrary to the common assumption that a vertical profile of SOC concentration decreases exponentially with depth, we find that in many situations SOC concentration below-ground could be higher than that at the surface. Tillage plays a complex role in organic matter dynamics. On one hand, tillage would accelerate the erosion rate, on the other hand, it would improve carbon storage by burying surface SOC into below ground. Our model consistently reproduces the observed above- and below-ground patterns of SOC in the field sites of Intensively Managed Landscapes Critical Zone Observatory (IMLCZO). This model bridges the gaps between the landscape evolution, below- and above-ground hydrologic cycle, and

  14. Psychiatric Case Management in the Emergency Department.

    Science.gov (United States)

    Turner, Stephanie B; Stanton, Marietta P

    2015-01-01

    The care of the mentally ill has reached a real crisis in the United States. There were more than 6.4 million visits to emergency departments (EDs) in 2010, or about 5% of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse (). That is up 28% from just 4 years earlier, according to the latest figures available from the Agency for Healthcare Research and Quality in Rockville, MD. Using a method called scoping, the purpose of this article is to examine the range, extent, and evidence available regarding case management as an intervention in the ED to manage mental health patients, to determine whether there is sufficient quantity and quality of evidence on this topic to conduct a meta-analysis, and to identify relevant studies that balance comprehensiveness with reasonable limitations. One solution for ensuring that the costs are contained, efficiency is maintained, and quality outcomes are achieved is the placement of a case manager in the ED. According to , because the majority of hospital admissions come through the ED, it makes sense to have case managers located there to act as gatekeepers and ensure that patients who are admitted meet criteria and are placed in the proper bed with the proper status. From the scoping techniques implemented in this study, the authors came to the conclusion that case management has been and can be used to effectively treat mental health patients in the emergency room. A good number of patients with psych mental health issues are frequent visitors and repeat visitors. Case management has not been used very often as a strategy for managing patients through the ED or for follow-up after the visit. Hospitals that have developed a protocol for managing these patients outside the main patient flow have had successful results. Staff training and development on psych mental health issues have been helpful in the ED. While there are not a large number of studies available on this topic

  15. Numerical study of the light output intensity of the bilayer organic light-emitting diodes

    Science.gov (United States)

    Lu, Feiping

    2017-02-01

    The structure of organic light-emitting diodes (OLEDs) is one of most important issues that influence the light output intensity (LOI) of OLEDs. In this paper, based on a simple but accurate optical model, the influences of hole and electron transport layer thickness on the LOI of bilayer OLEDs, which with N,N0- bis(naphthalen-1-yl)-N,N0- bis(phenyl)- benzidine (NPB) or N,N'- diphenyl-N,N'-bis(3-methylphenyl)-1,1'-biphenyl-4,4-diamine (TPD) as hole transport layer, with tris(8-hydroxyquinoline) aluminum (Alq3) as electron transport and light emitting layers, were investigated. The laws of LOI for OLEDs under different organic layer thickness values were obtained. The results show that the LOI of devices varies in accordance with damped cosine or sine function as the increasing of organic layer thickness, and the results show that the bilayer OLEDs with the structure of Glass/ITO/NPB (55 nm)/Alq3 (75 nm)/Al and Glass/ITO/TPB (60 nm)/Alq3 (75 nm)/Al have most largest LOI. When the thickness of Alq3 is less than 105 nm, the OLEDs with TPD as hole transport layer have larger LOI than that with NPB as hole transport layer. The results obtained in this paper can present an in-depth understanding of the working mechanism of OLEDs and help ones fabricate high efficiency OLEDs.

  16. Influence of temperature and light intensity on Ru(II) complex based organic-inorganic device

    International Nuclear Information System (INIS)

    Asubay, Sezai; Durap, Feyyaz; Aydemir, Murat; Baysal, Akin; Ocak, Yusuf Selim; Tombak, Ahmet

    2016-01-01

    An organic-inorganic junction was fabricated by forming [Ru(Cy_2PNHCH_2-C_4H_3O)(η"6-p-cymene)Cl_2] complex thin film using spin coating technique on n-Si and evaporating Au metal on the film. It was seen that the structure had perfect rectification property. Current-voltage (I-V) measurements were carried out in dark and under various illumination conditions (between 50-100 mW/cm"2) and with the temperature range from 303 to 380 K. The structure showed unusually forward and reverse bias temperature and light sensing behaviors. It was seen that the current both in forward and reverse bias increased with the increase in light intensity and temperature.

  17. [Evaluation by case managers dementia : An explorative practice based study on types and content].

    Science.gov (United States)

    Ketelaar, Nicole A B M; Jukema, Jan S; van Bemmel, Marlies; Adriaansen, Marian J M; Smits, Carolien H M

    2017-06-01

    This practice based explorative study aims to provide insight into the ways in which case managers shape and fill up the evaluation phase of their support of the informal care network of persons with dementia. A combination of quantitative and qualitative research methods were used. A group of 57 case managers of persons with dementia in three different organisational networks took part in this study. Results from the quantitative and qualitative data are organized into four themes: (1) attitude towards evaluation, (2) forms of evaluation, (3) implementation of evaluation and (4) content of evaluation. There are different ways in shaping evaluation and the content of it. The importance of interim and final evaluation is recognized, but is difficult to realize in a methodical way. Barriers experienced by the case managers include various factors associated both with clients as professionals. Case managers evaluate continuously and in an informal way to assess whether the extent of their assistance is meeting the needs of the client and informal network. Case managers do not use systematic evaluation to measure the quality of care they offer to persons with dementia and their caregivers. The findings demand a discussion on the level of clients, as well as on the professional and societal level about the way case managers should evaluate their support.

  18. Assessing the whole person: case managers take a holistic approach to physical and mental health.

    Science.gov (United States)

    Carter, Jolynne Jo; Zawalski, Sandra; Sminkey, Patrice V; Christopherson, Bruce

    2015-01-01

    Given the prevalence of mental health issues, particularly depressive disorders, in the U.S. population, professional case managers should increase their sensitivity to and awareness of mental illnesses, as well as their impact on physical health. Throughout the case management process, case managers frequently observe behaviors and symptoms such as those associated with depressive disorders. Case managers need to have, at a minimum, a working knowledge of mental and behavioral health issues and be familiar with basic screening tools. This will enable them to become more attuned to symptoms and behaviors that indicate that the individual should be further assessed and diagnosed by a physician. Across the case management spectrum, including acute care, accountable care organizations, patient-centered medical homes, physician practices, clinics, occupational health clinics, workers' compensation, and other settings in which case managers work with individuals (clients who receive case management services) and their families/support systems. With more than one quarter of the U.S. population affected by a depressive disorder, professional case managers who practice holistically bring together the mental and physical aspects of health. This is particularly important in a health care system and among payer sources that continue to divide the two. Case managers elevate their practice by demonstrating a greater understanding of the interconnectedness of mental and physical health and can positively influence the transdisciplinary care team to take a person-centered approach to address all health issues, in pursuit of the individual's health goals. Professional case managers must increase their understanding of mental health, becoming more aware of "red flags" that may necessitate a further evaluation and assessment by a mental health professional. They should also hone their communication skills, particularly the use of motivational interviewing techniques, to encourage

  19. Does training affect quality of diarrhoea case management.

    Science.gov (United States)

    Baig, L A; Thaver, I

    1997-08-01

    Improvement in diarrhoea case management through training of health care providers in the government and the private sector was the key element of diarrhoea policy in Pakistan in 1989. Numerous training sessions were organized by the Child Survival project. The aim of this project was to look at the effect of training on quality of diarrhoea case management at the oral rehydration therapy (ORT) corners and diarrhoea treatment units (DTUs) of Sindh. A systematic random sample of 62 ORT corners and DTUs in Sindh was assessed using the WHO drafted Health Facility Survey manual. It was observed that the trained health providers were better in taking history for blood in stools (P Plan A" and correct rehydration (p management. Thus diagnosis was good and training did improve the quality of assessment of child but treatment (inclusive of advice giving) was not significantly affected by training, except for a child with no dehydration. It is recommended that on the job training should emphasize on skills for management of diarrhoea. Further studies are needed to identify why inspite of training. Health providers do not offer better treatment than the untrained ones.

  20. Case managers' experiences of personal growth: learning from consumers.

    Science.gov (United States)

    Stein, Catherine H; Craft, Scott A

    2007-04-01

    This study examines aspects of case managers' perceived personal growth in their work with consumers. Using a sample of 98 case managers, the psychometric properties of a brief self-report measure of personal growth of case managers were examined. The Case Manager Personal Growth Scale (CMPG) showed good reliability and construct validity as evidenced by negative correlations with scores on professional burnout and positive correlations with personal accomplishment and job satisfaction scores. CMPG scores were unrelated to social desirability scores or caseload size and positively related to age and tenure in the mental health system. Results suggest the strong relevance of the construct of personal growth for case managers.

  1. Diversity in case management modalities: the Summit model.

    Science.gov (United States)

    Peterson, G A; Drone, I D; Munetz, M R

    1997-06-01

    Though ubiquitous in community mental health agencies, case management suffers from a lack of consensus regarding its definition, essential components, and appropriate application. Meaningful comparisons of various case management models await such a consensus. Global assessments of case management must be replaced by empirical studies of specific interventions with respect to the needs of specific populations. The authors describe a highly differentiated and prescriptive system of case management involving the application of more than one model of service delivery. Such a diversified and targeted system offers an opportunity to study the technology of case management in a more meaningful manner.

  2. The work of nurse case managers in a cancer and cardiovascular disease risk screening program.

    Science.gov (United States)

    Fawcett, Jacqueline; Schutt, Russell K; Gall, Gail B; Cruz, Elizabeth Riley; Woodford, Mary Lou

    2007-01-01

    The purpose of this conceptual model of nursing and health policy-based study was to identify the frequency and correlates of activities performed by nurse case managers. Massachusetts Women's Health Network (WHN) contracting organization sites for breast and cervical cancer and cardiovascular disease risk screening. Twenty nurse case managers were interviewed. More time was spent performing client service activities than bureaucratic activities. Frequently performed client service activities were tracking test results, finding/connecting with clients, assessing client needs, and educating clients. The most frequently performed activity was documenting services; the least, discharging clients. Client service activity frequency was correlated with client caseload size, social barriers, overall workload, satisfaction with the way activities are carried out in the WHN, special training in WHN policies and procedures, and contracting organization service delivery arrangements. Bureaucratic activity frequency was correlated with caseload size, workload, months as a WHN case manager, system barriers, satisfaction with the way activities were carried out in the WHN, and special training. Documentation requires a great deal of WHN nurse case managers' time, which perhaps could be more productively spent with clients. Thus, more efficient ways to document services need to be identified. Additional research is needed to determine similarities and differences in activities performed by WHN nurse case managers and other case managers working in cancer and cardiovascular disease screening programs. Strategies need to be identified to remove all barriers that interfere with performance of case manager practice activities. Strategies are needed to reduce client fear of bills, overcome scheduling constraints, and improve translation services to lessen language barriers to effective communication.

  3. A method to dynamically balance intensity modulated radiotherapy dose between organs-at-risk

    International Nuclear Information System (INIS)

    Das, Shiva K.

    2009-01-01

    The IMRT treatment planning process typically follows a path that is based on the manner in which the planner interactively adjusts the target and organ-at-risk (OAR) constraints and priorities. The time-intensive nature of this process restricts the planner from fully understanding the dose trade-off between structures, making it unlikely that the resulting plan fully exploits the extent to which dose can be redistributed between anatomical structures. Multiobjective Pareto optimization has been used in the past to enable the planner to more thoroughly explore alternatives in dose trade-off by combining pre-generated Pareto optimal solutions in real time, thereby potentially tailoring a plan more exactly to requirements. However, generating the Pareto optimal solutions can be nonintuitive and computationally time intensive. The author presents an intuitive and fast non-Pareto approach for generating optimization sequences (prior to planning), which can then be rapidly combined by the planner in real time to yield a satisfactory plan. Each optimization sequence incrementally reduces dose to one OAR at a time, starting from the optimization solution where dose to all OARs are reduced with equal priority, until user-specified target coverage limits are violated. The sequences are computationally efficient to generate, since the optimization at each position along a sequence is initiated from the end result of the previous position in the sequence. The pre-generated optimization sequences require no user interaction. In real time, a planner can more or less instantaneously visualize a treatment plan by combining the dose distributions corresponding to user-selected positions along each of the optimization sequences (target coverage is intrinsically maintained in the combination). Interactively varying the selected positions along each of the sequences enables the planner to rapidly understand the nature of dose trade-off between structures and, thereby, arrive at a

  4. Spatial and environmental correlates of organism colonization and infection in the neonatal intensive care unit.

    Science.gov (United States)

    Goldstein, Neal D; Tuttle, Deborah; Tabb, Loni P; Paul, David A; Eppes, Stephen C

    2018-05-01

    To examine organism colonization and infection in the neonatal intensive care unit as a result of environmental and spatial factors. A retrospective cohort of infants admitted between 2006 and 2015 (n = 11 428), to assess the relationship between location and four outcomes: methicillin-resistant Staphylococcus aureus (MRSA) colonization; culture-confirmed late-onset sepsis; and, if intubated, endotracheal tube colonization with Pseudomonas aeruginosa or Klebsiella pneumonia. Independent risk factors were identified with mixed-effects logistic regression models and Moran's I for spatial autocorrelation. All four outcomes statistically clustered by location; neighboring colonization also influenced risk of MRSA (p < 0.05). For P. aeruginosa, being in a location with space for more medical equipment was associated with 2.61 times the odds of colonization (95% CrI: 1.19, 5.78). Extrinsic factors partially explained risk for neonatal colonization and infection. For P. aeruginosa, infection prevention efforts at locations with space for more equipment may lower future colonization.

  5. Soil organic carbon of an intensively reclaimed region in China: Current status and carbon sequestration potential.

    Science.gov (United States)

    Deng, Xunfei; Zhan, Yu; Wang, Fei; Ma, Wanzhu; Ren, Zhouqiao; Chen, Xiaojia; Qin, Fangjin; Long, Wenli; Zhu, Zhenling; Lv, Xiaonan

    2016-09-15

    Land reclamation has been highly intensive in China, resulting in a large amount of soil organic carbon (SOC) loss to the atmosphere. Evaluating the factors which drive SOC dynamics and carbon sequestration potential in reclaimed land is critical for improving soil fertility and mitigating global warming. This study aims to determine the current status and factors important to the SOC density in a typical reclaimed land located in Eastern China, where land reclamation has been undergoing for centuries. A total of 4746 topsoil samples were collected from 2007 to 2010. The SOC density of the reclaimed land (3.18±0.05kgCm(-2); mean±standard error) is significantly lower than that of the adjacent non-reclaimed land (5.71±0.04kgCm(-2)) (pcarbon sequestration potential of the reclaimed lands may achieve a maximum of 5.80±1.81kgCO2m(-2) (mean±SD) when dryland is converted to flooded land with vegetable-rice cropping system and soil pH of ~5.9. Note that in some scenarios the methane emission substantially offsets the carbon sequestration potential, especially for continuous rice cropping system. With the optimal setting for carbon sequestration, it is estimated that the dryland reclaimed in the last 50years in China is able to sequester 0.12milliontons CO2 equivalent per year. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. A fixed-jaw method to protect critical organs during intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Chen, Jiayun; Chen, Xinyuan; Huang, Manni; Dai, Jianrong

    2014-01-01

    Intensity-modulated radiotherapy (IMRT) plays an important role in cancer radiotherapy. For some patients being treated with IMRT, the extremely low tolerances of critical organs (such as lens, ovaries, and testicles) cannot be met during treatment planning. The aim of this article is to introduce a new planning method to overcome that problem. In current planning practice, jaw positions are automatically set to cover all target volumes by the planning system (e.g., Pinnacle 3 system). Because of such settings, critical organs may be fully blocked by the multileaf collimator (MLC), but they still sit in the field that is shaped by collimator jaws. These critical organs receive doses from the transmission and leakage of MLC leaves. We manually fixed jaw positions to block them to further reduce such doses. This method has been used for different treatment sites in our clinic, and it was thoroughly evaluated in patients with radical hysterectomy plus ovarian transposition after surgery. For each patient, 2 treatment plans were designed with the same optimization parameters: the original plan with automatically chosen jaw positions (called O-plan) and the plan with fixed-jaw positions (named F-plan). In the F-plan, the jaws were manually fixed to block the ovaries. For target coverage, the mean conformity index (CI) of the F-plan (1.28 ± 0.02) was remarkably lower than that of the O-plan (1.53 ± 0.09) (p < 0.05). The F-plan and the O-plan performed similarly in target dose homogeneity. Meanwhile, for the critical organ sparing, the mean dose of both ovaries were much lower in the F-plan than that in the O-plan (p < 0.05). The V 20 , V 30 , and V 40 of bladder were also lower in the F-plan (93.57 ± 1.98, 73.99 ± 5.76, and 42.33 ± 3.7, respectively) than those in the O-plan (97.98 ± 1.11, 85.07 ± 4.04, and 49.71 ± 3.63, respectively) (p < 0.05). The maximum dose to the spinal cord planning organ at risk (OAR) volume (PRV) in the O-plan (3940.24 ± 102.8) was

  7. Abdominal multi-organ segmentation from CT images using conditional shape-location and unsupervised intensity priors.

    Science.gov (United States)

    Okada, Toshiyuki; Linguraru, Marius George; Hori, Masatoshi; Summers, Ronald M; Tomiyama, Noriyuki; Sato, Yoshinobu

    2015-12-01

    This paper addresses the automated segmentation of multiple organs in upper abdominal computed tomography (CT) data. The aim of our study is to develop methods to effectively construct the conditional priors and use their prediction power for more accurate segmentation as well as easy adaptation to various imaging conditions in CT images, as observed in clinical practice. We propose a general framework of multi-organ segmentation which effectively incorporates interrelations among multiple organs and easily adapts to various imaging conditions without the need for supervised intensity information. The features of the framework are as follows: (1) A method for modeling conditional shape and location (shape-location) priors, which we call prediction-based priors, is developed to derive accurate priors specific to each subject, which enables the estimation of intensity priors without the need for supervised intensity information. (2) Organ correlation graph is introduced, which defines how the conditional priors are constructed and segmentation processes of multiple organs are executed. In our framework, predictor organs, whose segmentation is sufficiently accurate by using conventional single-organ segmentation methods, are pre-segmented, and the remaining organs are hierarchically segmented using conditional shape-location priors. The proposed framework was evaluated through the segmentation of eight abdominal organs (liver, spleen, left and right kidneys, pancreas, gallbladder, aorta, and inferior vena cava) from 134 CT data from 86 patients obtained under six imaging conditions at two hospitals. The experimental results show the effectiveness of the proposed prediction-based priors and the applicability to various imaging conditions without the need for supervised intensity information. Average Dice coefficients for the liver, spleen, and kidneys were more than 92%, and were around 73% and 67% for the pancreas and gallbladder, respectively. Copyright © 2015

  8. Examining End-of-Life Case Management: Systematic Review

    Directory of Open Access Journals (Sweden)

    Roger E. Thomas

    2014-01-01

    Full Text Available Case management was initiated in the 1970s to reduce care discontinuity. A literature review focused on end-of-life (EOL case management identified 17 research articles, with content analysis revealing two themes: (a seeking to determine or establish the value of EOL case management and (b identifying ways to improve EOL case management. The evidence, although limited, suggests that EOL case management is helpful to dying individuals and their families. Research is needed to more clearly illustrate its usefulness or outcomes and the extent of need for it and actual availability. Among other benefits, EOL case management may help reduce hospital utilization, a major concern with the high cost of hospital-based care and the increased desire for home-based EOL care.

  9. The strengths perspective in client’s social case management

    OpenAIRE

    Valpētere, Laima

    2010-01-01

    The subject diploma paper is „The strengths perspective in client’s social case management.” The aim of the diploma paper is to research the strengths perspective in client’s social case management. Diploma paper consists of five chapters. In the first chapter the case management was theoretically researched. In the second chapter was done description of the strengths perspective in the social work. In the third chapter by describing principles and strategies of strengths perspective, cli...

  10. Managing the Social Determinants of Health: Part I: Fundamental Knowledge for Professional Case Management.

    Science.gov (United States)

    Fink-Samnick, Ellen

    PRIMARY PRACTICE SETTING(S):: Applicable to health and behavioral health settings, wherever case management is practiced. The SDH pose major challenges to the health care workforce in terms of effective resource provision, health and behavioral health treatment planning plus adherence, and overall coordination of care. Obstacles and variances to needed interventions easily lead to less than optimal outcomes for case managers and their health care organizations. Possessing sound knowledge and clear understanding of each SDH, the historical perspectives, main theories, and integral dynamics, as well as creative resource solutions, all support a higher level of intentional and effective professional case management practice. Those persons and communities impacted most by the SDH comprise every case management practice setting. These clients can be among the most vulnerable and disenfranchised members of society, which can easily engender biases on the part of the interprofessional workforce. They are also among the costliest to care for with 50% of costs for only 5% of the population. Critical attention to knowledge about managing the SDH leverages and informs case management practice, evolves more effective programming, and enhances operational outcomes across practice settings.

  11. Temporary organ displacement coupled with image-guided, intensity-modulated radiotherapy for paraspinal tumors

    International Nuclear Information System (INIS)

    Katsoulakis, Evangelia; Thornton, Raymond H; Yamada, Yoshiya; Solomon, Stephen B; Maybody, Majid; Housman, Douglas; Niyazov, Greg; Riaz, Nadeem; Lovelock, Michael; Spratt, Daniel E; Erinjeri, Joseph P

    2013-01-01

    To investigate the feasibility and dosimetric improvements of a novel technique to temporarily displace critical structures in the pelvis and abdomen from tumor during high-dose radiotherapy. Between 2010 and 2012, 11 patients received high-dose image-guided intensity-modulated radiotherapy with temporary organ displacement (TOD) at our institution. In all cases, imaging revealed tumor abutting critical structures. An all-purpose drainage catheter was introduced between the gross tumor volume (GTV) and critical organs at risk (OAR) and infused with normal saline (NS) containing 5-10% iohexol. Radiation planning was performed with the displaced OARs and positional reproducibility was confirmed with cone-beam CT (CBCT). Patients were treated within 36 hours of catheter placement. Radiation plans were re-optimized using pre-TOD OARs to the same prescription and dosimetrically compared with post-TOD plans. A two-tailed permutation test was performed on each dosimetric measure. The bowel/rectum was displaced in six patients and kidney in four patients. One patient was excluded due to poor visualization of the OAR; thus 10 patients were analyzed. A mean of 229 ml (range, 80–1000) of NS 5-10% iohexol infusion resulted in OAR mean displacement of 17.5 mm (range, 7–32). The median dose prescribed was 2400 cGy in one fraction (range, 2100–3000 in 3 fractions). The mean GTV D min and PTV D min pre- and post-bowel TOD IG-IMRT dosimetry significantly increased from 1473 cGy to 2086 cGy (p=0.015) and 714 cGy to 1214 cGy (p=0.021), respectively. TOD increased mean PTV D95 by 27.14% of prescription (p=0.014) while the PTV D05 decreased by 9.2% (p=0.011). TOD of the bowel resulted in a 39% decrease in mean bowel D max (p=0.008) confirmed by CBCT. TOD of the kidney significantly decreased mean kidney dose and D max by 25% (0.022). TOD was well tolerated, reproducible, and facilitated dose escalation to previously radioresistant tumors abutting critical structures while

  12. Changes in soil chemical properties as affected by pyrogenic organic matter amendment with different intensity and frequency

    NARCIS (Netherlands)

    Wang, Ruzhen; Zhang, Yulan; Cerda Bolinches, Artemio; Cao, Mingming; Zhang, Yongyong; Yin, Jinfei; Jiang, Yong; Chen, Lijun

    2017-01-01

    Pyrogenic organic matter (PyOM) has long been used as a soil amendment to improve soil physicochemical properties. However, few studies simultaneously investigated both intensities and frequencies of PyOM addition on soil chemical properties of soil base cations, soil pH buffering capacity (pHBC),

  13. Factors facilitating dementia case management : Results of online focus groups

    NARCIS (Netherlands)

    Dr. J. de Lange; E. Deusing; I.F.M. van Asch; J. Peeters; M. Zwaanswijk; A.M. Pot; A.L. Francke

    2016-01-01

    To obtain insight into facilitating factors for case management in dementia care, we conducted a qualitative study with 13 online focus groups (OFGs). Participants were professionals involved in dementia case management (N = 99). We used mind-maps and the method of constant comparison for analysis.

  14. The development and current status of Intensive Care Unit management of prospective organ donors

    Directory of Open Access Journals (Sweden)

    Margaret Kathleen Menzel Ellis

    2016-01-01

    Conclusions: Management of deceased organ donors should focus first on maintaining adequate perfusion to all organ systems through adherence to standard critical care guidelines, early referral to OPOs, and family support. Furthermore, several specific DMGs and strategies have been recently shown to improve both the rates and outcomes of organ transplantation.

  15. Case management directors: how to manage in a transition-focused world: part 2.

    Science.gov (United States)

    Bankston White, Cheri; Birmingham, Jackie

    2015-01-01

    Case management directors are in a dynamic position to affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role.This is Part 2 of a two-part article written for case management directors, particularly new ones.Part 1 covered the first 4 of 7 tracks: (1) Staffing and Human Resources, (2) Compliance and Accreditation, (3) Discharge Planning and (4) Utilization Review and Revenue Cycle. Part 2 addresses (5) Internal Departmental Relationships (Organizational), (6) External Relationships (Community Agency), and (7) Quality and Program Outcomes.This article attempts to answer the following questions: : The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems and have frontline case managers (CMs) reporting to them. Part 1 found that case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. The same conclusion applies to Part 2, which addresses the director's responsibilities outside her immediate department. Leadership and management skills apply as well to building strong, productive relationships across a broad spectrum of external organizations that include payer, provider, and regulatory agencies. At the same time, they must also develop the skills to positively influence the revenue cycle and financial health of both the organization for which they work and those to whom they transition patients. A director of case management with responsibility for transitions of care has more power and influence over patient safety than is commonly known. Few of the

  16. Reflective practice: a framework for case manager development.

    Science.gov (United States)

    Brubakken, Karen; Grant, Sara; Johnson, Mary K; Kollauf, Cynthia

    2011-01-01

    The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.

  17. Attitudes of intensive care and emergency physicians in Australia with regard to the organ donation process: A qualitative analysis.

    Science.gov (United States)

    Macvean, Emily; Yuen, Eva Yn; Tooley, Gregory; Gardiner, Heather M; Knight, Tess

    2018-04-01

    Specialized hospital physicians have direct capacity to impact Australia's sub-optimal organ donation rates because of their responsibility to identify and facilitate donation opportunities. Australian physicians' attitudes toward this responsibility are examined. A total of 12 intensive care unit and three emergency department physicians were interviewed using a constructionist grounded theory and situational analysis approach. A major theme emerged, related to physicians' conflicts of interest in maintaining patients'/next-of-kin's best interests and a sense of duty-of-care in this context. Two sub-themes related to this main theme were identified as follows: (1) discussions about organ donation and who is best to carry these out and (2) determining whether organ donation is part of end-of-life care; including the avoidance of non-therapeutic ventilation; and some reluctance to follow clinical triggers in the emergency department. Overall, participants indicated strong support for organ donation but would not consider it part of end-of-life care, representing a major obstacle to the support of potential donation opportunities. Findings have implications for physician education and training. Continued efforts are needed to integrate the potential for organ donation into end-of-life care within intensive care units and emergency departments.

  18. Incidence and distribution of transplantable organs from donors after circulatory determination of death in U.S. intensive care units.

    Science.gov (United States)

    Halpern, Scott D; Hasz, Richard D; Abt, Peter L

    2013-04-01

    All U.S. acute care hospitals must maintain protocols for recovering organs from donors after circulatory determination of death (DCDD), but the numbers, types, and whereabouts of available organs are unknown. To assess the maximal potential supply and distribution of DCDD organs in U.S. intensive care units. We conducted a population-based cohort study among a randomly selected sample of 50 acute care hospitals in the highest-volume donor service area in the United States. We identified all potentially eligible donors dying within 90 minutes of the withdrawal of life-sustaining therapy from July 1, 2008 to June 30, 2009. Using prespecified criteria, potential donors were categorized as optimal, suboptimal, or ineligible to donate their lungs, kidneys, pancreas, or liver. If only optimal DCDD organs were used, the deceased donor supplies of these organs could increase by up to 22.7, 8.9, 7.4, and 3.3%, respectively. If optimal and suboptimal DCDD organs were used, the corresponding supply increases could be up to 50.0, 19.7, 18.5, and 10.9%. Three-quarters of DCDD organs could be recovered from the 17.2% of hospitals with the highest annual donor volumes-typically those with trauma centers and more than 20 intensive care unit beds. Universal identification and referral of DCDD could increase the supply of transplantable lungs by up to one-half, and would not increase any other organ supply by more than one-fifth. The marked clustering of DCDD among a small number of identifiable hospitals could guide targeted interventions to improve DCDD identification, referral, and management.

  19. Caseload management, work-related stress and case manager self-efficacy among Victorian mental health case managers.

    Science.gov (United States)

    King, Robert

    2009-05-01

    In Australia and comparable countries, case management has become the dominant process by which public mental health services provide outpatient clinical services to people with severe mental illness. There is recognition that caseload size impacts on service provision and that management of caseloads is an important dimension of overall service management. There has been little empirical investigation, however, of caseload and its management. The present study was undertaken in the context of an industrial agreement in Victoria, Australia that required services to introduce standardized approaches to caseload management. The aims of the present study were therefore to (i) investigate caseload size and approaches to caseload management in Victoria's mental health services; and (ii) determine whether caseload size and/or approach to caseload management is associated with work-related stress or case manager self-efficacy among community mental health professionals employed in Victoria's mental health services. A total of 188 case managers responded to an online cross-sectional survey with both purpose-developed items investigating methods of case allocation and caseload monitoring, and standard measures of work-related stress and case manager personal efficacy. The mean caseload size was 20 per full-time case manager. Both work-related stress scores and case manager personal efficacy scores were broadly comparable with those reported in previous studies. Higher caseloads were associated with higher levels of work-related stress and lower levels of case manager personal efficacy. Active monitoring of caseload was associated with lower scores for work-related stress and higher scores for case manager personal efficacy, regardless of size of caseload. Although caseloads were most frequently monitored by the case manager, there was evidence that monitoring by a supervisor was more beneficial than self-monitoring. Routine monitoring of caseload, especially by a workplace

  20. Children as donors: a national study to assess procurement of organs and tissues in pediatric intensive care units.

    Science.gov (United States)

    Siebelink, Marion J; Albers, Marcel J I J; Roodbol, Petrie F; Van de Wiel, Harry B M

    2012-12-01

    A shortage of size-matched organs and tissues is the key factor limiting transplantation in children. Empirical data on procurement from pediatric donors is sparse. This study investigated donor identification, parental consent, and effectuation rates, as well as adherence to the national protocol. A national retrospective cohort study was conducted in all eight Dutch pediatric intensive care units. Records of deceased children were analyzed by an independent donation officer. Seventy-four (11%) of 683 deceased children were found to be suitable for organ donation and 132 (19%) for tissue donation. Sixty-two (84%) potential organ donors had been correctly identified; the parental consent and effectuation rate was 42%. Sixty-three (48%) potential tissue donors had been correctly identified; the parental consent and effectuation rate was 27%. Correct identification increased with age (logistic regression, organs: P = .024; tissues: P = .011). Although an overall identification rate of 84% of potential organ donors may seem acceptable, the variation observed suggests room for improvement, as does the overall low rate of identification of pediatric tissue donors. Efforts to address the shortage of organs and tissues for transplantation in children should focus on identifying potential donors and on the reasons why parents do not consent. © 2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation.

  1. Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre.

    Science.gov (United States)

    Kahan, Deborah; Poremski, Daniel; Wise-Harris, Deborah; Pauly, Daniel; Leszcz, Molyn; Wasylenki, Donald; Stergiopoulos, Vicky

    2016-01-01

    This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention. We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care. Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers. Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

  2. Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre.

    Directory of Open Access Journals (Sweden)

    Deborah Kahan

    Full Text Available This study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention.We conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care.Service users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers.Interventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

  3. Effectiveness of case management in the prevention of COPD re-admissions: a pilot study.

    Science.gov (United States)

    van Eeden, Annelies E; van de Poll, Ingrid; van Vulpen, Gertrud; Roldaan, Tim; Wagenaar, Wies; Boland, Melinde R S; Wolterbeek, Ron; Chavannes, Niels H

    2017-11-25

    Chronic obstructive pulmonary disease (COPD) exacerbations are associated with high disease burden and costs, especially in the case of hospitalizations. The overall number of hospital admissions due to exacerbations of COPD has increased. It is remarkable that re-admissions account for a substantial part of these hospitalizations. This pilot study investigates the use of case management to reduce re-admissions due to COPD. COPD patients with more than one hospitalization per year due to an exacerbation were included. The participants (n = 10) were closely monitored and intensively coached for 20 weeks after hospitalization. The case manager provided care in a person-focused manner. The case manager informed and supported the patient, took action when relapse threatened, coordinated and connected primary and secondary care. Data of 12 months before and after start of the intervention were compared. Primary outcome was the difference in number of hospitalizations. Secondary outcomes were health-related quality of life (measured by the Clinical COPD Questionnaire, CCQ) and dyspnoea (measured by the MRC Dyspnoea Scale). The incidence rate of hospitalizations was found to be 2.25 times higher (95% confidence interval [CI] 1.3-3.9; P = 0.004) 12 months before compared with 12 months after the start of case management. COPD patients had a mean CCQ score of 3.3 (95% CI 2.8-3.8) before and 2.4 (95% CI 1.9-2.8) after 20 weeks of case management; a difference of 1.0 (95% CI 0.4-1.6; P = 0.001). The mean MRC scores showed no significant differences before (4.3; 95% CI 3.7-4.9) and after the case management period (3.9; 95% CI 3.2-4.6); a difference of 0.4 (95% CI - 0.1 to 0.9; P = 0.114). This pilot study shows that the number of COPD hospital re-admissions decreased significantly after the introduction of a case manager. Moreover, there was an improvement in patient-reported health-related quality of life.

  4. Dental case manager encounters: the association with retention in dental care and treatment plan completion.

    Science.gov (United States)

    Lemay, Celeste A; Tobias, Carol; Umez-Eronini, Amarachi A; Brown, Carolyn; McCluskey, Amanda; Fox, Jane E; Bednarsh, Helene; Cabral, Howard J

    2013-01-01

    Little is known about dental case managers as few programs have been scientifically evaluated. The goal of this study was to explore the impact of dental case manager on retention in dental care and completion of treatment plans, while specifically exploring the number of dental case manager encounters. Fourteen programs enrolled people with HIV/AIDS (PLWHA) in dental care and a longitudinal study between 2007 and 2009. The 758 participants had a total of 2715 encounters with a dental case manager over twelve months: 29% had a single encounter; 21% had two; 27% had 3-4 and; 23% had 5-29 encounters. Adjusting for baseline characteristics, participants receiving more encounters were significantly more likely to complete their Phase 1 treatment plan, be retained in dental care, and experience improvements in overall oral health status. Organizations considering efforts to improve the oral health of vulnerable, hard-to-engage populations should consider these findings when planning interventions. ©2012 Special Care Dentistry Association and Wiley Periodicals, Inc.

  5. Knowledge workers and knowledge-intense organizations, Part 2: Designing and managing for productivity.

    Science.gov (United States)

    Weaver, D; Sorrells-Jones, J

    1999-09-01

    Our economy is shifting from a hard goods and material products base to one in which knowledge is the primary mode of production. Organizations are experimenting with designs that support knowledge work by clustering individuals with different but complementary skills in focused teams. The goal is to increase applied knowledge that furthers the organization's strategic intent. The team-based knowledge work model holds promise for healthcare organizations that are under pressure to use knowledge to improve clinical care, integrate care across disciplines and settings, and accept accountability for costs. However, the shift from the traditional bureaucratic model to the flexible team-based design mandates changes in the design of the organization, the role of leadership, and the attributes of the teams and team members. In Part 2 of this three-part series, the authors explore the necessary design changes and the new roles for leadership, teams, and their members. Additionally, implications for healthcare clinicians, particularly nurses, are discussed.

  6. Flocked nylon swabs versus RODAC plates for detection of multidrug-resistant organisms on environmental surfaces in intensive care units.

    Science.gov (United States)

    Okamoto, K; Rhee, Y; Schoeny, M; Lolans, K; Cheng, J; Reddy, S; Weinstein, R A; Hayden, M K; Popovich, K J

    2018-01-01

    To compare two culture methods [nylon fiber flocked swabs with broth enrichment versus RODAC ('replicate organism detection and counting') plates] for recovery of multidrug-resistant organisms, 780 environmental surfaces in 63 rooms of patients on contact precautions in four intensive care units at one hospital were examined. Among sites that had at least one positive culture, swab culture with broth enrichment detected the target organisms more frequently than RODAC plates (37.5% vs 26.0%, P = 0.06). There was moderate agreement between the two methods (κ = 0.44) with agreement better for small or flat surfaces compared to large or irregular surfaces. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  7. The organic contamination level based on the total soil mass is not a proper index of the soil contamination intensity

    Science.gov (United States)

    Hung, H.-W.; Daniel, Sheng G.; Lin, T.-F.; Su, Y.; Chiou, C.T.

    2009-01-01

    Concentrations of organic contaminants in common productive soils based on the total soil mass give a misleading account of actual contamination effects. This is attributed to the fact that productive soils are essentially water-saturated, with the result that the soil uptake of organic compounds occurs principally by partition into the soil organic matter (SOM). This report illustrates that the soil contamination intensity of a compound is governed by the concentration in the SOM (Com) rather than by the concentration in whole soil (Cs). Supporting data consist of the measured levels and toxicities of many pesticides in soils of widely differing SOM contents and the related levels in in-situ crops that defy explanation by the Cs values. This SOM-based index is timely needed for evaluating the contamination effects of food crops grown in different soils and for establishing a dependable priority ranking for intended remediation of numerous contamination sites.

  8. Schizophrenia, violence, and case management: being supportive and overwhelmed.

    Science.gov (United States)

    Rice, Elizabeth I

    2009-01-01

    The aim of this study is to understand the experiences of case managers as they delivered care to women who were diagnosed with schizophrenia and live with histories of violence. Interpretive phenomenology. Providers valued their relationships with women, yet felt overwhelmed and frustrated with aspects of the case management role. Case managers at times blamed women for the violence in their lives and lacked clarity with regard to their role assisting women in recovery. The violence and poverty that is common for these women is a key factor that increased providers' alienation and confusion as to their role in the provision of care. The educational and supportive needs of case managers must be addressed to uphold recovery-oriented services.

  9. The development of an acute care case manager orientation.

    Science.gov (United States)

    Strzelecki, S; Brobst, R

    1997-01-01

    The authors describe the development of an inpatient acute care case manager orientation in a community hospital. Benner's application of the Dreyfus model of skill acquisition provides the basis for the orientation program. The candidates for the case manager position were expert clinicians. Because of the role change it was projected that they would function as advanced beginners. It was also predicted that, as the case managers progressed within the role, the educational process would need to be adapted to facilitate progression of skills to the proficient level. Feedback from participants reinforced that the model supported the case manager in the role transition. In addition, the model provided a predictive framework for ongoing educational activities.

  10. [Effects of precipitation intensity on soil organic carbon fractions and their distribution under subtropical forests of South China].

    Science.gov (United States)

    Chen, Xiao-mei; Liu, Ju-xiu; Deng, Qi; Chu, Guo-wei; Zhou, Guo-yi; Zhang, De-qiang

    2010-05-01

    From December 2006 to June 2008, a field experiment was conducted to study the effects of natural precipitation, doubled precipitation, and no precipitation on the soil organic carbon fractions and their distribution under a successional series of monsoon evergreen broad-leaf forest, pine and broad-leaf mixed forest, and pine forest in Dinghushan Mountain of Southern China. Different precipitation treatments had no significant effects on the total organic carbon (TOC) concentration in the same soil layer under the same forest type (P > 0.05). In treatment no precipitation, particulate organic carbon (POC) and light fraction organic carbon (LFOC) were mainly accumulated in surface soil layer (0-10 cm); but in treatments natural precipitation and doubled precipitation, the two fractions were infiltrated to deeper soil layers. Under pine forest, soil readily oxidizable organic carbon (ROC) was significantly higher in treatment no precipitation than in treatments natural precipitation and doubled precipitation (P organic carbon storage. Precipitation intensity less affected TOC, but had greater effects on the labile components POC, ROC, and LFOC.

  11. Building Perinatal Case Manager Capacity Using Quality Improvement

    OpenAIRE

    Fitzgerald, Elaine

    2015-01-01

    Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote a...

  12. The Construction of Intensive and Organized Agricultural Industrialization Model with Farmers as the Main Body

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    The current agricultural conflicts of China are analyzed and the forms and drawbacks of current agricultural industrial structure are listed.The situations for intensifying the farmland with appropriate scale are analyzed from the aspects of policy,farmers,farms and modernization of agriculture.It is pointed out that the situations for the intensive use of land are becoming mature.Taking the single pig-breeding chain as an example,the agricultural industrialization model,which takes farmers as the main body,is expounded.Besides,its functions and significance in solving "the three agriculture problems" and facilitating the modernization of agriculture are discussed.

  13. A new method of organizing spectral line intensity ratio fluctuations of nightglow emissions

    International Nuclear Information System (INIS)

    Thelin, B.

    1986-02-01

    In this paper a new kind of linearization effect between the atmospheric night airglow emissions is presented. The same kind of linearization effect has previously been studied with spectrochemical light sources together with a spectrometer. A linear graph was obtained for atomic spectral lines and vibrational bandspectra when the spectral line intensity ratio fluctuations were plotted versus the photon energies of these emissions. To study this effect data from a number of different photometer investigations of night airglow emissions at different times and places have been used. (author)

  14. Collaborative partnerships between organic farmers in livestock-intensive areas of Denmark

    DEFF Research Database (Denmark)

    Asai, Masayasu; Langer, Vibeke

    2014-01-01

    as well as social connections and location. Trust and reciprocal relationships through high-quality communication and well-functioning institutional arrangements seem to play pivotal roles for partnerships to be maintained. As organic farmers are continuously facing global market conditions and tightening......Specialisation within organic agriculture in many western European countries has led to the decoupling of crop and animal systems, resulting in a shortfall in manure fertilisers on most farms and a surplus on others. One solution to solve a problem has been the establishment of collaborative...

  15. Mobile phones and computer keyboards: unlikely reservoirs of multidrug-resistant organisms in the tertiary intensive care unit.

    Science.gov (United States)

    Smibert, O C; Aung, A K; Woolnough, E; Carter, G P; Schultz, M B; Howden, B P; Seemann, T; Spelman, D; McGloughlin, S; Peleg, A Y

    2018-03-02

    Few studies have used molecular epidemiological methods to study transmission links to clinical isolates in intensive care units. Ninety-four multidrug-resistant organisms (MDROs) cultured from routine specimens from intensive care unit (ICU) patients over 13 weeks were stored (11 meticillin-resistant Staphylococcus aureus (MRSA), two vancomycin-resistant enterococci and 81 Gram-negative bacteria). Medical staff personal mobile phones, departmental phones, and ICU keyboards were swabbed and cultured for MDROs; MRSA was isolated from two phones. Environmental and patient isolates of the same genus were selected for whole genome sequencing. On whole genome sequencing, the mobile phone isolates had a pairwise single nucleotide polymorphism (SNP) distance of 183. However, >15,000 core genome SNPs separated the mobile phone and clinical isolates. In a low-endemic setting, mobile phones and keyboards appear unlikely to contribute to hospital-acquired MDROs. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  16. Organic matter dynamics in an intensive dairy production system on a Dutch Spodosol

    NARCIS (Netherlands)

    Verloop, J.; Hilhorst, G.J.; Pronk, A.A.; Sebek, L.B.; Keulen, van H.; Janssen, B.H.; Ittersum, van M.K.

    2015-01-01

    In many studies, possibilities are being explored to adjust farm management to increase or maintain soil organic matter (SOM) contents in agricultural soils. Some options may be conflicting with efficient nutrient (N and P) management, i.e. management aiming at maximum conversion of imported

  17. Developing novel farming systems: effective use of nutrients from cover crops in intensive organic farming

    NARCIS (Netherlands)

    Burgt, van der G.J.H.M.; Scholberg, J.M.S.; Koopmans, C.J.

    2011-01-01

    On-farm nitrogen fixation is a driving force in organic agriculture. The efficiency with which this nitrogen is used can be increased by using alfalfa or grass-clover crops directly as fertilizer on other fields: cut-and-carry fertilizers. In two crops in two years, the use of several types of

  18. Speaking up in case management, part II: implementing speaking up behaviors.

    Science.gov (United States)

    Banja, John D; Craig, Kathy

    2010-01-01

    Case managers will occasionally witness colleagues from their own or other healthcare disciplines providing care in ways that frankly deviate from or violate standards of care, rules, regulations, policies, and procedures. This article discusses the case manager's ethical obligation to speak up in such instances, as well as lists strategies and techniques that facilitate and enhance professional communications around "speaking up." All case management work environments. When healthcare professionals practice in ways that deviate from established policies, procedures, rules, regulations, and standards of care, they jeopardize the safety and welfare of their clients and, often, their employing institutions. Unfortunately, professionals often remain silent about such errors and deviations for fear that they might suffer retaliation if they speak up or because they do not anticipate a constructive or positive organizational response. Nevertheless, organizations and employees who recognize the value of speaking up can use a variety of strategies described in this article that enable speaking up to become a professional and organizational reality. Because they practice in the midst of multidisciplinary care, case managers have a marked opportunity to witness any number of practice standards being ignored or violated. Case managers need to develop communication skills and organizational savvy regarding how to approach and remedy such situations, especially when deviations from standards of care have become routine or "normalized." Critical elements in speaking up include cultivating a method to discern the moral perils of remaining silent, learning communication techniques to conduct emotionally challenging conversations, and building organizational leadership that recognizes the value of speaking up and supports safe harbors for employees who speak up appropriately.

  19. The Dosimetric Consequences of Intensity Modulated Radiotherapy for Cervix Cancer: The Impact of Organ Motion, Deformation and Tumour Regression

    Science.gov (United States)

    Lim, Karen Siah Huey

    Hypothesis: In intensity modulated radiotherapy (IMRT) for cervix cancer, the dose received by the tumour target and surrounding normal tissues is significantly different to that indicated by a single static plan. Rationale: The optimal use of IMRT in cervix cancer requires a greater attention to clinical target volume (CTV) definition and tumour & normal organ motion to assure maximum tumour control with the fewest side effects. Research Aims: 1) Generate consensus CTV contouring guidelines for cervix cancer; 2) Evaluate intra-pelvic tumour and organ dynamics during radiotherapy; 3) Analyze the dose consequences of intra-pelvic organ dynamics on different radiotherapy strategies. Results: Consensus CTV definitions were generated using experts-in-the-field. Substantial changes in tumour volume and organ motion, resulted in significant reductions in accumulated dose to tumour targets and variability in accumulated dose to surrounding normal tissues. Significance: Formalized CTV definitions for cervix cancer is important in ensuring consistent standards of practice. Complex and unpredictable tumour and organ dynamics mandates daily soft-tissue image guidance if IMRT is used. To maximize the benefits of IMRT for cervix cancer, a strategy of adaptation is necessary.

  20. Strategies to enhance the competitiveness of semi-intensive aquaculture systems in costal earth ponds: the organic aquaculture approach

    Directory of Open Access Journals (Sweden)

    Manuel Sardinha

    2014-06-01

    Full Text Available Earthen ponds are the main production system for European seabass (Dicentrarchus labrax and gilthead seabream (Sparus aurata in Portugal and in Southern Spain. Production costs in this low productivity farming system are higher compared to intensive cage farms, and its economic sustainability depends on product differentiation and optimization of production. The development of new farming protocols, to enhance productivity of ponds and lagoons, or the implementation of certification processes to add value to products from extensive and semi-intensive systems, could render these activities more economics benefits and be attractive for a new generation of farmers. One clear strategy to differentiate and add value to seabream produced in semi-intensive systems is its production under organic standards. Feeds often represent 40-60% of the operational costs of fish farming. In relation to the traditional feeds, the organic certified feeds currently present a price-differential of about +30%. To assess it economic feasibility, it is therefore essential to validate if such higher feeding costs will represent an increase on productivity (fish growth and feed conversion or can be fully integrated in the final sale price. Throughout a full production cycle of gilthead seabream (from 9 grams until >350 grams, a series of trials allowed us to assess the effects of: a an organic certified feed; b variable feeding levels (100 and 80% of recommendations; and c culture density (0.5 and 1.0 kg/m3 on the overall growth performance, body composition and environmental impact at the fish farm level. Results show that growth performance (weight gain and feed conversion ratio of seabream fed the organic feed was similar to that found in fish fed a traditional diet. With the organic feed, a reduction of the feeding level by 20% of the manufacturer recommendations led to a lower growth, while a similar reduction on the feeding level of the traditional feed had no impact

  1. Response of vegetable organisms to quasi-monochromatic light of different duration, intensity and wavelength

    Energy Technology Data Exchange (ETDEWEB)

    Budagovsky, A V; Solovykh, N V [I.V.Michurin All-Russian Recearch Institute of Fruit Crops Genetics and Breeding (Russian Federation); Budagovskaya, O N [I.V.Michurin All-Russia Research and Development Institute of Gardening, Michurinsk, Tambov region (Russian Federation); Budagovsky, I A [P N Lebedev Physics Institute, Russian Academy of Sciences, Moscow (Russian Federation)

    2015-04-30

    By the example of vegetable organisms differing in structure and functional properties it is shown that their response to the action of quasi-monochromatic light from laser sources does not obey the Bunsen – Roscoe dose law. The dependence of biological effect on the irradiation time has the multimodal (multiextremal) form with alternating maxima and minima of the stimulating effect. Such a property manifests itself in the spectral ranges, corresponding to photoinduced conversion of chromoproteins of photocontrol systems and is probably related to the cyclic variations of metabolic activity in vegetable cells. (biophotonics)

  2. Effect on light intensity and mineral nutrition on carbohydrate and organic acid content in leaves of young coffee plants

    International Nuclear Information System (INIS)

    Georgiev, G.; Vento, Kh.

    1975-01-01

    Young coffee plants (Coffea arabica, L., var. Caturra) were grown under different conditions of mineral nutrition (1/8 N-P-K, N-P-K, 3 N-P-K, N 1/2-P-K and N-2P-K) and illumination (directly in the sunlight or shaded) with the aim of studying the effect of light and mineral nutrition on carbohydrate and organic acid content of the leaves. For determining these compounds 14 CO 2 was used. Sugars were separated after the method of paper chromatography. The results obtained showed that the incorporation of 14 C in sugars and organic acids was more intensive in plants grown directly in the sunlight, while in starch 14 C was incorporated more intensively in the shaded plants. Carbohydrate content rose parallel to the increase of nitrogen in the nutrient solution. Changingthe rate of phosphorus from 1/2P to two doses exerted highest effect on 14 C incorporation in starch and in hemicellulose. (author)

  3. Case management considerations of progressive dementia in a home setting.

    Science.gov (United States)

    Pierce, Mary Ellen

    2010-01-01

    Nursing theory, research, and best practice guidelines contribute substantially to the field of dementia care. Interventional plans are challenged most by those dementias considered progressive and deteriorative in nature, requiring ongoing reassessment and modification of care practices as the clinical course changes. The purpose of this article is to provide guidelines for case managers in the development of effective, individualized care plans for clients with progressive dementia residing in a home setting. The application of these guidelines is illustrated through the presentation of an actual case. The practice setting is a private home in the Pacific Northwest. Geriatric case management is provided by an RN case manager. Progressive dementia presents challenges to home care. Professional case management using comprehensive, holistic assessment, collaborative approaches, and best practice fundamentals serve to create an effective, individualized plan of care. The increasing geriatric population presents great opportunities for case managers in strategic management for creating successful home care models in clients with progressive dementia. Use of nursing diagnoses, dementia research, and collaborative approaches with families and other medical providers creates a viable alternative for clients with progressive dementia.

  4. Is Case Management Effective for Long-Lasting Suicide Prevention?

    Science.gov (United States)

    Wang, Liang-Jen; Wu, Ya-Wen; Chen, Chih-Ken

    2015-01-01

    Case management services have been implemented in suicide prevention programs. To investigate whether case management is an effective strategy for reducing the risks of repeated suicide attempts and completed suicides in a city with high suicide rates in northern Taiwan. The Suicide Prevention Center of Keelung City (KSPC) was established in April 2005. Subjects included a consecutive sample of individuals (N = 2,496) registered in KSPC databases between January 1, 2006, and December 31, 2011, with at least one episode of nonfatal self-harm. Subjects were tracked for the duration of the study. Of all the subjects, 1,013 (40.6%) received case management services; 416 (16.7%) had at least one other deliberate self-harm episode and 52 (2.1%) eventually died by suicide. No significant differences were found in the risks of repeated self-harm and completed suicides between suicide survivors who received case management and those who refused the services. However, a significant reduction in suicide rates was found after KSPC was established. Findings suggest that case management services might not reduce the risks of suicide repetition among suicide survivors during long-term follow-up. Future investigation is warranted to determine factors impacting the downward trend of suicide rates.

  5. The effects of different mixing intensities during anaerobic digestion of the organic fraction of municipal solid waste

    International Nuclear Information System (INIS)

    Lindmark, Johan; Eriksson, Per; Thorin, Eva

    2014-01-01

    Highlights: • Effects of mixing on the anaerobic digestion of municipal solid waste. • Digestion of fresh substrate and post-digestion at three mixing intensities were evaluated. • Mixing performed at 150 RPM, 25 RPM and minimally intermittently. • Increased biogas production rates and yields at lower mixing intensities. - Abstract: Mixing inside an anaerobic digester is often continuous and is not actively controlled. The selected mixing regime can however affect both gas production and the energy efficiency of the biogas plant. This study aims to evaluate these effects and compare three different mixing regimes, 150 RPM and 25 RPM continuous mixing and minimally intermittent mixing for both digestion of fresh substrate and post-digestion of the organic fraction of municipal solid waste. The results show that a lower mixing intensity leads to a higher biogas production rate and higher total biogas production in both cases. 25 RPM continuous mixing and minimally intermittent mixing resulted in similar biogas production after process stabilization, while 150 RPM continuous mixing resulted in lower production throughout the experiment. The lower gas production at 150 RPM could not be explained by the inhibition of volatile fatty acids. Cumulative biogas production until day 31 was 295 ± 2.9, 317 ± 1.9 and 304 ± 2.8 N ml/g VS added during digestion of fresh feed and 113 ± 1.3, 134 ± 1.1 and 130 ± 2.3 N ml/g VS added during post digestion for the 150 RPM, 25 RPM and minimally mixed intensities respectively. As well as increasing gas production, optimal mixing can improve the energy efficiency of the anaerobic digestion process

  6. The effects of different mixing intensities during anaerobic digestion of the organic fraction of municipal solid waste

    Energy Technology Data Exchange (ETDEWEB)

    Lindmark, Johan, E-mail: Johan.lindmark@mdh.se; Eriksson, Per; Thorin, Eva, E-mail: Eva.Thorin@mdh.se

    2014-08-15

    Highlights: • Effects of mixing on the anaerobic digestion of municipal solid waste. • Digestion of fresh substrate and post-digestion at three mixing intensities were evaluated. • Mixing performed at 150 RPM, 25 RPM and minimally intermittently. • Increased biogas production rates and yields at lower mixing intensities. - Abstract: Mixing inside an anaerobic digester is often continuous and is not actively controlled. The selected mixing regime can however affect both gas production and the energy efficiency of the biogas plant. This study aims to evaluate these effects and compare three different mixing regimes, 150 RPM and 25 RPM continuous mixing and minimally intermittent mixing for both digestion of fresh substrate and post-digestion of the organic fraction of municipal solid waste. The results show that a lower mixing intensity leads to a higher biogas production rate and higher total biogas production in both cases. 25 RPM continuous mixing and minimally intermittent mixing resulted in similar biogas production after process stabilization, while 150 RPM continuous mixing resulted in lower production throughout the experiment. The lower gas production at 150 RPM could not be explained by the inhibition of volatile fatty acids. Cumulative biogas production until day 31 was 295 ± 2.9, 317 ± 1.9 and 304 ± 2.8 N ml/g VS added during digestion of fresh feed and 113 ± 1.3, 134 ± 1.1 and 130 ± 2.3 N ml/g VS added during post digestion for the 150 RPM, 25 RPM and minimally mixed intensities respectively. As well as increasing gas production, optimal mixing can improve the energy efficiency of the anaerobic digestion process.

  7. [Structure, organization and capacity problems in emergency medical services, emergency admission and intensive care units].

    Science.gov (United States)

    Dick, W

    1994-01-01

    Emergency medicine is subjected worldwide to financial stringencies and organizational evaluations of cost-effectiveness. The various links in the chain of survival are affected differently. Bystander assistance or bystander CPR is available in only 30% of the emergencies, response intervals--if at all required by legislation--are observed to only a limited degree or are too extended for survival in cardiac arrest. A single emergency telephone number is lacking. Too many different phone numbers for emergency reporting result in confusion and delays. Organizational realities are not fully overcome and impair efficiency. The position of the emergency physician in the EMS System is inadequately defined, the qualification of too many emergency physicians are unsatisfactory. In spite of this, emergency physicians are frequently forced to answer out-of-hospital emergency calls. Conflicts between emergency physicians and EMTs may be overcome by providing both groups with comparable qualifications as well as by providing an explicit definition of emergency competence. A further source of conflict occurs at the juncture of prehospital and inhospital emergency care in the emergency department. Deficiencies on either side play a decisive role. At least in principle there are solutions to the deficiencies in the EMSS and in intensive care medicine. They are among others: Adequate financial compensation of emergency personnel, availability of sufficient numbers of highly qualified personnel, availability of a central receiving area with an adjacent emergency ward, constant information flow to the dispatch center on the number of available emergency beds, maintaining 5% of all beds as emergency beds, establishing intermediate care facilities. Efficiency of emergency physician activities can be demonstrated in polytraumatized patients or in patients with ventricular fibrillation or acute myocardial infarction, in patients with acute myocardial insufficiency and other emergency

  8. Respiration intensiveness and inclusion of 32P in the composition of phosphorus-organic combinations in radiomutants of cotton plants and their initial forms under salinization of soil

    International Nuclear Information System (INIS)

    Nazirov, N.N.; Tashmatov, N.T.; Vakhabov, A.; Nabiev, A.G.

    1981-01-01

    Salinization of soil affects respiration intensity, 32 P introduction into plants and its inclusion in the content of phosphoric organic compounds as well as their content in tissues of cotton plants. Respiration intensity increases: respiration intensity of weakly-stable plants increases to a greater degree. General character of changes caused by the salinization effect of different cotton sorts, is analogous, differences are only in the destruction degree [ru

  9. Critical success factors in implementing clinical pathways/case management.

    Science.gov (United States)

    Choo, J

    2001-07-01

    With the advent of casemix reimbursement implementation, rapid technological changes, an ageing population and changing consumer behaviour, the Singapore health care industry is faced with the impetus to provide a cost-effective and efficient care delivery system. One ubiquitous tool used is the establishment of a clinical pathway/case management programme within the hospital. As the concept of clinical pathway for patient care is a relatively new concept in Singapore, several critical factors must be considered to ensure successful implementation of clinical pathway/case management programme. One key success factor lies in continued clinician support and acceptance. Other factors include top management leadership and support and a dedicated team of case managers, nurses and paramedical professionals.

  10. Case management for persons with substance use disorders

    DEFF Research Database (Denmark)

    Hesse, Morten; Vanderplasschen, Wouter; Rapp, Richard

    2007-01-01

    ). Reference searching; personal communication; conference abstracts; book chapters on case management. Selection criteria Randomized controlled studies that compared a specific model of case management with either treatment as usual or another treatment model, included only patients with at least one alcohol...... or drug related problem. Data collection & analysis Two groups of reviewers extracted the data independently . Standardized mean difference was estimated. Main results In total, we could extract results from 15 studies. Outcome on illicit drug use was reported from 7 studies with 2391 patients. The effect...

  11. A case management agency and bank create a service innovation.

    Science.gov (United States)

    Katz, K S; Stowe, A W

    1992-01-01

    Connecticut Community Care, Inc. (CCCI), a statewide, nonprofit case management agency, in collaboration with Connecticut National Bank (CNB), developed a unique model of delivering case management services to bank trust clients. No reports of such a collaborative model have been found in the published literature in the United States. The article presents a historical overview of this innovative initiative; the identification of the target population; the delivery of the assessment, coordination, and monitoring services; and the marketing techniques. Utilization statistics, a synopsis of the model outcomes as viewed by the trust officers, and suggestions for replication are also presented.

  12. The effect of land use intensity on soil organic carbon stocks of European croplands

    Science.gov (United States)

    Dechow, Rene; Gebbert, Sören; Franko, Uwe; Kätterer, Thomas; Kolbe, Hartmut

    2013-04-01

    Croplands cover about one third of Europe and are assumed to be the biggest source of greenhouse gas emissions of the European biosphere with the degradation of soil organic carbon (SOC) being a major contributor of this source. Soil carbon stocks of croplands are subjected to ranges of natural and anthropogenic influences that control the release or uptake of CO2. The separation of drivers is essential for assessing recent and prospective GHG mitigation potentials by cropland management. Within the last decades the management of European croplands is characterized by an ongoing intensification. The increasing influence of the global market on farmers' decision and the establishment of industrialized farming practise in Europe had significant impact on the shift of crop rotations during the last decades. Due to the high spatial variability and the dominating fraction of slowly degradable carbon it needs at least decades to detect changes while agricultural management is characterized by short term system interventions. Long term observations representing time intervals of decades to hundreds of years are therefore essential to make reliable suggestions about the sensitivity of soil carbon turnover against external impacts because the temporal scale of these experiments corresponds to the temporal scale of soil C turnover. A data set of about 32 European long-term experiments (380 variants) was used to quantify the uncertainty of the RothC soil carbon model. The parameters of the model were adapted to represent the sensitivity of SOC on weather conditions and crop types found in the data set by applying an Monte Carlo Markov Chain algorithm. Integrated in a GIS environment the modified model was used to run scenarios that vary in terms of climate conditions and crop rotations within the time period 1970-2010 on a European scale. Regionalized sensitivities of SOC on natural drivers and crop rotations will be presented.

  13. Conventional intensive logging promotes loss of organic carbon from the mineral soil.

    Science.gov (United States)

    Dean, Christopher; Kirkpatrick, James B; Friedland, Andrew J

    2017-01-01

    There are few data, but diametrically opposed opinions, about the impacts of forest logging on soil organic carbon (SOC). Reviews and research articles conclude either that there is no effect, or show contradictory effects. Given that SOC is a substantial store of potential greenhouse gasses and forest logging and harvesting is routine, resolution is important. We review forest logging SOC studies and provide an overarching conceptual explanation for their findings. The literature can be separated into short-term empirical studies, longer-term empirical studies and long-term modelling. All modelling that includes major aboveground and belowground biomass pools shows a long-term (i.e. ≥300 years) decrease in SOC when a primary forest is logged and then subjected to harvesting cycles. The empirical longer-term studies indicate likewise. With successive harvests the net emission accumulates but is only statistically perceptible after centuries. Short-term SOC flux varies around zero. The long-term drop in SOC in the mineral soil is driven by the biomass drop from the primary forest level but takes time to adjust to the new temporal average biomass. We show agreement between secondary forest SOC stocks derived purely from biomass information and stocks derived from complex forest harvest modelling. Thus, conclusions that conventional harvests do not deplete SOC in the mineral soil have been a function of their short time frames. Forest managers, climate change modellers and environmental policymakers need to assume a long-term net transfer of SOC from the mineral soil to the atmosphere when primary forests are logged and then undergo harvest cycles. However, from a greenhouse accounting perspective, forest SOC is not the entire story. Forest wood products that ultimately reach landfill, and some portion of which produces some soil-like material there rather than in the forest, could possibly help attenuate the forest SOC emission by adding to a carbon pool in

  14. Simulating the effects of light intensity and carbonate system composition on particulate organic and inorganic carbon production in Emiliania huxleyi.

    Science.gov (United States)

    Holtz, Lena-Maria; Wolf-Gladrow, Dieter; Thoms, Silke

    2015-05-07

    Coccolithophores play an important role in the marine carbon cycle. Variations in light intensity and external carbonate system composition alter intracellular carbon fluxes and therewith the production rates of particulate organic and inorganic carbon. Aiming to find a mechanistic explanation for the interrelation between dissolved inorganic carbon fluxes and particulate carbon production rates, we develop a numerical cell model for Emiliania huxleyi, one of the most abundant coccolithophore species. The model consists of four cellular compartments, for each of which the carbonate system is resolved dynamically. The compartments are connected to each other and to the external medium via substrate fluxes across the compartment-confining membranes. By means of the model we are able to explain several pattern observed in particulate organic and inorganic carbon production rates for different strains and under different acclimation conditions. Particulate organic and inorganic carbon production rates for instance decrease at very low external CO2 concentrations. Our model suggests that this effect is caused mainly by reduced HCO3(-) uptake rates, not by CO2 limitation. The often observed decrease in particulate inorganic carbon production rates under Ocean Acidification is explained by a downregulation of cellular HCO3(-) uptake. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Changes of Phosphate Solubilizing Bacteria Population on Paddy Field with Intensive Farming became Sustainable Organic Farming System

    Directory of Open Access Journals (Sweden)

    Dermiyati

    2009-05-01

    Full Text Available The research aimed to study the change of population of phosphate solubilizing microorganisms according to the application time of bokashi which were applied continously on organic paddy rice fields since years of 2000 up to 2006. The research was conducted in a Randomized Completely Block Design in four replicates. The treatments were without bokashi (control; with intensively application of NPK fertilizers, bokashi application for 3 planting seasons (12 t ha-1, bokashi application for 4 planting seasons (16 t ha-1, bokashi application for 7 planting seasons (28 t ha-1, and bokashi application for 9 planting seasons (36 t ha-1. The results showed that the population of phosphate solubilizing microorganisms were not affected by continously applied of bokashi and did not have correlations to organic carbon, total nitrogen, ratio C/N, soil pH, and soil water content. However, the phosphate solubilizing microorganisms had played a role in the availability of the soil available-P which were shown by increasing of paddy yields year by year, although the contribution of soil phosphorus from bokashi is a relatively low. Yet, the bokashi application on the organic paddy fields did not increase the soil availble-P because most of the P which was absorbed by the plants coming from residual P fertilizers either from bokashi or SP-36 which were intensevely given before.

  16. Linkages between organization climate and work outcomes: perceptual differences among health service professionals as a function of customer contact intensity.

    Science.gov (United States)

    Scotti, Dennis J; Harmon, Joel

    2014-01-01

    The delivery of high-quality service, rendered by health service professionals who interact with customers (patients), increases the likelihood that customers will form positive evaluations of the quality of their service encounters as well as high levels of customer satisfaction. Using linkage theory to develop our conceptual framework, we identify four clusters of variables which contribute to a chain of sequential events that connect organization climate to personal and operational work outcomes. We then examine the perceptual differences of service professionals, grouped by intensity of customer contact, with respect to these variables. National data for this project were obtained from multiple sources made available by the Veterans Healthcare Administration (VHA). Cross-group differences were tested using a series of variance analyses. The results indicate that level of customer-contact intensity plays a significant role in explaining variation in perceptions of support staff, clinical practitioners, and nurses at the multivariate and univariate levels of analysis. Contact intensity appears to be a core determinant of the nature of work performed by health service professionals as well as their psychological responses to organizational and customer-related dynamics. Health service professionals are important resources because of their specialized knowledge, labor expense, and scarcity. Based on findings from our research, managers are advised to survey employees' perceptions of their organizational environment and design practices that respond to the unique viewpoints of each of the professional groups identified in this study. Such tailoring should help executives maximize the value of investments in human resources by underwriting patient satisfaction and financial sustainability.

  17. Improving Parolees' Participation in Drug Treatment and Other Services through Strengths Case Management.

    Science.gov (United States)

    Prendergast, Michael; Cartier, Jerome J

    2008-01-01

    In an effort to increase participation in community aftercare treatment for substance-abusing parolees, an intervention based on a transitional case management (TCM) model that focuses mainly on offenders' strengths has been developed and is under testing. This model consists of completion, by the inmate, of a self-assessment of strengths that informs the development of the continuing care plan, a case conference call shortly before release, and strengths case management for three months post-release to promote retention in substance abuse treatment and support the participant's access to designated services in the community. The post-release component consists of a minimum of one weekly client/case manager meeting (in person or by telephone) for 12 weeks. The intervention is intended to improve the transition process from prison to community at both the individual and systems level. Specifically, the intervention is designed to improve outcomes in parolee admission to, and retention in, community-based substance-abuse treatment, parolee access to other needed services, and recidivism rates during the first year of parole. On the systems level, the intervention is intended to improve the communication and collaboration between criminal justice agencies, community-based treatment organizations, and other social and governmental service providers. The TCM model is being tested in a multisite study through the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative funded by the National Institute of Drug Abuse.

  18. Student Affairs Case Management: Merging Social Work Theory with Student Affairs Practice

    Science.gov (United States)

    Adams, Sharrika D.; Hazelwood, Sherry; Hayden, Bruce

    2014-01-01

    Case management is a functional area in higher education and student affairs that emerged after the mass shootings at Virginia Tech in 2007. Although new to higher education, case management emerged from established social work practice. This article compares social work theory and case management standards with a new case management model for…

  19. Evaluation of Probation Case Management (PCM) for Drug-Involved Women Offenders

    Science.gov (United States)

    Chan, Monica; Guydish, Joseph; Prem, Rosemary; Jessup, Martha A.; Cervantes, Armando; Bostrom, Alan

    2005-01-01

    Based on availability of case management services, drug-involved women offenders entered either a probation case management (PCM) intervention(n = 65) or standard probation(n = 44). Participants were placed in the case management condition until all slots were filled, then placed in standard probation until case management slots opened.…

  20. Dynamic Condition Response Graphs for Trustworthy Adaptive Case Management

    DEFF Research Database (Denmark)

    Mukkamala, Raghava Rao; Hildebrandt, Thomas; Slaats, Tijs

    2013-01-01

    semantics that supports both run time changes and formal verification. We show how these techniques are being implemented in industry as a component of the Exformatics case management tools. Finally we discuss the planned future work, which will aim to allow changes to be tested for conformance wrt policies...

  1. Towards Trustworthy Adaptive Case Management with Dynamic Condition Response Graphs

    DEFF Research Database (Denmark)

    Mukkamala, Raghava Rao; Hildebrandt, Thomas; Slaats, Tijs

    2013-01-01

    We describe how the declarative Dynamic Condition Response (DCR) Graphs process model can be used for trustworthy adaptive case management by leveraging the flexible execution, dynamic composition and adaptation supported by DCR Graphs. The dynamically composed and adapted graphs are verified for...

  2. Community case management improves use of treatment for ...

    African Journals Online (AJOL)

    Objective: Evaluate the performance of volunteers in providing Community Case Management (CCM) for diarrhea, fever and pneumonia – in a pre-HEW setting in Liben Woreda, Oromiya Regional State. Methods: Save the Children supported Ministry of Health and communities to deliver child survival interventions from ...

  3. School Asthma Screening and Case Management: Attendance and Learning Outcomes

    Science.gov (United States)

    Moricca, Michelle L.; Grasska, Merry A.; BMarthaler, Marcia; Morphew, Tricia; Weismuller, Penny C.; Galant, Stanley P.

    2013-01-01

    Asthma is related to school absenteeism and underperformance in elementary students. This pilot study assessed whether school nurse case management (CM) in children identified with asthma impacts academic performance and school absenteeism in one school. A validated questionnaire was used to identify children at risk for asthma and CM was provided…

  4. Acuity and case management: a healthy dose of outcomes, part III.

    Science.gov (United States)

    Huber, Diane L; Craig, Kathy

    2007-01-01

    This is the third of a 3-part series presenting 2 effective applications--acuity and dosage--that describe how the business case for case management (CM) can be made. In Part I, dosage and acuity concepts were explained as client need-severity, CM intervention-intensity, and CM activity-dose prescribed by amount, frequency, duration, and breadth of activities. Concepts were presented that related the practice of CM to the use of evidence-based practice (EBP), knowledge, and methods and the development of instruments that measure and score pivotal CM actions. Part I also featured a specific exemplar, the CM Acuity Tool, and described how to use acuity to identify and score the complexity of a CM case. Part II further explained dosage and 2 acuity instruments, the Acuity Tool and AccuDiff. Part III presents linkage to EBP and practical applications. The information contained in the 3-part series applies to all CM practice settings and contains ideas and recommendations useful to CM generalists, specialists, supervisors, and business and outcomes managers. The Acuity Tools Project was developed from frontline CM practice in one large, national telephonic CM company. Dosage: A literature search failed to find research into dosage of a behavioral intervention. The Huber-Hall model was developed and tested in a longitudinal study of CM models in substance abuse treatment and reported in the literature. Acuity: A structured literature search and needs assessment launched the development of the suite of acuity tools. A gap analysis identified that an instrument to assign and measure case acuity specific to CM activities was needed. Clinical experts, quality specialists, and business analysts (n = 7) monitored the development and testing of the tools, acuity concepts, scores, differentials, and their operating principles and evaluated the validity of the acuity tools' content related to CM activities. During the pilot phase of development, interrater reliability testing of

  5. Acuity and case management: a healthy dose of outcomes, part II.

    Science.gov (United States)

    Craig, Kathy; Huber, Diane L

    2007-01-01

    This is the second of a 3-part series presenting 2 effective applications-acuity and dosage-that describe how the business case for case management (CM) can be made. In Part I, dosage and acuity concepts were explained as client need-severity, CM intervention-intensity, and CM activity-dose prescribed by amount, frequency, duration, and breadth of activities. Part I also featured a specific exemplar, the CM Acuity Tool, and described how to use acuity to identify and score the complexity of a CM case. Appropriate dosage prescription of CM activity was discussed. Part II further explains dosage and presents two acuity instruments, the Acuity Tool and AccuDiff. Details are provided that show how these applications produce opportunities for better communication about CM cases and for more accurate measurement of the right content that genuinely reflects the essentials of CM practice. The information contained in the 3-part series applies to all CM practice settings and contains ideas and recommendations useful to CM generalists, specialists, and supervisors, plus business and outcomes managers. The Acuity Tools Project was developed from frontline CM practice in one large, national telephonic CM company. Dosage: A literature search failed to find research into dosage of a behavioral intervention. The Huber-Hall model was developed and tested in a longitudinal study of CM models in substance abuse treatment and reported in the literature. Acuity: A structured literature search and needs assessment launched the development of the suite of acuity tools. A gap analysis identified that an instrument to assign and measure case acuity specific to CM activities was needed. Clinical experts, quality specialists, and business analysts (n = 7) monitored the development and testing of the tools, acuity concepts, scores, differentials, and their operating principles and evaluated the validity of the Acuity Tools' content related to CM activities. During the pilot phase of

  6. An Acuity Tool for Heart Failure Case Management: Quantifying Workload, Service Utilization, and Disease Severity.

    Science.gov (United States)

    Kilgore, Matthew D

    The cardiology service line director at a health maintenance organization (HMO) in Washington State required a valid, reliable, and practical means for measuring workloads and other productivity factors for six heart failure (HF) registered nurse case managers located across three geographical regions. The Kilgore Heart Failure Case Management (KHFCM) Acuity Tool was systematically designed, developed, and validated to measure workload as a dependent function of the number of heart failure case management (HFCM) services rendered and the duration of times spent on various care duties. Research and development occurred at various HMO-affiliated internal medicine and cardiology offices throughout Western Washington. The concepts, methods, and principles used to develop the KHFCM Acuity Tool are applicable for any type of health care professional aiming to quantify workload using a high-quality objective tool. The content matter, scaling, and language on the KHFCM Acuity Tool are specific to HFCM settings. The content matter and numeric scales for the KHFCM Acuity Tool were developed and validated using a mixed-method participant action research method applied to a group of six outpatient HF case managers and their respective caseloads. The participant action research method was selected, because the application of this method requires research participants to become directly involved in the diagnosis of research problems, the planning and execution of actions taken to address those problems, and the implementation of progressive strategies throughout the course of the study, as necessary, to produce the most credible and practical practice improvements (; ; ; ). Heart failure case managers served clients with New York Heart Association Functional Class III-IV HF (), and encounters were conducted primarily by telephone or in-office consultation. A mix of qualitative and quantitative results demonstrated a variety of quality improvement outcomes achieved by the design

  7. Case management approaches to home support for people with dementia.

    Science.gov (United States)

    Reilly, Siobhan; Miranda-Castillo, Claudia; Malouf, Reem; Hoe, Juanita; Toot, Sandeep; Challis, David; Orrell, Martin

    2015-01-05

    Over 35 million people are estimated to be living with dementia in the world and the societal costs are very high. Case management is a widely used and strongly promoted complex intervention for organising and co-ordinating care at the level of the individual, with the aim of providing long-term care for people with dementia in the community as an alternative to early admission to a care home or hospital. To evaluate the effectiveness of case management approaches to home support for people with dementia, from the perspective of the different people involved (patients, carers, and staff) compared with other forms of treatment, including 'treatment as usual', standard community treatment and other non-case management interventions. We searched the following databases up to 31 December 2013: ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group,The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, Web of Science (including Science Citation Index Expanded (SCI-EXPANDED) and Social Science Citation Index), Campbell Collaboration/SORO database and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group. We updated this search in March 2014 but results have not yet been incorporated. We include randomised controlled trials (RCTs) of case management interventions for people with dementia living in the community and their carers. We screened interventions to ensure that they focused on planning and co-ordination of care. We used standard methodological procedures as required by The Cochrane Collaboration. Two review authors independently extracted data and made 'Risk of bias' assessments using Cochrane criteria. For continuous outcomes, we used the mean difference (MD) or standardised mean difference (SMD) between groups along with its confidence interval (95% CI). We applied a fixed- or random-effects model as appropriate. For binary or dichotomous data, we generated the corresponding odds

  8. Hospital‑based case management for migrant patients

    DEFF Research Database (Denmark)

    Ølholm, Anne Mette; Christensen, Janne B; Kamionka, Stine Lundstrøm

    2016-01-01

    management programme might include reducing inequality and improving clinical outcomes. No studies supporting the argument that specialized hospital care is stigmatizing or reduces quality of care were identified. Conclusion: The review highlights a fundamental lack of evidence against specialized care...... to patients with a refugee or immigrant background. Provision of specialized services for migrant patients, including case management with multidisciplinary physical, cognitive and social interventions, has been suggested as a way to tackle inequalities in response to a growing recognition of the complexity...... - b ased case management for ethnic minority patients. Methods: This review used a health technology assessment model, including a systematic search of literature in the PubMed, Embase, the Cochrane Library, Sociological Abstracts, the Cumulative Index to Nursing and Allied Health Literature databases...

  9. Strategies for Online Organ Motion Correction for Intensity-Modulated Radiotherapy of Prostate Cancer: Prostate, Rectum, and Bladder Dose Effects

    International Nuclear Information System (INIS)

    Rijkhorst, Erik-Jan; Lakeman, Annemarie; Nijkamp, Jasper; Bois, Josien de; Herk, Marcel van; Lebesque, Joos V.; Sonke, Jan-Jakob

    2009-01-01

    Purpose: To quantify and evaluate the accumulated prostate, rectum, and bladder dose for several strategies including rotational organ motion correction for intensity-modulated radiotherapy (IMRT) of prostate cancer using realistic organ motion data. Methods and Materials: Repeat computed tomography (CT) scans of 19 prostate patients were used. Per patient, two IMRT plans with different uniform margins were created. To quantify prostate and seminal vesicle motion, repeat CT clinical target volumes (CTVs) were matched onto the planning CTV using deformable registration. Four different strategies, from online setup to full motion correction, were simulated. Rotations were corrected for using gantry and collimator angle adjustments. Prostate, rectum, and bladder doses were accumulated for each patient, plan, and strategy. Minimum CTV dose (D min ), rectum equivalent uniform dose (EUD, n = 0.13), and bladder surface receiving ≥78 Gy (S78), were calculated. Results: With online CTV translation correction, a 7-mm margin was sufficient (i.e., D min ≥ 95% of the prescribed dose for all patients). A 4-mm margin required additional rotational correction. Margin reduction lowered the rectum EUD(n = 0.13) by ∼2.6 Gy, and the bladder S78 by ∼1.9%. Conclusions: With online correction of both translations and rotations, a 4-mm margin was sufficient for 15 of 19 patients, whereas the remaining four patients had an underdosed CTV volume <1%. Margin reduction combined with online corrections resulted in a similar or lower dose to the rectum and bladder. The more advanced the correction strategy, the better the planned and accumulated dose agreed.

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

    Science.gov (United States)

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

    2017-10-22

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

  11. Recommendation for a contouring method and atlas of organs at risk in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Sun, Ying; Yu, Xiao-Li; Luo, Wei; Lee, Anne W.M.; Wee, Joseph Tien Seng; Lee, Nancy; Zhou, Guan-Qun; Tang, Ling-Long; Tao, Chang-Juan; Guo, Rui; Mao, Yan-Ping; Zhang, Rong; Guo, Ying; Ma, Jun

    2014-01-01

    Background and purpose: To recommend contouring methods and atlas of organs at risk (OARs) for nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy, in order to help reach a consensus on interpretations of OARs delineation. Methods and materials: Two to four contouring methods for the middle ear, inner ear, temporal lobe, parotid gland and spinal cord were identified via systematic literature review; their volumes and dosimetric parameters were compared in 41 patients. Areas under the receiver operating characteristic curves for temporal lobe contouring were compared in 21 patients with unilateral temporal lobe necrosis (TLN). Results: Various contouring methods for the temporal lobe, middle ear, inner ear, parotid gland and spinal cord lead to different volumes and dosimetric parameters (P < 0.05). For TLN, D1 of PRV was the most relevant dosimetric parameter and 64 Gy was the critical point. We suggest contouring for the temporal lobe, middle ear, inner ear, parotid gland and spinal cord. A CT–MRI fusion atlas comprising 33 OARs was developed. Conclusions: Different dosimetric parameters may hinder the dosimetric research. The present recommendation and atlas, may help reach a consensus on subjective interpretation of OARs delineation to reduce inter-institutional differences in NPC patients

  12. Models of community care for severe mental illness: a review of research on case management.

    Science.gov (United States)

    Mueser, K T; Bond, G R; Drake, R E; Resnick, S G

    1998-01-01

    We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.

  13. Intensity Modulated Proton Therapy for Craniospinal Irradiation: Organ-at-Risk Exposure and a Low-Gradient Junctioning Technique

    International Nuclear Information System (INIS)

    Stoker, Joshua B.; Grant, Jonathan; Zhu, X. Ronald; Pidikiti, Rajesh; Mahajan, Anita; Grosshans, David R.

    2014-01-01

    Purpose: To compare field junction robustness and sparing of organs at risk (OARs) during craniospinal irradiation (CSI) using intensity modulated proton therapy (IMPT) to conventional passively scattered proton therapy (PSPT). Methods and Materials: Ten patients, 5 adult and 5 pediatric patients, previously treated with PSPT-based CSI were selected for comparison. Anterior oblique cranial fields, using a superior couch rotation, and posterior spinal fields were used for IMPT planning. To facilitate low-gradient field junctioning along the spine, the inverse-planning IMPT technique was divided into 3 stages. Dose indices describing target coverage and normal tissue dose, in silico error modeling, and film dosimetry were used to assess plan quality. Results: Field junction robustness along the spine was improved using the staged IMPT planning technique, reducing the worst case impact of a 4-mm setup error from 25% in PSPT to <5% of prescription dose. This was verified by film dosimetry for clinical delivery. Exclusive of thyroid dose in adult patients, IMPT plans demonstrated sparing of organs at risk as good or better than PSPT. Coverage of the cribriform plate for pediatric (V95% [percentage of volume of the target receiving at least 95% of the prescribed dose]; 87 ± 11 vs 92 ± 7) and adult (V95%; 94 ± 7 vs 100 ± 1) patients and the clinical target in pediatric (V95%; 98 ± 2 vs 100 ± 1) and adult (V95%; 100 ± 1 vs 100 ± 1) patients for PSPT and IMPT plans, respectively, were comparable or improved. For adult patients, IMPT target dose inhomogeneity was increased, as determined by heterogeneity index (HI) and inhomogeneity coefficient (IC). IMPT lowered maximum spinal cord dose, improved spinal dose homogeneity, and reduced exposure to other OARs. Conclusions: IMPT has the potential to improve CSI plan quality and the homogeneity of intrafractional dose at match lines. The IMPT approach developed may also simplify treatments and reduce

  14. Presence of biofilm containing viable multiresistant organisms despite terminal cleaning on clinical surfaces in an intensive care unit.

    Science.gov (United States)

    Vickery, K; Deva, A; Jacombs, A; Allan, J; Valente, P; Gosbell, I B

    2012-01-01

    Despite recent attention to surface cleaning and hand hygiene programmes, multiresistant organisms (MROs) continue to be isolated from the hospital environment. Biofilms, consisting of bacteria embedded in exopolymeric substances (EPS) are difficult to remove due to their increased resistance to detergents and disinfectants, and periodically release free-swimming planktonic bacteria back into the environment which may may act as an infection source. To establish whether reservoirs of MROs exist in the environment as biofilms. Following terminal cleaning, equipment and furnishings were removed aseptically from an intensive care unit (ICU) and subjected to culture and scanning electron microscopy (SEM). Samples were placed in 5 mL of tryptone soya broth, sonicated for 5 min before plate culture on horse blood agar, Brillance MRSA and Brilliance VRE agar plates. Samples for SEM were fixed in 3% glutaraldehyde and hexamethyldisilizane (HMDS) prior to sputter-coating with gold and examination in an electron microscope. Biofilm was demonstrated visually on the sterile supply bucket, the opaque plastic door, the venetian blind cord, and the sink rubber, whereas EPS alone was seen on the curtain. Viable bacteria were grown from three samples, including MRSA from the venetian blind cord and the curtain. Biofilm containing MROs persist on clinical surfaces from an ICU despite terminal cleaning, suggesting that current cleaning practices are inadequate to control biofilm development. The presence of MROs being protected within these biofilms may be the mechanism by which MROs persist within the hospital environment. Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  15. Implementation of consumer providers into mental health intensive case management teams.

    Science.gov (United States)

    Hamilton, Alison B; Chinman, Matthew; Cohen, Amy N; Oberman, Rebecca Shoai; Young, Alexander S

    2015-01-01

    In mental health care, consumer providers (CPs) are individuals with serious mental illness (SMI) who draw upon their lived experiences while providing services to others with SMI. Implementation of CPs has proven to be challenging in a variety of settings. The PEER project (Peers Enhancing Recovery) involved rolling out CPs using an implementation science model and evaluating implementation and impact in mental health treatment settings (three intervention, three control). In qualitative interviews, facilitators and challenges to implementation were described by the CPs, their team members, clients, and study researchers. Site preparation, external facilitation, and positive, reinforcing experiences with CPs facilitated implementation. Role definitions and deficiencies in CPs' technical knowledge posed challenges to implementation. Sustainability was not realized due to insufficient resources. However, implementation was positive overall, characterized by diffusion of innovation concepts of high relative advantage, strong trialability, compatibility with prevailing norms, compelling observability, and relatively low complexity. By preparing and working systematically with intervention sites to incorporate new services, implementation was strengthened and challenges were minimized.

  16. The Impact of Comprehensive Case Management on HIV Client Outcomes.

    Directory of Open Access Journals (Sweden)

    Mark Brennan-Ing

    Full Text Available In 1990, New York State instituted Comprehensive Medicaid Case Management, also known as Target Case Management (TCM, for people dealing with multiple comorbid conditions, including HIV. The goal of TCM is to assist clients in navigating the health care system to increase care engagement and treatment adherence for individuals with complex needs. HIV-positive individuals engaged in care are more likely to be virally suppressed, improving clinical outcomes and decreasing chances of HIV transmission. The purpose of this study was to understand the impact of TCM management on outcomes for people with HIV. Data were obtained from Amida Care, which operates not-for-profit managed care Medicaid and Medicare Special Needs Plans (SNPs for HIV clients. Changes in clinical, cost, as well as medical and pharmacy utilization data among TCM clients were examined between January 2011 through September 2012 from the start of case management enrollment through the end of the study period (i.e., up to 6 months after disenrollment. Additionally, CD4 counts were compared between Amida Care TCM clients and non-TCM clients. Notable findings include increased CD4 counts for TCM clients over the one-year study period, achieving parity with non-TCM clients (i.e., Mean CD4 count > 500. When looking exclusively at TCM clients, there were increases in medication costs over time, which were concomitant with increased care engagement. Current findings demonstrate that TCM is able to achieve its goals of improving care engagement and treatment adherence. Subsequent policy changes resulting from the Affordable Care Act and the New York State Medicaid Redesign have made the Health Home the administrator of TCM services. Government entities charged with securing and managing TCM and care coordination for people with HIV should provide thoughtful and reasonable guidance and oversight in order to maintain optimal clinical outcomes for TCM clients and reduce the transmission of

  17. Exformatics Declarative Case Management Workflows as DCR Graphs

    DEFF Research Database (Denmark)

    Slaats, Tijs; Mukkamala, Raghava Rao; Hildebrandt, Thomas

    2013-01-01

    Declarative workflow languages have been a growing research subject over the past ten years, but applications of the declarative approach in industry are still uncommon. Over the past two years Exformatics A/S, a Danish provider of Electronic Case Management systems, has been cooperating...... with researchers at IT University of Copenhagen (ITU) to create tools for the declarative workflow language Dynamic Condition Response Graphs (DCR Graphs) and incorporate them into their products and in teaching at ITU. In this paper we give a status report over the work. We start with an informal introduction...

  18. Quality in translation: case management in the international marketplace.

    Science.gov (United States)

    Beichl, Lisa; Craig, Kathy

    2009-01-01

    This article identifies three categories of case management (CM), in-country, international, and micro, that are poised to serve as the quality proxy for the international medical patient in the rapidly emerging globalized healthcare marketplace. The content concentrates on describing in-country CM and international CM (ICM). Because CM professionals are the providers of patient-centered quality and safety improvements, they are capable of filling the chasm between the travel industry and the regulators who specialize in accrediting hospital systems. In-country and ICM case managers are equipped to perform surveillance and intervention at the level of the international patient's bedside, activate network connections, and use culture-sensitive communication skills to safeguard patients in their individual sojourns abroad. The article discusses useful concepts and sources, including an algorithmic tool under development that is geared to identify and quantify risks for lay and business individuals who seek to engage the global medical market. The article's information is provided for front-line and front-office healthcare practitioners to understand or enter the worldwide medical marketplace. Content is targeted to CM generalists, specialists, and business developers interested in learning about safeguarding the patients who travel internationally to receive medical care. It can also be applied by those within and outside the healthcare practice arena, particularly those interested in the development of quality initiatives. All research and syntheses were executed by the authors. Sources included scholarly treatises, business correspondence, medical tourism literature, corporate Internet profiles, news releases, and healthcare industry investigative and monitoring agencies. International health insurance, economics, and financing expertise stems from one author (L.B.). Clinical competencies stem from the international practice experiences of one author (K.C.). This

  19. Translating childhood tuberculosis case management research into operational policies.

    Science.gov (United States)

    Safdar, N; Hinderaker, S G; Baloch, N A; Enarson, D A; Khan, M A; Morkve, O

    2011-08-01

    The control of childhood tuberculosis (TB) has been of low priority in TB programmes in high-burden settings. The objective of this paper was to describe the development and testing of tools for the management of childhood TB. The Pakistan National TB Control Programme embarked on a number of activities, including the establishment of policy guidelines for the management of childhood TB and later a guidance document, 'Case Management Desk Guide and Structured Monitoring', to demonstrate the implementation of childhood TB interventions in a programme context. Initial results showed improved case finding and treatment outcome in implementation sites compared with control districts. However, further programme attention is required to improve quality.

  20. Experiences of case management with chronic illnesses: a qualitative systematic review.

    Science.gov (United States)

    Joo, J Y; Liu, M F

    2018-03-01

    This qualitative systematic review aimed to identify and synthesize recent qualitative studies to improve understanding of the experiences and perceptions of case management interventions that individuals with chronic illnesses and their caregivers have. Case management has been shown to be effective at improving quality of care and lowering costs for individuals with chronic illnesses. However, no qualitative review has been synthesized with recent qualitative studies about case management experiences by individual with chronic illnesses. This qualitative systematic review uses a thematic synthesis method to review 10 qualitative studies published within the last 10 years, from 2007 to 2016, thereby identifying and discussing the understandings that individuals with chronic illnesses and their caregivers have about case management. From this synthesis, three themes were identified as facilitators of case management (access to healthcare resources, health status supports and emotional aid) and two themes were identified as barriers to it (low information about case management and time constraints). This is the first qualitative systematic review of the perceptions and experiences that individuals with chronic illnesses and their caregivers have about case management. The facilitators of case management can be employed to inform patients about the benefits of case management and to improve population health. The findings about barriers to case management can be used to reform case management for populations with chronic illnesses. These factors should be considered by nursing researchers and healthcare policymakers when implementing case management. © 2018 International Council of Nurses.

  1. A clear case. Selective investment in case management applications can yield significant returns.

    Science.gov (United States)

    Hagland, Mark

    2009-03-01

    Strategically conceived case management system implementation makes good patient care and business sense, CIOs agree. Significant financial savings can be achieved from case management IS implementations, if those implementations are executed in the context of partnership between clinical leaders and the CIO's team. CIOs agree that applying the concept of "investment" to the implementation of case management IT can make resource allocation decisions easier.

  2. [Applying the Modified Delphi Technique to Develop the Role of HIV Case Managers and Essential Nursing Competencies in HIV Care].

    Science.gov (United States)

    Ko, Nai-Ying; Hsieh, Chia-Yin; Chen, Yen-Chin; Tsai, Chen-Hsi; Liu, Hsiao-Ying; Liu, Li-Fang

    2015-08-01

    Since 2005, the Taiwan Centers for Disease Control (Taiwan CDC) initiated an HIV case management program in AIDS-designated hospitals to provide integrative services and risk-reduction counseling for HIV-infected individuals. In light of the increasingly complex and highly specialized nature of clinical care, expanding and improving competency-based professional education is important to enhance the quality of HIV/AIDS care. The aim of this study was to develop the essential competency framework for HIV care for HIV case managers in Taiwan. We reviewed essential competencies of HIV care from Canada, the United Kingdom, and several African countries and devised descriptions of the roles of case managers and of the associated core competencies for HIV care in Taiwan. The modified Delphi technique was used to evaluate the draft framework of these roles and core competencies. A total of 15 HIV care experts were invited to join the expert panel to review and rank the draft framework. The final framework consisted of 7 roles and 27 competencies for HIV case managers. In Round 1, only 3 items did not receive consensus approval from the experts. After modification based on opinions of the experts, 7 roles and 27 competencies received 97.06% consensus approval in Round 2 and were organized into the final framework for HIV case managers. These roles and associated core competencies were: HIV Care Expert (9 competencies), Communicator (1 competency), Collaborator (4 competencies), Navigator (2 competencies), Manager (4 competencies), Advocate (2 competencies), and Professional (5 competencies). The authors developed an essential competency framework for HIV care using the consensus of a multidisciplinary expert panel. Curriculum developers and advanced nurses and practitioners may use this framework to support developments and to ensure a high quality of HIV care.

  3. What Case Managers Should Know About Their Roles and Functions: A National Study From the Commission for Case Manager Certification: Part 1.

    Science.gov (United States)

    Tahan, Hussein M; Watson, Annette C; Sminkey, Patrice V

    2015-01-01

    The purpose of this national role and function study was to identify the essential activities and necessary knowledge areas for effective case manager practice from the perspective of those currently functioning in various care settings and across diverse professional disciplines. The national study covered all case management practices and/or work settings across the full continuum of health care. This cross-sectional descriptive study used the practice analysis method and online survey research design. It employed a purposive sample of case managers, in which 52,370 individuals received an invitation to participate. Data collection completed over a 4-week period, resulting in 7,668 useable survey responses (nearly a 15% response rate). The study identified the common activities and knowledge areas necessary for competent and effective performance of case managers, as is highlighted in this article, which is the first of a 2-part series on the role and function study. The results informed the needed update of the test specifications for the Certified Case Manager (CCM) certification examination, as will be delineated in Part 2 of the article series, to ensure that it continues to be substantiated in current practice. Of special note are the emergence of specific activity and knowledge domains in the area of case management ethical, legal, and practice standards, and an increase in the number of employers requiring certified case managers to fill vacant positions and compensating them financially for such qualifications. This study helps keep the CCM credentialing examination evidence-based and maintain its validity for evaluating competency of case managers. Specifically, the study identified essential activities and knowledge domains that define competent case management practice. Findings can be used for developing programs and curricula for the training and development of case managers. The study instrument also can be used for further research of case

  4. Meeting the challenges of case management with remote patient monitoring technology.

    Science.gov (United States)

    Cherry, J C; Colliflower, S J; Tsiperfal, A

    2000-01-01

    The article presents an overview of some of the current trends in health care and the challenges faced by nurse case managers who are providing disease management services. It discusses some of the emerging technologies available today for innovative case management. In particular, this article describes a program run by a healthcare system in Sacramento, California that uses an Internet-based technology to enhance their nurse case management model. The article demonstrates how the Health Hero platform enables interactive communication between nurse case managers and their patients, thereby meeting some of the challenges the nurse case managers are faced with in the modern disease-management world.

  5. What is case management in palliative care? An expert panel study

    Directory of Open Access Journals (Sweden)

    van der Plas Annicka G M

    2012-06-01

    Full Text Available Abstract Background Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands. Methods A modified version of the RAND®/University of California at Los Angeles (UCLA appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round. Results Nine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager. Conclusions Although aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent.

  6. Adapters, strugglers, and case managers: a typology of spouse caregivers.

    Science.gov (United States)

    Davis, Linda Lindsey; Chestnutt, Deborah; Molloy, Margory; Deshefy-Longhi, Tess; Shim, Bomin; Gilliss, Catherine L

    2014-11-01

    Although family home care problems are frequently described in the health care literature, the ways in which families and other informal caregivers manage those problems are not often addressed. We conducted a descriptive analysis of interviews in which spouses caring for a partner with Alzheimer's or Parkinson's disease were asked to describe difficult home care problems and how they managed those problems. Analysis of these interviews indicated three recurring management styles. Adapters told stories about applying pre-existing skills to manage home care problems. Strugglers told stories of reoccurring home care problems for which they had few or no management strategies. Case managers' interview stories focused on the challenges of finding and coordinating home care services. These findings suggest that caregiving burden might be influenced more by the caregiver's management style than the demands of the care situation. Suggestions for tailoring support programs for the three types of caregivers are proposed. © The Author(s) 2014.

  7. Flexible Process Notations for Cross-organizational Case Management Systems

    DEFF Research Database (Denmark)

    Slaats, Tijs

    : the notations in which the processes are defined. Traditional process notations are flow-based: control of the process flows from one activity to the next. This paradigm inherently encourages modellers to think in terms of strict orderings instead of supporting flexibility. Flow-based models that do try...... of the process and techniques for runtime adaptation. This dissertation reports on the results of the Technologies for Flexible Cross-organizational Case Management Systems (FLExCMS) research project which was started in cooperation between ITU and the company Exformatics A/S. The goals of the project were...... to strengthen the industrial adoption of constraintbased notations and techniques by further developing DCR Graphs to be industrially applicable, with a particular focus on guaranteeing safety for cross-organizational processes. We will show how DCR Graphs have been extended with new dimensions such as time...

  8. Quality improvement initiatives in a case management service: case study.

    Science.gov (United States)

    Davies, Deborah J

    2015-01-01

    This article explores the importance of quality practices in underpinning the person-centred approach at a Community Options Program (COP) case management service in northern NSW. The NSW community care sector does not have a statutory excellence body to identify, promote and support improved practices and quality and safety across community services, and therefore the COP provider decided to establish a dedicated role to focus on the quality improvement of its service. The subsequent quality improvement initiatives have included mapping the clients' journey through the service, identifying areas to standardise practice, and creating service pathways. The clients' journey was used as the framework to identify where standardised practice was required, and a robust process was implemented to develop over 25 good practice guidelines and tools that addressed the variations in practice and enabled the service pathways to be developed. Prior to trialling the guidelines and tools, staff received education sessions on the anticipated changes to practice, and the practicality and applicability of the guidelines were evaluated at the end of the trials. This information was reviewed and the guidelines were amended accordingly before being rolled out. The guidelines have been in use for over 12 months and have provided the benchmark against which to audit practice, and have resulted in key performance improvements such as an increase in client review rates and a rise in the feedback response rate from clients, with a noticeable shift in the comments about the brokered support worker to acknowledging the role of their case manager. Formalising informal supports for those clients that lived alone also increased, which means these people are less reliant on services and there is a reduced risk of social isolation.

  9. Cryptosporidium and Giardia in Danish organic pig farms: seasonal and age-related variation in prevalence, infection intensity and species/genotypes

    DEFF Research Database (Denmark)

    Petersen, Heidi Huus; Jianmin, Wang; Katakam, Kiran K.

    2015-01-01

    Although pigs are commonly infected with Cryptosporidium spp. and Giardia duodenalis, including potentially zoonotic species or genotypes, little is known about age-related infection levels, seasonal differences and genetic variation in naturally infected pigs raised in organic management systems....... Therefore, the current study was conducted to assess seasonal and age-related variations in prevalence and infection intensity of Cryptosporidium and Giardia, evaluate zoonotic potential and uncover correlations between species/genotypes, infection intensity and faecal consistency. Shedding of oocysts...... and cysts ((oo-) cysts) was monitored at quarterly intervals (September 2011 to June 2012) in piglets (n=152), starter pigs (n=234), fatteners (n=230) and sows (n=240) from three organic farms in Denmark. (Oo-) cysts were quantified by immunofluorescence microscopy; and 56/75 subsamples from Cryptosporidium...

  10. Case management for the elderly with complex needs: cross-linking the views of their role held by elderly people, their informal caregivers and the case managers.

    Science.gov (United States)

    Balard, Frédéric; Gely-Nargeot, Marie-Christine; Corvol, Aline; Saint-Jean, Olivier; Somme, Dominique

    2016-11-08

    In 2009, case management interventions were a new social service in France implemented within the framework of the PRISMA-France program (2006-2010). People who had benefitted from case management intervention were individuals, over 60 years old living at home in situations deemed complex by professionals. Their informal caregivers were also considered as users of the service. This research accompanied the interventions during the implementation of PRISMA-France attempting to explore the users' (old people and their informal caregivers) and case managers' first experiences of case management. Its aim is to provide a thorough knowledge of the dispositive in order to reveal any initial failings and to ensure optimum conditions for the onset of full implementation. The study had a qualitative explorative design. Cross-linked representations of case-management were obtained through opened-ended and guided interviews with three types of informants: old people (19), their informal caregivers (11) and the case managers (5) who participated in the program during the first 6 months. Thematic analysis of the data was carried out. The analysis revealed that each group of people generated its own representations of the case manager's role, even though the three groups of informants shared the idea that the case manager is first and foremost a helper. The case managers insisted on their proximity to the old people and their role as coordinators. The informal caregivers saw the professional as a partner and potential provider of assistance in accompanying old people. The old people focused on the personal connections established with the case manager. The innovative and experimental dimension of case management in France and the flexible nature of the role generated a broad spectrum of representations by those involved. These different representations are, in part, the fruit of each individual's projected expectations of this social service. Analyzing the first representations

  11. Get Connected: an HIV prevention case management program for men and women leaving California prisons.

    Science.gov (United States)

    Myers, Janet; Zack, Barry; Kramer, Katie; Gardner, Mick; Rucobo, Gonzalo; Costa-Taylor, Stacy

    2005-10-01

    Individuals leaving prison face challenges to establishing healthy lives in the community, including opportunities to engage in behavior that puts them at risk for HIV transmission. HIV prevention case management (PCM) can facilitate linkages to services, which in turn can help remove barriers to healthy behavior. As part of a federally funded demonstration project, the community-based organization Centerforce provided 5 months of PCM to individuals leaving 3 state prisons in California. Program effects were measured by assessing changes in risk behavior, access to services, reincarnation, and program completion. Although response rates preclude definitive conclusions, HIV risk behavior did decrease. Regardless of race, age, or gender, those receiving comprehensive health services were significantly more likely to complete the program. PCM appears to facilitate healthy behavior for individuals leaving prison.

  12. Disease Management, Case Management, Care Management, and Care Coordination: A Framework and a Brief Manual for Care Programs and Staff.

    Science.gov (United States)

    Ahmed, Osman I

    2016-01-01

    With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.

  13. Sequential organ failure assessment scoring and prediction of patient's outcome in Intensive Care Unit of a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Aditi Jain

    2016-01-01

    Conclusion: SOFA score is a simple, but effective prognostic indicator and evaluator for patient progress in ICU. Day 1 SOFA can triage the patients into risk categories. For further management, mean and maximum score help determine the severity of illness and can act as a guide for the intensity of therapy required for each patient.

  14. The impact of changes in intensive care organization on patient outcome and cost-effectiveness-a narrative review

    NARCIS (Netherlands)

    van der Sluijs, Alexander F.; van Slobbe-Bijlsma, Eline R.; Chick, Stephen E.; Vroom, Margreeth B.; Dongelmans, Dave A.; Vlaar, Alexander P. J.

    2017-01-01

    The mortality rate of critically ill patients is high and the cost of the intensive (ICU) department is among the highest within the health-care industry. The cost will continue to increase because of the aging population in the western world. In the present review, we will discuss the impact of

  15. Assessment of organ dose reduction and secondary cancer risk associated with the use of proton beam therapy and intensity modulated radiation therapy in treatment of neuroblastomas

    International Nuclear Information System (INIS)

    Fuji, Hiroshi; Harada, Hideyuki; Asakura, Hirofumi; Nishimura, Tetsuo; Schneider, Uwe; Ishida, Yuji; Konno, Masahiro; Yamashita, Haruo; Kase, Yuki; Murayama, Shigeyuki; Onoe, Tsuyoshi; Ogawa, Hirofumi

    2013-01-01

    To compare proton beam therapy (PBT) and intensity-modulated radiation therapy (IMRT) with conformal radiation therapy (CRT) in terms of their organ doses and ability to cause secondary cancer in normal organs. Five patients (median age, 4 years; range, 2–11 years) who underwent PBT for retroperitoneal neuroblastoma were selected for treatment planning simulation. Four patients had stage 4 tumors and one had stage 2A tumor, according to the International Neuroblastoma Staging System. Two patients received 36 Gy, two received 21.6 Gy, and one received 41.4 Gy of radiation. The volume structures of these patients were used for simulations of CRT and IMRT treatment. Dose–volume analyses of liver, stomach, colon, small intestine, pancreas, and bone were performed for the simulations. Secondary cancer risks in these organs were calculated using the organ equivalent dose (OED) model, which took into account the rates of cell killing, repopulation, and the neutron dose from the treatment machine. In all evaluated organs, the mean dose in PBT was 20–80% of that in CRT. IMRT also showed lower mean doses than CRT for two organs (20% and 65%), but higher mean doses for the other four organs (110–120%). The risk of secondary cancer in PBT was 24–83% of that in CRT for five organs, but 121% of that in CRT for pancreas. The risk of secondary cancer in IMRT was equal to or higher than CRT for four organs (range 100–124%). Low radiation doses in normal organs are more frequently observed in PBT than in IMRT. Assessments of secondary cancer risk showed that PBT reduces the risk of secondary cancer in most organs, whereas IMRT is associated with a higher risk than CRT

  16. Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases.

    Science.gov (United States)

    Morales-Asencio, Jose M; Kaknani-Uttumchandani, Shakira; Cuevas-Fernández-Gallego, Magdalena; Palacios-Gómez, Leopoldo; Gutiérrez-Sequera, José L; Silvano-Arranz, Agustina; Batres-Sicilia, Juan Pedro; Delgado-Romero, Ascensión; Cejudo-Lopez, Ángela; Trabado-Herrera, Manuel; García-Lara, Esteban L; Martin-Santos, Francisco J; Morilla-Herrera, Juan C

    2015-10-01

    Complex chronic diseases are a challenge for the current configuration of health services. Case management is a service frequently provided for people with chronic conditions, and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers and services used. The study was divided into three phases, covering the detection of information needs, the design and its implementation in the health care system, using literature review and expert consensus methods to select variables that would be included in the registry. A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. A web-based registry with modular and layered architecture was designed. The framework follows a pattern based on the model-view-controller approach. In its first 6 months after the implementation, 102 case managers have introduced an average number of 6.49 patients each one. The registry permits a complete and in-depth analysis of the characteristics of the patients who receive case management, the interventions delivered and some major outcomes as mortality, readmissions or adverse events. © 2015 John Wiley & Sons, Ltd.

  17. Case management services for work related upper extremity disorders. Integrating workplace accommodation and problem solving.

    Science.gov (United States)

    Shaw, W S; Feuerstein, M; Lincoln, A E; Miller, V I; Wood, P M

    2001-08-01

    A case manager's ability to obtain worksite accommodations and engage workers in active problem solving may improve health and return to work outcomes for clients with work related upper extremity disorders (WRUEDs). This study examines the feasibility of a 2 day training seminar to help nurse case managers identify ergonomic risk factors, provide accommodation, and conduct problem solving skills training with workers' compensation claimants recovering from WRUEDs. Eight procedural steps to this case management approach were identified, translated into a training workshop format, and conveyed to 65 randomly selected case managers. Results indicate moderate to high self ratings of confidence to perform ergonomic assessments (mean = 7.5 of 10) and to provide problem solving skills training (mean = 7.2 of 10) after the seminar. This training format was suitable to experienced case managers and generated a moderate to high level of confidence to use this case management approach.

  18. Stuck in the middle: The emotional labours of case managers in the personal injury compensation system.

    Science.gov (United States)

    Newnam, Sharon; Petersen, Alan; Keleher, Helen; Collie, Alex; Vogel, Adam; McClure, Rod

    2016-10-17

    Case managers within injury compensation systems are confronted with various emotional demands. Employing the concept of emotional labour, this paper explores distinctive aspects of these demands. The findings are drawn from focus groups with 21 Australian case managers. Case managers work was characterised by extra-role commitments, emotional control, stress and balancing tensions arising from differing stakeholder expectations about outcomes related to compensation and return to work. By examining the experiences of case managers, the findings add to the literature on the emotional labour of front line service workers, especially with respect to the demands involved in managing the conflicting demands of work.

  19. Outpatient case management in low-income epilepsy patients.

    Science.gov (United States)

    Tatum, William O; Al-Saadi, Sam; Orth, Thomas L

    2008-12-01

    Case management (CM) has been shown to improve the medical care of patients in several paradigms of general medicine. This study was undertaken to assess the impact of CM on low-income patients with epilepsy. From 2002 to 2003, 737 epilepsy patients had CM provided by a non-profit, state-supported, epilepsy service subserving a four county region in southeastern Florida. Standardized survey forms distributed by the Florida Department of Health were completed by 159 consecutive patients at program admission. Follow-up information regarding seizure frequency, antiepileptic drugs, and quality of life self-rating was performed after 1 year of CM. The patients evaluated were composed of 58.5% men, with a mean age of 41.0 years. After CM, an increase in self-reported seizure control was seen in 40.2% of patients (preduction of ED visits per patient from 1.83 per patient per year before CM to 0.14 per patient per year after CM (p<0.0001, Wilcoxon matched-pairs test). Following CM, fewer patients reported difficulty with friends, employers, problems socializing, and feelings of anger (p<0.05, Fisher's exact test). CM of low-income patients with epilepsy resulted in self-reported improvement in seizure control, QoL, and significantly reduced ED visitation. CM in epilepsy is feasible and represents a cost-effective improvement in outpatient epilepsy management.

  20. Spatial distribution of soils determines export of nitrogen and dissolved organic carbon from an intensively managed agricultural landscape

    DEFF Research Database (Denmark)

    Wohlfart, T; Exbrayat, J-F; Schelde, Kirsten

    2012-01-01

    nitrogen (TDN), nitrate (NO3−), ammonium nitrogen and dissolved organic carbon (DOC) concentrations were measured, and dissolved organic nitrogen (DON) was calculated for each grabbed sample. Electrical conductivity, pH and flow velocity were measured during sampling. Statistical analyses showed...... significant differences between the northern, southern and converged stream parts, especially for NO3− concentrations with average values between 1.4 mg N l−1 and 9.6 mg N l−1. Furthermore, throughout the sampling period DON concentrations increased to 2.8 mg N l−1 in the northern stream contributing up to 81...

  1. Developing a rural transitional care community case management program using clinical nurse specialists.

    Science.gov (United States)

    Baldwin, Kathleen M; Black, Denice; Hammond, Sheri

    2014-01-01

    This quality improvement project developed a community nursing case management program to decrease preventable readmissions to the hospital and emergency department by providing telephonic case management and, if needed, onsite assessment and treatment by a clinical nurse specialist (CNS) with prescriptive authority. As more people reach Medicare age, the number of individuals with worsening chronic diseases with dramatically increases unless appropriate disease management programs are developed. Care transitions can result in breakdown in continuity of care, resulting in increased preventable readmissions, particularly for indigent patients. The CNS is uniquely educated to managing care transitions and coordination of community resources to prevent readmissions. After a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis, we developed and implemented a cost-avoidance model to prevent readmissions in our uninsured and underinsured patients. The project CNS used a wide array of interventions to decrease readmissions. In the last 2 years, there have been a total of 22 less than 30-day readmissions to the emergency department or hospital in 13 patients, a significant decrease from readmissions in these patients prior to the program. Three of them required transfer to a larger hospital for a higher level of care. Using advanced practice nurses in transitional care can prevent readmissions, resulting in cost avoidance. The coordination of community resources during transition from hospital to home is a job best suited to CNSs, because they are educated to work within organizations/systems. The money we saved with this project more than justified the cost of hiring a CNS to lead it. More research is needed into this technology. Guidelines for this intervention need to be developed. Replicating our cost-avoidance transitional care model can help other facilities limit that loss.

  2. Community perceptions and attitudes on malaria case management and the role of community health workers.

    Science.gov (United States)

    Owek, Collins J; Oluoch, Elizabeth; Wachira, Juddy; Estambale, Benson; Afrane, Yaw A

    2017-07-04

    Community Case Management of malaria (CCMm) is one of the new approaches adopted by the World Health Organization for malaria endemic countries to reduce the burden of malaria for vulnerable populations. It is based on the evidence that well-trained and supervised community health workers (CHWs) can provide prompt and adequate treatment to fever cases within 24 h to help reduce morbidity and mortality associated with malaria among under-five children. The perception and attitudes of the community members on the CHWs' role is of greater importance for acceptance of their services. The aim of the study was to assess community's perception and attitude towards CCMm and on CHWs who undertake it. This study was conducted in five districts in western Kenya where Community Case Management was being undertaken. This was a qualitative cross-sectional study in which in-depth interviews and focus group discussions were conducted with mothers of under-five children and key stakeholders. Overall, there were more positive expressions of perceptions and attitudes of the community members towards the CCMm programme and the role of CHWs. The positive perceptions included among others; recognition and appreciation of services of CHWs, bringing health services to close proximity to the community, avoiding long queues in the health facilities, provision of health education that encourages good health practices, and promotion of positive health-seeking behaviour from within the communities. This programme is not without challenges as some of the negative perceptions expressed by the community members included the fact that some clinicians doubt the capacity of CHWs on dispensing drugs in the community, some CHWs do not keep client's secrets and mistrust of CHWs due to conflicting information by government. It was evident that the community had more positive perceptions and attitudes towards the role of CHWs in CCMm than negative ones. There should however, be deliberate efforts

  3. Children as donors : a national study to assess procurement of organs and tissues in pediatric intensive care units

    NARCIS (Netherlands)

    Siebelink, Marion J.; Albers, Marcel J. I. J.; Roodbol, Petrie F.; Van de Wiel, Harry B. M.

    2012-01-01

    A shortage of size-matched organs and tissues is the key factor limiting transplantation in children. Empirical data on procurement from pediatric donors is sparse. This study investigated donor identification, parental consent, and effectuation rates, as well as adherence to the national protocol.

  4. Strategies used by case managers supporting frail, community-dwelling older persons, to engage primary care physicians in interprofessional collaboration

    OpenAIRE

    Van Durme, Thérèse; Cès, Sophie; Karam, Marlène; Macq, Jean; RCN 2014 Annual International Nursing Research Conference

    2014-01-01

    Background and aim Although it is known that case management for frail older persons (FOP) is more likely to foster positive outcomes when the case manager works closely with the primary care physicians (PCP) [1], engaging PCPs to collaborate is often a difficult process, especially when the case management function is new [2]. The aim of this study was to provide insight on how newly implemented case management projects managed to engage FOPs’ PCP in the case management process, (to what ext...

  5. Zika virus infections in pregnancy: epidemics and case management

    Directory of Open Access Journals (Sweden)

    Fatih sahiner

    2016-03-01

    Full Text Available Zika virus is an RNA virus belonging to the Flaviviridae family, and is primarily transmitted by Aedes mosquitoes. Only a small number of cases had been described until 2007 when the first major Zika virus outbreak occurred on Yap Island, Micronesia. Approximately 80% of people infected with Zika virus do not exhibit any symptoms. Symptomatic infections are generally moderate and characterized by acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis. The virus has recently attracted a broad interest due to the emerging cases of microcephaly that are possibly associated with mothers infected by the Zika virus during pregnancy, and the regional increases in the incidence of Guillain-Barre syndrome during the epidemic periods. Although the relationship between Zika virus infection and these abnormalities is not obviously understood yet, Zika virus testing is recommended for infants with microcephaly or intracranial calcifications whose mothers were potentially infected with the Zika virus during pregnancy. Every day, new reports are being published about the outbreaks associated with this virus; nevertheless, no new cases of this virus have been reported in Turkey. Despite this, we cannot currently exclude the possibility of the encounter with the virus because of the presence of Aedes mosquitoes, which are responsible for the spread of the virus, are prevalent in Turkey, and an increasing number of travel-related cases are being reported from different countries. In the light of the current knowledge on this virus, this review aims to discuss the course of Zika virus infections in detail, especially congenital infection, and presenting current information about the case management and preventive measures. [Cukurova Med J 2016; 41(1.000: 143-151

  6. Case management for the elderly with complex needs: cross-linking the views of their role held by elderly people, their informal caregivers and the case managers

    Directory of Open Access Journals (Sweden)

    Frédéric Balard

    2016-11-01

    Full Text Available Abstract Background In 2009, case management interventions were a new social service in France implemented within the framework of the PRISMA-France program (2006–2010. People who had benefitted from case management intervention were individuals, over 60 years old living at home in situations deemed complex by professionals. Their informal caregivers were also considered as users of the service. This research accompanied the interventions during the implementation of PRISMA-France attempting to explore the users’ (old people and their informal caregivers and case managers’ first experiences of case management. Its aim is to provide a thorough knowledge of the dispositive in order to reveal any initial failings and to ensure optimum conditions for the onset of full implementation. Methods The study had a qualitative explorative design. Cross-linked representations of case-management were obtained through opened-ended and guided interviews with three types of informants: old people (19, their informal caregivers (11 and the case managers (5 who participated in the program during the first 6 months. Thematic analysis of the data was carried out. Results The analysis revealed that each group of people generated its own representations of the case manager’s role, even though the three groups of informants shared the idea that the case manager is first and foremost a helper. The case managers insisted on their proximity to the old people and their role as coordinators. The informal caregivers saw the professional as a partner and potential provider of assistance in accompanying old people. The old people focused on the personal connections established with the case manager. Conclusion The innovative and experimental dimension of case management in France and the flexible nature of the role generated a broad spectrum of representations by those involved. These different representations are, in part, the fruit of each individual’s projected

  7. Another look at roles and functions: has hospital case management lost its way?

    Science.gov (United States)

    Reynolds, John J

    2013-01-01

    The purpose of this study was to identify the roles, functions, and types of activities that hospital case managers engage in on a day-to-day basis and that leverage the most amounts of time. Previous studies superimpose a priori categories on research tools. Hospital case management. This study analyzes 4,064 spontaneous, unstructured list serve postings from the American Case Management Association Learning Link list serve from August 15, 2011, to August 18, 2012. The study group was a cross section of 415 case management professionals. The data suggest that hospital case managers' time is inordinately leveraged by issues related to observation status/leveling of patients and the Centers for Medicare and Medicaid Services compliance. The data also suggest that hospital case management has taken a conceptual trajectory that has deviated significantly from what was initially conceived (quality, advocacy, and care coordination) and what is publicly purported. Case management education and practical orientation will need to be commensurate with this emerging emphasis. Case management leadership will need to be adept at mitigating the stresses of role confusion, role conflict, and role ambiguity.

  8. Case management interviews and the return to work of disabled employees

    DEFF Research Database (Denmark)

    Høgelund, Jan; Holm, Anders

    In response to an increasing number of sickness and disability beneficiaries, many countries have launched policies that emphasize the role of case management. This study measures the effect of case-management interview (CMI) on long-term sick-listed employees’ probability of returning to work...

  9. 25 CFR 20.318 - What case management responsibilities does the social services worker have?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false What case management responsibilities does the social... HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Direct Assistance Employment Requirements § 20.318 What case management responsibilities does the social services worker have? In working...

  10. Defining, Delivering, and Documenting the Outcomes of Case Management by School Nurses

    Science.gov (United States)

    Engelke, Martha Keehner; Guttu, Martha; Warren, Michelle B.

    2009-01-01

    Case management is a component of school nurse practice that provides an opportunity to demonstrate the contribution that school nurses make to the health and academic success of children, particularly children with chronic health conditions. However, case management programs vary in their mission and scope, leading to confusion about what it…

  11. Delphi-research for exploring essential components and preconditions for case management for people with dementia.

    NARCIS (Netherlands)

    Verkade, P.J.; Meijel, B. van; Brink, C.; Os-Medendorp, H. van; Koekkoek, B.; Francke, A.L.

    2010-01-01

    Background: Case management programmes for home-dwelling people with dementia and their informal carers exist in multiple forms and shapes. The aim of this research was to identify the essential components of case management for people with dementia as well as the preconditions for an effective

  12. Recovery-oriented services for individuals with mental illness and case managers' experience of professional burnout.

    Science.gov (United States)

    Kraus, Shane W; Stein, Catherine H

    2013-02-01

    Present cross-sectional study examined perceptions of recovery-oriented services and reports of professional burnout and job satisfaction in a sample of 114 case managers working in community mental health centers across Ohio. The research examined the relative contribution of demographic characteristics, the structure of case management services, and case managers' beliefs about recovery-oriented services in describing their reports of professional burnout and job satisfaction. Regardless of individual characteristics of case managers and reports of the structure of their jobs, case managers who perceived their agency to offer higher levels of recovery-oriented services also reported lower levels of depersonalization and emotional exhaustion at work, and higher levels of professional accomplishment and job satisfaction. Directions for future research in the area are discussed.

  13. Ion induced scintillation in organic solids: development of an average track model,degradation of the scintillation intensity and dosimetric applications

    International Nuclear Information System (INIS)

    Broggio, D.

    2004-12-01

    This work deals with a specific aspect of the ion-matter interaction: the scintillation induced by ions in organic materials. In the first chapter we tackle the issue in a theoretical way by proposing a method to compute the radial doses within the framework of the mean track model. We have developed a model based on the Lewis transport equation and on the Spencer distribution of the loss energy in order to take into account the transport of secondary electrons in a more realistic way. In the second chapter we study the physical mechanisms that trigger ion-induced scintillation. Ion-induced scintillation is featured by the dependence in charge number of the intensity of scintillation for ions with same energy loss and by the saturation of the scintillation efficiency for ions with high stopping-power. We have applied our model of radial doses to ion-induced scintillation. In the third chapter we study the gradual degradation of the scintillation intensity and ion-induced chemical damages. In the last chapter we propose a prototype of dosimeters based on the combination of scintillators and optical fibers that allows the real-time measurement of the dose delivered by a carbon ion beam in therapeutical use conditions. This dosimeter gives the relationship between the dose and the scintillation intensity but its accuracy is not yet sufficient for uses in radiotherapy. (A.C.)

  14. Evaluation of diffuse diseases of the upper abdominal organs by MRI. Determination of a normal range in signal intensity ratio of each organ to the renal medulla in T1- and T2-weighted images and evaluation of diffuse diseases of an organ by using it

    International Nuclear Information System (INIS)

    Mitsuhashi, Hiroshi

    1995-01-01

    Diffuse diseases of the upper abdominal organs, including the liver, spleen, pancreas, and vertebral marrow, were evaluated by using signal intensity ratio of each organ to the renal medulla in T1- and T2-weighted images. Conventional T1- and T2-weighted images were obtained in 1.5 T MR system in 203 persons, including 122 controls and 81 patients with a diffuse disease in the upper abdominal organ. In controls, though there was neither sexual nor age difference in signal intensity ratios of the liver and pancreas, those of the spleen and vertebral marrow showed sexual and age difference, respectively. A normal range of signal intensity ratio of each organ in each image was determined in each decade of each sex by using controls. The signal intensity ratio of the liver was significantly low in T1- and T2-weighted images in patients with abundant iron deposit and within normal limits in patients with liver cirrhosis or scant iron deposit. The signal intensity ratio of the liver was significantly high only in a T2-weighted image in patients with fatty deposit in the liver, which was suspected to be due to inflammatory change in the liver with fatty deposit. The signal intensity ratios of the spleen, pancreas, and vertebral marrow were significantly low only in a T2-weighted image in patients with iron metabolic disturbance. The signal intensity ratio of the pancreas was significantly high in 40% of patients with acute and/or chronic pancreatitis, which was more sensitive in detection of pancreatitis than data in other studies. it can be concluded that the signal intensity ratio of each organ to the renal medulla in T1- and T2-weighted images is useful for detection of diffuse diseases of the upper abdominal organs by using the normal range in each decade of each sex. (S.Y.)

  15. Organic matter decomposition and microarthropod community structure in corn fields under low input and intensive management in Guaíra (SP

    Directory of Open Access Journals (Sweden)

    G.S Rodrigues

    1997-01-01

    Full Text Available The rate of organic matter decomposition and the structure of the communities of microarthropods were compared between two corn fields receiving contrasting agricultural management practices (low input and intensive farming. The rate of decomposition tended to be higher in the intensively managed field in the beginning of the growing season, but decreased to a level significantly lower than the observed in the low input field by the end of the growing season. This suggested that the biological community associated with the decomposition process could be negatively influenced in the intensively managed field. Analyses of the structure of microarthropod communities indicated differences between the two areas. The microarthropod populations present in the intensively managed field suffered abrupt decrease in numbers as the season progressed.A taxa de decomposição da matéria orgânica e a estrutura da comunidade de microartrópodes foram comparadas entre dois campos cultivados com milho mas recebendo manejos distintos, sendo um campo manejado intensivamente e outro com baixo uso de insumos. A taxa de decomposição foi mais alta no campo intensivamente manejado no início da cultura, mas decresceu para um nível significativamente inferior àquela observada no campo com baixo uso de insumos ao final da estação. Tal tendência sugeriu que a estrutura da comunidade dos organismos associados ao processo de decomposição poderia estar sendo negativamente influenciada no campo intensivamente manejado. Análises da estrutura das comunidades de microartrópodes indicaram que diferentes comunidades estavam presentes nos dois campos. As populações de microartrópodes presentes no campo sob manejo intensivo sofreram queda abrupta em números, sendo praticamente eliminadas já no segundo mês de desenvolvimento da cultura.

  16. Response saturation of monochromatic increments on intense achromatic backgrounds: implications for color-opponent organization in human vision

    Science.gov (United States)

    Drum, Bruce; Sternheim, Charles E.

    2005-10-01

    We present evidence that steady achromatic adapting fields can produce response saturation in color-opponent pathways. We measured tvi (log increment threshold illuminance versus log background illuminance) functions at four test wavelengths (430, 490, 575, and 660 nm) and nine background illuminances from 4.0 to 5.6 log Td. Foveal, 2° diameter, 1 s duration test stimuli were presented on a concentric, perceptually white (5128°K color temperature), 7° diameter, steady background. Thresholds were obtained by the method of adjustment, after which the test stimulus illuminances were increased 0.6 log unit and the subject estimated percentages of red, yellow, green, blue, and white. Average tvi slopes for two subjects were 2.06 for 430 nm, 1.6 for 490 nm, 1.11 for 575 nm and 1.34 for 660 nm, consistent with the estimated ratios of chromatic to achromatic sensitivity at the same wavelengths. Also, the percentage of white seen in the suprathreshold increments increased with increasing background illuminance despite increases in excitation purity. These findings imply that steady, intense, achromatic backgrounds can produce response saturation in color-opponent mechanisms at wavelengths across the visible spectrum. The saturation was more extreme at short wavelengths than at middle or long wavelengths, producing a tritanopic condition at the highest background illuminances. The tritanopia reduced color space to a predominately red-blue dichromacy, in agreement with previous findings. The results support a multistage opponent-color model in which precortical koniocellular and parvocellular opponent pathways interact to produce the observed red-green and yellow-blue color-opponent channels at a cortical level.

  17. Methane oxidation in an intensively cropped tropical rice field soil under long-term application of organic and mineral fertilizers.

    Science.gov (United States)

    Nayak, D R; Babu, Y Jagadeesh; Datta, A; Adhya, T K

    2007-01-01

    Methane (CH4) oxidation is the only known biological sink process for mitigating atmospheric and terrestrial emissions of CH4, a major greenhouse gas. Methane oxidation in an alluvial soil planted to rice (Oryza sativa L.) under long-term application of organic (compost with a C/N ratio of 21.71), and mineral fertilizers was measured in a field-cum-laboratory incubation study. Oxidation rates were quantified in terms of decrease in the concentration of CH4 in the headspace of incubation vessels and expressed as half-life (t(1)2) values. Methane oxidation rates significantly differed among the treatments and growth stages of the rice crop. Methane oxidation rates were high at the maximum tillering and maturity stages, whereas they were low at grain-filling stage. Methane oxidation was low (t(1)2) = 15.76 d) when provided with low concentration of CH4. On the contrary, high concentration of CH4 resulted in faster oxidation (t(1)2) = 6.67 d), suggesting the predominance of "low affinity oxidation" in rice fields. Methane oxidation was stimulated following the application of mineral fertilizers or compost implicating nutrient limitation as one of the factors affecting the process. Combined application of compost and mineral fertilizer, however, inhibited CH4 oxidation probably due to N immobilization by the added compost. The positive effect of mineral fertilizer on CH4 oxidation rate was evident only at high CH4 concentration (t(1)2 = 4.80 d), while at low CH4 concentration their was considerable suppression (t(1) = 17.60 d). Further research may reveal that long-term application of fertilizers, organic or inorganic, may not inhibit CH4 oxidation.

  18. Cognitive Behavioral Therapy for Psychosis (CBT-p) Delivered in a Community Mental Health Setting: A Case Comparison of Clients Receiving CBT Informed Strategies by Case Managers Prior to Therapy.

    Science.gov (United States)

    Sivec, Harry J; Montesano, Vicki L; Skubby, David; Knepp, Kristen A; Munetz, Mark R

    2017-02-01

    This exploratory case comparison examines the influence of case management activities on engagement and progress in psychotherapy for clients with schizophrenia. Six clients were recruited to participate in ten sessions of Cognitive Behavioral Therapy for psychosis (CBT-p). Three clients who had received Cognitive Behavioral techniques for psychosis (CBt-p, a low-intensity case management intervention) prior to receiving therapy were selected from referrals. A comparison group of three clients who had received standard case management services was selected from referrals. Cases within and across groups were compared on outcome measures and observations from case review were offered to inform future research. Delivering CBT-p services on a continuum from low- to high-intensity is discussed.

  19. Case management helps prevent criminal justice recidivism for people with serious mental illness.

    Science.gov (United States)

    Leutwyler, Heather; Hubbard, Erin; Zahnd, Elaine

    2017-09-11

    Purpose The purpose of this paper is to discuss how case management can decrease recidivism for people with serious mental illness (SMI) because people with SMI are at high risk for incarceration and recidivism. Design/methodology/approach Examples of successful case management models for formerly incarcerated individuals with SMI found through a secondary analysis of qualitative data and an analysis of the literature are presented. Findings Currently, no international, national, or statewide guidelines exist to ensure that formerly incarcerated individuals with SMI receive case management upon community reentry despite evidence that such services can prevent further criminal justice involvement. Recommendations include establishment of and evaluation of best practices for case management. In addition, the authors recommend additional funding for case management with the goal of greatly increasing the number of individuals with SMI leaving the criminal justice system in their ability to access adequate case management. Originality/value Providing effective case management tailored to the needs of formerly incarcerated people with SMI improves their quality of life and reduces their involvement in the criminal justice system with clear positive outcomes for public safety and public health.

  20. Impact of grazing intensity on seasonal variations in soil organic carbon and soil CO2 efflux in two semiarid grasslands in southern Botswana

    Science.gov (United States)

    Thomas, Andrew D.

    2012-01-01

    Biological soil crusts (BSCs) are an important source of organic carbon, and affect a range of ecosystem functions in arid and semiarid environments. Yet the impact of grazing disturbance on crust properties and soil CO2 efflux remain poorly studied, particularly in African ecosystems. The effects of burial under wind-blown sand, disaggregation and removal of BSCs on seasonal variations in soil CO2 efflux, soil organic carbon, chlorophyll a and scytonemin were investigated at two sites in the Kalahari of southern Botswana. Field experiments were employed to isolate CO2 efflux originating from BSCs in order to estimate the C exchange within the crust. Organic carbon was not evenly distributed through the soil profile but concentrated in the BSC. Soil CO2 efflux was higher in Kalahari Sand than in calcrete soils, but rates varied significantly with seasonal changes in moisture and temperature. BSCs at both sites were a small net sink of C to the soil. Soil CO2 efflux was significantly higher in sand soils where the BSC was removed, and on calcrete where the BSC was buried under sand. The BSC removal and burial under sand also significantly reduced chlorophyll a, organic carbon and scytonemin. Disaggregation of the soil crust, however, led to increases in chlorophyll a and organic carbon. The data confirm the importance of BSCs for C cycling in drylands and indicate intensive grazing, which destroys BSCs through trampling and burial, will adversely affect C sequestration and storage. Managed grazing, where soil surfaces are only lightly disturbed, would help maintain a positive carbon balance in African drylands. PMID:23045706

  1. Hubungan antara Rasio Neutrofil-Limfosit dan Skor Sequencial Organ Failure Assesment pada Pasien yang Dirawat di Ruang Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Adi Nugroho

    2013-12-01

    Full Text Available Physiological response of immune system against systemic inflammation involves an increased level of neutrophils and a reduction of lymphocyte or an increase of neutrophil-lymphocyte ratio (RNL. The aim of this study was to identify the relationship between systemic inflammation, characterized by increasing in RNL on organ malfunction, assessed by Sequential Organ Failure Assessment (SOFA score in Intensive Care Unit (ICU patients. This study was a observational study with cross sectional design. This study was conducted by observing RNL and SOFA score at 0, 24th and 48th hour of 78 patients treated in the ICU Dr. Hasan Sadikin General Hospital Bandung in December 2012–February 2013. Patients were divided into 3 categories of sepsis A, B and C. This study showed that there was a relationship between RNL, SOFA scores and sepsis categories (p<0.001. Pearson Correlation Test showed that there was relationship between RNL and SOFA scores (p<0.05, R= 0.63. In conclusion, there is a relationship between systemic inflammatory condition, characterized by RNL and organ failure, characterized by the SOFA score, in patients treated in the ICU Dr. Hasan Sadikin General Hospital Bandung

  2. The impact of introducing malaria rapid diagnostic tests on fever case management

    DEFF Research Database (Denmark)

    Bruxvoort, Katia J; Leurent, Baptiste; Chandler, Clare I R

    2017-01-01

    , to evaluate the impact of mRDT introduction on case management across settings that vary in malaria endemicity and healthcare provider type. This synthesis includes 562,368 outpatient encounters (study size range 2,400-432,513). mRDTs were associated with significantly lower ACT prescription (range 8......RDTs increased referral of patients to other providers. This synthesis provides an overview of shifts in case management that may be expected with mRDT introduction and highlights areas of focus to improve design and implementation of future case management programs....

  3. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

    Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model.Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation.Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes.Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve

  4. Case management to reduce cardiovascular disease risk in American Indians and Alaska Natives with diabetes: results from the Special Diabetes Program for Indians Healthy Heart Demonstration Project.

    Science.gov (United States)

    Moore, Kelly; Jiang, Luohua; Manson, Spero M; Beals, Janette; Henderson, William; Pratte, Katherine; Acton, Kelly J; Roubideaux, Yvette

    2014-11-01

    We evaluated cardiovascular disease (CVD) risk factors in American Indians/Alaska Natives (AI/ANs) with diabetes in the Special Diabetes Program for Indians Healthy Heart (SDPI-HH) Demonstration Project. Multidisciplinary teams implemented an intensive case management intervention among 30 health care programs serving 138 tribes. The project recruited 3373 participants, with and without current CVD, between 2006 and 2009. We examined data collected at baseline and 1 year later to determine whether improvements occurred in CVD risk factors and in Framingham coronary heart disease (CHD) risk scores, aspirin use, and smoking status. A1c levels decreased an average of 0.2% (P risk scores also decreased significantly. Aspirin therapy increased significantly, and smoking decreased. Participants with more case management visits had significantly greater reductions in LDL cholesterol and A1c values. SDPI-HH successfully translated an intensive case management intervention. Creative retention strategies and an improved understanding of organizational challenges are needed for future Indian health translational efforts.

  5. Pollution from organic contaminants in Greek marine areas, receiving anthropogenic pressures from intense activities in the coastal zone

    Science.gov (United States)

    Hatzianestis, Ioannis

    2014-05-01

    Polycyclic aromatic hydrocarbons (PAHs) are widespread pollutants in marine sediments, receiving the pressures from various anthropogenic activities in the coastal zone. Due to their mutagenic and carcinogenic behaviour, PAHs are classified as priority contaminants to be monitored in environmental quality control schemes. The purpose of this study was to determine the levels of PAHs in coastal areas of Greece directly influenced from the operation of major industrial units in the coastal zone, investigate their sources and evaluate their potential toxicity by comparison against effect - based sediment quality guidelines. Thirty two surface sediment samples were collected from three areas of the Hellenic coastline: a) Antikyra bay in Korinthiakos gulf, influenced from the operation of an alumina and aluminium production plant b) Larymna bay in Noth Evoikos gulf, influenced from the operation of a nickel production plant and c) Aliveri bay in South Evoikos Gulf, influenced from a cement production plant. In all the areas studied, aquaculture and fishing activities have been also developed in the coastal zone. PAH concentrations were determined by GC-MS, after soxhlet extraction and fractionation by silica column chromatography. PAH sources and origin were investigated by applying several isomeric ratio diagnostic criteria. The mean quotient Effect- Range Median (m-ERM) was used to evaluate the potential of adverse effects posed to benthic organisms. Three m-ERM-q values were used to differentiate the probability of observing toxicity and classify sites into four categories: sediments with m-ERM1.5 have the highest probability (76%) of toxicity. Extremely high PAH concentrations more than 100,000 ng/g were found in the close vicinity of the alumina production plant in Antikyra bay. High levels of PAHs up to 22,000 ng/g were also found in Aliveri bay, whereas lowest values, but still indicating significant pollution, were measured close to the nickel production plant

  6. Predictive Performance of the Simplified Acute Physiology Score (SAPS) II and the Initial Sequential Organ Failure Assessment (SOFA) Score in Acutely Ill Intensive Care Patients

    DEFF Research Database (Denmark)

    Granholm, Anders; Møller, Morten Hylander; Kragh, Mette

    2016-01-01

    PURPOSE: Severity scores including the Simplified Acute Physiology Score (SAPS) II and the Sequential Organ Failure Assessment (SOFA) score are used in intensive care units (ICUs) to assess disease severity, predict mortality and in research. We aimed to assess the predictive performance of SAPS II...... compared the discrimination of SAPS II and initial SOFA scores, compared the discrimination of SAPS II in our cohort with the original cohort, assessed the calibration of SAPS II customised to our cohort, and compared the discrimination for 90-day mortality vs. in-hospital mortality for both scores....... Discrimination was evaluated using areas under the receiver operating characteristics curves (AUROC). Calibration was evaluated using Hosmer-Lemeshow's goodness-of-fit Ĉ-statistic. RESULTS: AUROC for in-hospital mortality was 0.80 (95% confidence interval (CI) 0.77-0.83) for SAPS II and 0.73 (95% CI 0...

  7. The additional dose to radiosensitive organs caused by using under-collimated X-ray beams in neonatal intensive care radiography

    International Nuclear Information System (INIS)

    Datz, H.; Ben-Shlomo, A.; Margaliot, M.; Bader, D.; Sadetzki, S.; Juster-Reicher, A.; Marks, K.; Smolkin, T.; Zangen, S.

    2008-01-01

    Radiographic technique and exposure parameters were recorded in five Israeli Neonatal Intensive Care Units for chest, abdomen and both chest and abdomen X-ray examinations. Equivalent dose and effective dose values were calculated according to actual examination field size borders and proper technique field size recommendations using PCXMC, a PC-based Monte Carlo program. Exposure of larger than required body areas resulted in an increase of the organ doses by factors of up to 162 (testes), 162 (thyroid) and 8 (thyroid) for chest, abdomen and both chest and abdomen examinations, respectively. These exposures increased the average effective dose by factors of 2.0, 1.9 and 1.3 for the chest, abdomen and both chest and abdomen examinations, respectively. Differences in exposure parameters were found between the different neonatal intensive care units - tube voltage, current-time product and focal to skin distance differences up to 13, 44 and 22%, respectively. Reduction of at least 50% of neonate exposure is feasible and can be implemented using existing methodology without any additional costs. (authors)

  8. Response of soil organic carbon fractions, microbial community composition and carbon mineralization to high-input fertilizer practices under an intensive agricultural system

    Science.gov (United States)

    Wu, Xueping; Gebremikael, Mesfin Tsegaye; Wu, Huijun; Cai, Dianxiong; Wang, Bisheng; Li, Baoguo; Zhang, Jiancheng; Li, Yongshan; Xi, Jilong

    2018-01-01

    Microbial mechanisms associated with soil organic carbon (SOC) decomposition are poorly understood. We aim to determine the effects of inorganic and organic fertilizers on soil labile carbon (C) pools, microbial community structure and C mineralization rate under an intensive wheat-maize double cropping system in Northern China. Soil samples in 0–10 cm layer were collected from a nine-year field trial involved four treatments: no fertilizer, CK; nitrogen (N) and phosphorus (P) fertilizers, NP; maize straw combined with NP fertilizers, NPS; and manure plus straw and NP fertilizers, NPSM. Soil samples were analyzed to determine labile C pools (including dissolved organic C, DOC; light free organic C, LFOC; and microbial biomass C, MBC), microbial community composition (using phospholipid fatty acid (PLFA) profiles) and SOC mineralization rate (from a 124-day incubation experiment). This study demonstrated that the application of chemical fertilizers (NP) alone did not alter labile C fractions, soil microbial communities and SOC mineralization rate from those observed in the CK treatment. Whereas the use of straw in conjunction with chemical fertilizers (NPS) became an additional labile substrate supply that decreased C limitation, stimulated growth of all PLFA-related microbial communities, and resulted in 53% higher cumulative mineralization of C compared to that of CK. The SOC and its labile fractions explained 78.7% of the variance of microbial community structure. Further addition of manure on the top of straw in the NPSM treatment did not significantly increase microbial community abundances, but it did alter microbial community structure by increasing G+/G- ratio compared to that of NPS. The cumulative mineralization of C was 85% higher under NPSM fertilization compared to that of CK. Particularly, the NPSM treatment increased the mineralization rate of the resistant pool. This has to be carefully taken into account when setting realistic and effective goals

  9. Consumer and case manager perspectives of service empowerment: relationship to mental health recovery.

    Science.gov (United States)

    Crane-Ross, Dushka; Lutz, Wilma J; Roth, Dee

    2006-04-01

    This study examines the relationship between service empowerment and recovery. Service empowerment is defined as the extent to which consumers participate in service decisions and the level of reciprocity and respect within the relationship with their case managers. Assessments were made from two perspectives: consumers and their case managers. Structural equation models were developed to examine the direct and indirect effects of service empowerment on four recovery outcomes: Quality of Life, Level of Functioning, Consumer-Reported Symptomatology, and Case Manager-Reported Symptomatology. Consumers' perceptions of service empowerment were the most powerful predictor of recovery outcomes across the four models. Consumers' and case managers' perceptions were related but the magnitude of the relationship was small, indicating that considerable differences exist between their perceptions of service empowerment.

  10. Collaborations in leadership: the nurse case management and nursing administration connection.

    Science.gov (United States)

    Carr, Dana Deravin

    2009-01-01

    With a multiple decade's long surge in managed care and the growth of case management as a profession, there is increasing recognition of the leadership role that case managers employ daily as they coordinate and facilitate patient-centered initiatives. Now, more than ever, case managers are being called upon to further expand their leadership capabilities and take a more active role in professional partnering to ensure the continued attainment of clinical, fiscal, and quality outcomes. All settings, particularly acute care hospitals and integrated delivery systems. The collaboration between nurse case managers and nursing administration provides a framework for the establishment of a collegial and supportive working relationship: one that is built on the strength of mutual goals, shared leadership abilities, respect, and professional loyalty.

  11. Using 137Cs to quantify the redistribution of soil organic carbon and total N affected by intensive soil erosion in the headwaters of the Yangtze River, China

    International Nuclear Information System (INIS)

    Wei Guoxiao; Wang Yibo; Wang Yanlin

    2008-01-01

    Characteristics of soil organic carbon (SOC) and total nitrogen (total N) are important for determining the overall quality of soils. Studies on spatial and temporal variation in SOC and total N are of great importance because of global environmental concerns. Soil erosion is one of the major processes affecting the redistribution of SOC and total N in the test fields. To characterize the distribution and dynamics of SOC and N in the intensively eroded soil of the headwaters of the Yangtze River, China, we measured profiles of soil organic C, total N stocks, and 137 Cs in a control plot and a treatment plot. The amounts of SOC, 137 Cs of sampling soil profiles increased in the following order, lower>middle>upper portions on the control plot, and the amounts of total N of sampling soil profile increase in the following order: upper>middle>lower on the control plot. Intensive soil erosion resulted in a significant decrease of SOC amounts by 34.9%, 28.3% and 52.6% for 0-30 cm soil layer at upper, middle and lower portions and 137 Cs inventory decreased by 68%, 11% and 85% at upper, middle and lower portions, respectively. On the treatment plot total N decreased by 50.2% and 14.6% at the upper and middle portions and increased by 48.9% at the lower portion. Coefficients of variation (CVs) of SOC decreased by 31%, 37% and 30% in the upper, middle and lower slope portions, respectively. Similar to the variational trend of SOC, CVs of 137 Cs decreased by 19.2%, 0.5% and 36.5%; and total N decreased by 45.7%, 65.1% and 19% in the upper, middle and lower slope portions, respectively. The results showed that 137 Cs, SOC and total N moved on the sloping land almost in the same physical mechanism during the soil erosion procedure, indicating that fallout of 137 Cs could be used directly for quantifying dynamic SOC and total N redistribution as the soil was affected by intensive soil erosion

  12. Using (137)Cs to quantify the redistribution of soil organic carbon and total N affected by intensive soil erosion in the headwaters of the Yangtze River, China.

    Science.gov (United States)

    Guoxiao, Wei; Yibo, Wang; Yan Lin, Wang

    2008-12-01

    Characteristics of soil organic carbon (SOC) and total nitrogen (total N) are important for determining the overall quality of soils. Studies on spatial and temporal variation in SOC and total N are of great importance because of global environmental concerns. Soil erosion is one of the major processes affecting the redistribution of SOC and total N in the test fields. To characterize the distribution and dynamics of SOC and N in the intensively eroded soil of the headwaters of the Yangtze River, China, we measured profiles of soil organic C, total N stocks, and (137)Cs in a control plot and a treatment plot. The amounts of SOC, (137)Cs of sampling soil profiles increased in the following order, lower>middle>upper portions on the control plot, and the amounts of total N of sampling soil profile increase in the following order: upper>middle>lower on the control plot. Intensive soil erosion resulted in a significant decrease of SOC amounts by 34.9%, 28.3% and 52.6% for 0-30cm soil layer at upper, middle and lower portions and (137)Cs inventory decreased by 68%, 11% and 85% at upper, middle and lower portions, respectively. On the treatment plot total N decreased by 50.2% and 14.6% at the upper and middle portions and increased by 48.9% at the lower portion. Coefficients of variation (CVs) of SOC decreased by 31%, 37% and 30% in the upper, middle and lower slope portions, respectively. Similar to the variational trend of SOC, CVs of (137)Cs decreased by 19.2%, 0.5% and 36.5%; and total N decreased by 45.7%, 65.1% and 19% in the upper, middle and lower slope portions, respectively. The results showed that (137)Cs, SOC and total N moved on the sloping land almost in the same physical mechanism during the soil erosion procedure, indicating that fallout of (137)Cs could be used directly for quantifying dynamic SOC and total N redistribution as the soil was affected by intensive soil erosion.

  13. Improving Parolees' Participation in Drug Treatment and Other Services through Strengths Case Management

    OpenAIRE

    Prendergast, Michael; Cartier, Jerome J.

    2008-01-01

    In an effort to increase participation in community aftercare treatment for substance-abusing parolees, an intervention based on a transitional case management (TCM) model that focuses mainly on offenders' strengths has been developed and is under testing. This model consists of completion, by the inmate, of a self-assessment of strengths that informs the development of the continuing care plan, a case conference call shortly before release, and strengths case management for three months post...

  14. Effect of nurse case management on the treatment of older women with breast cancer.

    Science.gov (United States)

    Goodwin, James S; Satish, Shiva; Anderson, Elizabeth T; Nattinger, Ann B; Freeman, Jean L

    2003-09-01

    To evaluate the effect of nurse case management on the treatment of older women with breast cancer. Randomized prospective trial. Sixty surgeons practicing at 13 community and two public hospitals in southeast Texas. Three hundred thirty-five women (166 control and 169 intervention) aged 65 and older newly diagnosed with breast cancer. Women seeing surgeons randomized to the intervention group received the services of a nurse case manager for 12 months after the diagnosis of breast cancer. The primary outcome was the type and use of cancer-specific therapies received in the first 6 months after diagnosis. Secondary outcomes were patient satisfaction and arm function on the affected side 2 months after diagnosis. More women in the intervention group received breast-conserving surgery (28.6% vs 18.7%; P=.031) and radiation therapy (36.0% vs 19.0%; P=.003). Of women undergoing breast-conserving surgery, greater percentages in the case management group received adjuvant radiation (78.3% vs 44.8%; P=.001) and axillary dissection (71.4% vs 44.8%; P=.057). Women in the case management group were also more likely to receive more breast reconstruction surgery (9.3% vs 2.6%, P=.054), and women in the case management group with advanced cancer were more likely to receive chemotherapy (72.7% vs 30.0%, P=.057). Two months after surgery, higher percentages of women in the case manager group had normal arm function (93% vs 84%; P=.037) and were more likely to state that they had a real choice in their treatment (82.2% vs 69.9%, P=.020). Women with indicators of poor social support were more likely to benefit from nurse case management. Nurse case management results in more appropriate management of older women with breast cancer.

  15. Moral Decision-Making among Assertive Community Treatment (ACT) Case Managers

    DEFF Research Database (Denmark)

    Lerbæk, Birgitte; Aagaard, Jørgen; Andersen, Mette Braendstrup

    2015-01-01

    The context of care in assertive community treatment (ACT) can be precarious and generate ethical issues involving the principles of autonomy and paternalism. This focus group study examined case managers' situated accounts of moral reasoning. Our findings show how they expressed strong moral...... obligation towards helping the clients. Their moral reasoning reflected a paternalistic position where, on different occasions, the potential benefits of their interventions would be prioritised at the expense of protecting the clients' personal autonomy. The case managers' reasoning emphasised situational...

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

    OpenAIRE

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

    1991-01-01

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

  17. Meaningful Solutions for the Unemployed or Their Counsellors? The Role of Case Managers' Conceptions of Their Work

    Science.gov (United States)

    Värk, Aare; Reino, Anne

    2018-01-01

    This article reports the outcomes of a phenomenographical study of case managers' conceptions of case management work and its influence on the process and performance of the work of counselling the unemployed. A heterogeneous sample of 11 Estonian case managers was selected for in-depth interviews. Analysis of the interviews revealed three…

  18. Spontaneous cervical epidural hematoma: Report of a case managed conservatively

    Directory of Open Access Journals (Sweden)

    Halim Tariq

    2008-01-01

    Full Text Available Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.

  19. Organics.

    Science.gov (United States)

    Chian, Edward S. K.; DeWalle, Foppe B.

    1978-01-01

    Presents water analysis literature for 1978. This review is concerned with organics, and it covers: (1) detergents and surfactants; (2) aliphatic and aromatic hydrocarbons; (3) pesticides and chlorinated hydrocarbons; and (4) naturally occurring organics. A list of 208 references is also presented. (HM)

  20. Organizers.

    Science.gov (United States)

    Callison, Daniel

    2000-01-01

    Focuses on "organizers," tools or techniques that provide identification and classification along with possible relationships or connections among ideas, concepts, and issues. Discusses David Ausubel's research and ideas concerning advance organizers; the implications of Ausubel's theory to curriculum and teaching; "webbing," a…

  1. Impact of residual setup error on parotid gland dose in intensity-modulated radiation therapy with or without planning organ-at-risk margin

    International Nuclear Information System (INIS)

    Delana, Anna; Menegotti, Loris; Valentini, Aldo; Bolner, Andrea; Tomio, Luigi; Vanoni, Valentina; Lohr, Frank

    2009-01-01

    Purpose: To estimate the dosimetric impact of residual setup errors on parotid sparing in head-and-neck (H and N) intensity-modulated treatments and to evaluate the effect of employing an PRV (planning organ-at-risk volume) margin for the parotid gland. Patients and methods: Ten patients treated for H and N cancer were considered. A nine-beam intensity-modulated radiotherapy (IMRT) was planned for each patient. A second optimization was performed prescribing dose constraint to the PRV of the parotid gland. Systematic setup errors of 2 mm, 3 mm, and 5 mm were simulated. The dose-volume histograms of the shifted and reference plans were compared with regard to mean parotid gland dose (MPD), normal-tissue complication probability (NTCP), and coverage of the clinical target volume (V 95% and equivalent uniform dose [EUD]); the sensitivity of parotid sparing on setup error was evaluated with a probability-based approach. Results: MPD increased by 3.4%/mm and 3.0%/mm for displacements in the craniocaudal and lateral direction and by 0.7%/mm for displacements in the anterior-posterior direction. The probability to irradiate the parotid with a mean dose > 30 Gy was > 50%, for setup errors in cranial and lateral direction and 95% and EUD variations < 1% and < 1 Gy). Conclusion: The parotid gland is more sensitive to craniocaudal and lateral displacements. A setup error of 2 mm guarantees an MPD ≤ 30 Gy in most cases, without adding a PRV margin. If greater displacements are expected/accepted, an adequate PRV margin could be used to meet the clinical parotid gland constraint of 30 Gy, without affecting target volume coverage. (orig.)

  2. "Because somebody cared about me. That's how it changed things": homeless, chronically ill patients' perspectives on case management.

    Directory of Open Access Journals (Sweden)

    Elizabeth Davis

    Full Text Available Case management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants' perspectives on case management interventions.This qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program.FOUR RECURRENT THEMES EMERGED: (1 Participants described profound social isolation prior to case management program enrollment; (2 Participants perceived that caring personal relationships with case managers were key to the program; (3 Participants valued assistance with navigating medical and social systems; and (4 Participants perceived that their health improved through both the interpersonal and the practical aspects of case management.Chronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients.

  3. Case management after long-term absence from work in China: a case report.

    Science.gov (United States)

    Tang, Dan; Yu, Ignatius Tak Sun; Luo, Xiaoyuan; Liang, Youxin; He, Yonghua

    2011-03-01

    Return-to-work (RTW) after occupational injuries is an important and challenging issue. Case managers are expected to play a vital role in successful RTW. In China, RTW intervention is in its early phase and requires further research and practice. This case report describes Mr. H's RTW process for illustrating the work of a case management team in China. Suggestions on developing and optimizing the process in China are given. After 9 years of absence from work due to severe burn injuries at work, Mr. H was referred for RTW interventions. Mr. H received social and occupational rehabilitation services of 3 months, and the following workplace visits and work trials. After the job placement, the case manager continued the liaison with the worker and employer. Mr. H showed positive changes in occupational and social adjustment after the case management interventions. This was reflected from the shift from the contemplation to action stage on the Lam Assessment of Stages of Employment Readiness. Despite he did not show significant changes on functional capacity and fear avoidance beliefs, Mr. H passed the job credential test and was offered a maintenance technician position at a new company. Both the worker and the employer were satisfied with the outcome of the case management. The RTW interventions carried out by the case managers appeared to be effective within the Chinese system. The results suggested that professional training of case managers, RTW-related policies and technological standards, early integrated interventions should be further developed in China. Disability Adjustment Group Therapy and RTW Support Groups perhaps are useful approaches in workers' returning to work.

  4. Potential rainfall-intensity and pH-driven shifts in the apparent fluorescent composition of dissolved organic matter in rainwater.

    Science.gov (United States)

    Zhou, Yongqiang; Yao, Xiaolong; Zhang, Yibo; Shi, Kun; Zhang, Yunlin; Jeppesen, Erik; Gao, Guang; Zhu, Guangwei; Qin, Boqiang

    2017-05-01

    Perturbations of rainwater chromophoric dissolved organic matter (CDOM) fluorescence induced by changes in rainfall intensity and pH were investigated by field observations and laboratory pH titrations. Microbial humic-like fluorophores dominated the rainwater CDOM pool, followed by tryptophan-like and tyrosine-like substances. Increased rainfall intensity had notable dilution effects on all six fluorescent components (C1-C6) identified using parallel factor (PARAFAC) analysis, the effect being especially pronounced for the microbial humic-like C1, tryptophan-like C3, and tyrosine-like C5. The results also indicated that increasing pH from 7 to 9 led to decreased fluorescence intensity (F max ) of all the six components, while a pH increase from 5 to 7, resulted in increasing F max of terrestrial humic-like C2, tyrosine-like C5, and tryptophan-like C6 and decreasing microbial humic-like C1, tryptophan-like C3, and fulvic-like C4. Two-dimensional correlation spectroscopy (2D-COS) demonstrated that synchronous fluorescence responded first to pH modifications at fulvic-like wavelength (λ Ex /λ Em  = ∼316/416 nm), followed by tyrosine-like wavelength (λ Ex /λ Em  = ∼204/304 nm), tryptophan-like wavelength (λ Ex /λ Em  = ∼226/326 nm), microbial humic-like wavelength (∼295/395 nm), and finally terrestrial humic-like wavelength (∼360/460 nm). Our results suggest that a decrease in areas affected by acid rain in South China occurring at present may possibly result in apparent compositional changes of CDOM fluorescence. The decreased rainfall in South-West China and increased rainfall in North-West China during the past five decades may possibly accordingly result in increased and decreased F max of all the six components identified in South-West and North-West China, respectively. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Organizations

    DEFF Research Database (Denmark)

    Hatch, Mary Jo

    and considers many more. Mary Jo Hatch introduces the concept of organizations by presenting definitions and ideas drawn from the a variety of subject areas including the physical sciences, economics, sociology, psychology, anthropology, literature, and the visual and performing arts. Drawing on examples from......Most of us recognize that organizations are everywhere. You meet them on every street corner in the form of families and shops, study in them, work for them, buy from them, pay taxes to them. But have you given much thought to where they came from, what they are today, and what they might become...... prehistory and everyday life, from the animal kingdom as well as from business, government, and other formal organizations, Hatch provides a lively and thought provoking introduction to the process of organization....

  6. [Refusal of care faced by case manager from elderly persons in complex situation: cross perspectives].

    Science.gov (United States)

    Corvol, A; Balard, F; Moutel, G; Somme, D

    2014-01-01

    Case management is a new professional field in France. It is addressed to elderly persons living in community whose situation is regarded as particularly complex. Case managers have to assess needs and coordinate necessary services. One common criteria of complexity is refusal of care. The objective of this study is to compare the words of users with those of case managers about refusal of care, in order to understand its meaning, professionals' attitudes and ethical challenges. Two researchers have cooperated on this qualitative research: the first one, anthropologist, interviewed 19 individuals, and 11 of their caregivers. The second one, geriatrician and researcher in medical ethics, lead four focus groups gathering a total of 18 case managers. Refusal of care often is the result of the will of preserving one's identity, compromised by illness. Individuals seek control on their life. Facing this behaviour, case managers try to secure the individual, by establishing a personal relationship that respects their choices, even if care has to be delayed. Refusal of care may sometimes disclose a desire to vanish, in front of which professionals meet their own limits. To recognise an elderly person that refuses care as a unique individual who can make choices secure his identity, and allow him to change. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  7. The Evolution of End-of-Life Care: Ethical Implications for Case Management.

    Science.gov (United States)

    Fink-Samnick, Ellen

    2016-01-01

    This article: : Applicable to all health care sectors where case management is practiced. Few topics are more intimate and multifaceted for case managers than engaging with today's culturally diverse patient populations around end-of-life processes. The already prominent focus of this issue has been further elevated by a series of events to receive public attention. These include the Institute of Medicine's 2014 report-Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life, rising numbers of patients around the globe requesting to end life on their own terms, and corresponding death with dignity initiatives and legislation.Another vital factor in the end-of-life equation involves how the latest generation of shared decision making influences the management of treatment dialogues among practitioners, patients, as well as insurance companies. Case managers are at the intersection of these complex interactions, working to achieve ethical, as well as legal accountability to the patient, employer, and profession while balancing personal perspectives. Professionals strive to effectively intervene with patients and their support systems facing end-of-life care decisions. It is essential case managers actively consider the intricacies of ethical practice and current contexts including death with dignity legislation, shared decision making, and shifts in regulations and reimbursement for end-of-life care.Case management's ethical envelope will continue to be pushed. To that end amid shifting societal constructs, professionals must have mastery of applicable codes, standards, principles, and rules essential for adherence to ethical practice.

  8. Towards a Business Process Modeling Technique for Agile Development of Case Management Systems

    Directory of Open Access Journals (Sweden)

    Ilia Bider

    2017-12-01

    Full Text Available A modern organization needs to adapt its behavior to changes in the business environment by changing its Business Processes (BP and corresponding Business Process Support (BPS systems. One way of achieving such adaptability is via separation of the system code from the process description/model by applying the concept of executable process models. Furthermore, to ease introduction of changes, such process model should separate different perspectives, for example, control-flow, human resources, and data perspectives, from each other. In addition, for developing a completely new process, it should be possible to start with a reduced process model to get a BPS system quickly running, and then continue to develop it in an agile manner. This article consists of two parts, the first sets requirements on modeling techniques that could be used in the tools that supports agile development of BPs and BPS systems. The second part suggests a business process modeling technique that allows to start modeling with the data/information perspective which would be appropriate for processes supported by Case or Adaptive Case Management (CM/ACM systems. In a model produced by this technique, called data-centric business process model, a process instance/case is defined as sequence of states in a specially designed instance database, while the process model is defined as a set of rules that set restrictions on allowed states and transitions between them. The article details the background for the project of developing the data-centric process modeling technique, presents the outline of the structure of the model, and gives formal definitions for a substantial part of the model.

  9. Daily organ tracking in intensity-modulated radiotherapy of prostate cancer using an electronic portal imaging device with a dose saving acquisition mode

    International Nuclear Information System (INIS)

    Vetterli, Daniel; Thalmann, Sandrine; Behrensmeier, Frank; Kemmerling, Ludger; Born, Ernst J.; Mini, Roberto; Greiner, Richard H.; Aebersold, Daniel M.

    2006-01-01

    Background and purpose: Daily use of conventional electronic portal imaging devices (EPID) for organ tracking is limited due to the relatively high dose required for high quality image acquisition. We studied the use of a novel dose saving acquisition mode (RadMode) allowing to take images with one monitor unit per image in prostate cancer patients undergoing intensity-modulated radiotherapy (IMRT) and tracking of implanted fiducial gold markers. Patients and methods: Twenty five patients underwent implantation of three fiducial gold markers prior to the planning CT. Before each treatment of a course of 37 fractions, orthogonal localization images from the antero-posterior and from the lateral direction were acquired. Portal images of both the setup procedure and the five IMRT treatment beams were analyzed. Results: On average, four localization images were needed for a correct patient setup, resulting in four monitor units extra dose per fraction. The mean extra dose delivered to the patient was thereby increased by 1.2%. The procedure was precise enough to reduce the mean displacements prior to treatment to ≤0.3 mm. Conclusions: The use of a new dose saving acquisition mode enables to perform daily EPID-based prostate tracking with a cumulative extra dose of below 1 Gy. This concept is efficiently used in IMRT-treated patients, where separation of setup beams from treatment beams is mandatory

  10. SU-F-P-26: Study of Radiation Dose Evaluation for Organs at Risk Using MRI in Intensity Modulated Radiation Therapy for Nasopharyngeal Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Gong, G; Guo, Y; Yin, Y [Shandong Cancer Hospital and Institute, Jinan, Shandong (China)

    2016-06-15

    Purpose: To study the contour and dosimetric feature of organs at risk (OARs) applying magnetic resonance imaging (MRI) images in intensity modulated radiation therapy (IMRT) of nasopharyngeal carcinoma (NPC) compared to computed tomography (CT) images. Methods: 35 NPC patients was selected into this trail. CT simulation with non-contrast and contrast enhanced scan, MRI simulation with non-contrast and contrast enhanced T1, T2 and diffusion weighted imaging were achieved sequentially. And the OARs were contoured on the CT and MRI images after rigid registration respectively. 9 beams IMRT plan with equal division angle were designed for every patients, and the prescription dose for tumor target was set as 72Gy (2.4Gy/ fration). The boundary display, volume and dose-volume indices of each organ were compared between on MRI and CT images. Results: Compared to CT, MRI showed clearer boundary of brainstem, spinal cord, the deep lobe of Parotid gland and the optical nerve in canal. MRI images increase the volume of lens, optical nerve, while reducing the volume of eye slightly, and the maximum dose of lens, the mean dose of eyes and optical raised in different percentage, while there was no statistical differences were found. The left and right parotid volume on MRI increased by 7.07%, 8.13%, and the mean dose raised by 14.95% (4.01Gy), 18.76% (4.95Gy) with statistical significant difference (p<0.05). The brainstem volume reduced by 9.33% (p<0.05), and the dose of 0.1cm3 volume (D0.1cm3) reduced by mean 8.46% (4.32Gy), and D0.1cm3 of spinal cord increased by 1.5Gy on MRI. Conclusion: It is credible to evaluate the radiation dose of lens, eye and the spinal cord, while it should be necessary to evaluate the dose of brainstem, parotid and the optical nerve applying MRI images sometime, it will be more meaningful for these organs with high risk of radiation injury.

  11. Case management: evolution of the concept in the 80's and 90's

    Directory of Open Access Journals (Sweden)

    Casarin Santina Nunes Alves

    2002-01-01

    Full Text Available Case Management is a term that is present in almost every American health care situation. It is mostly used to coordinate community services with satisfactory results for the patient within a certain period of time, with limited resources. Through time, it has been used for different purposes. The goal of this study was to show the historical evolution of case management as expressed by the American nursing literature, in the 80's and 90's, according to its use, meaning, and application, and following a theoretical framework for concept analysis. The data was extracted from two journals: "Nursing Management" and "Journal of Nursing Administration". The publications showed case management portrayed as a process that serves a common goal; where quality and cost of care were the prevalent and influential elements along time, and its practice focusing in a given population defined as of high risk and high cost for health care.

  12. Case Management Reduces Length of Stay, Charges, and Testing in Emergency Department Frequent Users

    Directory of Open Access Journals (Sweden)

    Jameel Sughair

    2018-02-01

    Full Text Available Introduction: Case management is an effective, short-term means to reduce emergency department (ED visits in frequent users of the ED. This study sought to determine the effectiveness of case management on frequent ED users, in terms of reducing ED and hospital length of stay (LOS, accrued costs, and utilization of diagnostic tests. Methods: The study consisted of a retrospective chart review of ED and inpatient visits in our hospital’s ED case management program, comparing patient visits made in the one year prior to enrollment in the program, to the visits made in the one year after enrollment in the program. We examined the LOS, use of diagnostic testing, and monetary charges incurred by these patients one year prior and one year after enrollment into case management. Results: The study consisted of 158 patients in case management. Comparing the one year prior to enrollment to the one year after enrollment, ED visits decreased by 49%, inpatient admissions decreased by 39%, the use of computed tomography imaging decreased 41%, the use of ultrasound imaging decreased 52%, and the use of radiographs decreased 38%. LOS in the ED and for inpatient admissions decreased by 39%, reducing total LOS for these patients by 178 days. ED and hospital charges incurred by these patients decreased by 5.8 million dollars, a 41% reduction. All differences were statistically significant. Conclusion: Case management for frequent users of the ED is an effective method to reduce patient visits, the use of diagnostic testing, length of stay, and cost within our institution.

  13. Case management directors: how to manage in a transition-focused world: part 1.

    Science.gov (United States)

    Bankston-White, Cheri; Birmingham, Jackie

    2015-01-01

    Case management directors are in a dynamic position to affect the transition of care for patients across the continuum, work with all levels of providers, and support the financial well-being of a hospital. Most importantly, they can drive good patient outcomes. Although the position is critical on many different levels, there is little to help guide a new director in attending to all the "moving parts" of such a complex role. The purpose of this two-part article is to provide case management directors, particularly new ones, with a framework for understanding and fulfilling their role.We have divided the guide into seven tracks of responsibility. Part 1 discusses the first four tracks: (1) staffing and human resources, (2) compliance and accreditation, (3) discharge planning, and (4) utilization review and revenue cycle. Part 2 addresses (5) internal departmental relationships (organizational), (6) external relationships (Community agency), and (7) quality and program outcomes. The information is most meaningful to those case management directors who work in either stand-alone hospitals or integrated health systems, and have frontline case managers reporting to them. Case management directors would benefit from further research and documentation of "best practices" related to their role, particularly in the areas of leadership and management. New directors would benefit from mentoring and networking with one another. As new regulations and models of care bring increased emphasis and focus to transitions of care, the role of the case management director continues to evolve, growing in importance and complexity. The growing financial impact of readmissions also brings added scrutiny and increased pressure to get the transitions of care right the first time.To operate most effectively, case management directors must understand the full range of their responsibilities and impact. They must find opportunities for themselves and their departments to learn and stay

  14. Bio-Kil, a nano-based disinfectant, reduces environmental bacterial burden and multidrug-resistant organisms in intensive care units.

    Science.gov (United States)

    Lee, Wen-Sen; Hsieh, Tai-Chin; Shiau, Justine C; Ou, Tsong-Yih; Chen, Fu-Lun; Liu, Yu-Hsin; Yen, Muh-Yong; Hsueh, Po-Ren

    2017-10-01

    This prospective before-after study was intended to investigate the effect of Bio-Kil on reducing environmental bacterial burden and healthcare-associated infections (HAIs) in intensive care units (ICUs) at the Municipal Wan-Fang Hospital, Taipei, Taiwan in 2014. Four rooms in the medical and surgical ICUs were investigated and designated as study rooms (n = 2) or control rooms (n = 2). Routine disinfection was performed during the pre-intervention period in both room types. Bio-Kil was applied to the fomites and surroundings of the study rooms during the intervention period. Total bacterial burden and proportion of colonization of fomites and surroundings by multidrug-resistance organisms (MDROs) were determined before and after the intervention. The demographic characteristics, underlying conditions, and clinical outcomes of patients were analyzed. After application of Bio-Kil, the bacterial burden declined in both groups, although the reduction was greater in the study rooms as compared with the control rooms (p = 0.001). During the pre-intervention period, 16 patients were admitted to control rooms and 18 patients to study rooms. After the intervention, 22 patients were admitted to control rooms and 21 patients to study rooms. The number of cases of new-onset sepsis declined in the intervention group (from 33% to 23.8%), but increased in the control group (from 25% to 40.9%); however, there was no significant difference in incidence of new-onset sepsis between the study and control rooms after intervention. Application of Bio-Kil reduced the environmental bacterial burden and MDROs in ICUs. Further studies are needed to evaluate the efficacy of this nanotechnology-based disinfectant in reducing HAIs. Copyright © 2016. Published by Elsevier B.V.

  15. SU-F-T-397: Evaluating the Impact of Bladder Filling Status for the Organs at Risk Dose Distribution in Cervical Cancer Patients with Intensity Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Zhang, JY; Hong, DL

    2016-01-01

    Purpose: To investigate the impact of bladder filling status of the organs at risk (OARs) on dose distribution during intensity modulated radiotherapy (IMRT) for cervical cancer patients. Methods: Twelve cervical cancer patients treated with IMRT were selected for this study. The prescription dose was 45Gy/25 fractions with the 6 MV photon beam. All patients performed two CT scans, one with an empty bladder, the other one with bladder filled. For the registration of two CT scans, the fusion was automatically carried out upon the bony anatomy. The OARs (bladder, rectum, pelvic bone and small intestine) were delineated to planning CT to evaluate the dose distributions. These dose distributions were compared between empty bladder and bladder filling. Results: The bladder volume with empty bladder and bladder filling was 403.2±124.13cc and 101.4±87.5cc, respectively. There were no statistical differences between empty bladder and bladder filling in the mean value of pelvic bone V10Gy, V20Gy, V40Gy; rectum V40Gy and V45Gy. The bladder V40Gy and V45Gy were lower in the bladder filling group than in the empty bladder group (63.7%±5.8% vs 87.5%±7.8%, 45.1%±9.5% vs 62.4%±11.8%, respectively). The V45Gy for small intestine in the bladder filling group was significantly less than the empty bladder group (146.7cc±95.3cc vs 245.7cc±101.8cc). Conclusion: Our study finds that the bladder filling status did not have a significant impact on dose distribution in the rectum and pelvic bone. However, the changes of bladder filling have a large impact on bladder and small intestine doses. A full bladder is strongly recommended during treatment for cervical cancer patients.

  16. SU-F-T-397: Evaluating the Impact of Bladder Filling Status for the Organs at Risk Dose Distribution in Cervical Cancer Patients with Intensity Modulated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, JY [Cancer Hospital of Shantou University Medical College, Shantou, Guangdong (China); Hong, DL [The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong (China)

    2016-06-15

    Purpose: To investigate the impact of bladder filling status of the organs at risk (OARs) on dose distribution during intensity modulated radiotherapy (IMRT) for cervical cancer patients. Methods: Twelve cervical cancer patients treated with IMRT were selected for this study. The prescription dose was 45Gy/25 fractions with the 6 MV photon beam. All patients performed two CT scans, one with an empty bladder, the other one with bladder filled. For the registration of two CT scans, the fusion was automatically carried out upon the bony anatomy. The OARs (bladder, rectum, pelvic bone and small intestine) were delineated to planning CT to evaluate the dose distributions. These dose distributions were compared between empty bladder and bladder filling. Results: The bladder volume with empty bladder and bladder filling was 403.2±124.13cc and 101.4±87.5cc, respectively. There were no statistical differences between empty bladder and bladder filling in the mean value of pelvic bone V10Gy, V20Gy, V40Gy; rectum V40Gy and V45Gy. The bladder V40Gy and V45Gy were lower in the bladder filling group than in the empty bladder group (63.7%±5.8% vs 87.5%±7.8%, 45.1%±9.5% vs 62.4%±11.8%, respectively). The V45Gy for small intestine in the bladder filling group was significantly less than the empty bladder group (146.7cc±95.3cc vs 245.7cc±101.8cc). Conclusion: Our study finds that the bladder filling status did not have a significant impact on dose distribution in the rectum and pelvic bone. However, the changes of bladder filling have a large impact on bladder and small intestine doses. A full bladder is strongly recommended during treatment for cervical cancer patients.

  17. An adaptive control algorithm for optimization of intensity modulated radiotherapy considering uncertainties in beam profiles, patient set-up and internal organ motion

    International Nuclear Information System (INIS)

    Loef, Johan; Lind, Bengt K.; Brahme, Anders

    1998-01-01

    A new general beam optimization algorithm for inverse treatment planning is presented. It utilizes a new formulation of the probability to achieve complication-free tumour control. The new formulation explicitly describes the dependence of the treatment outcome on the incident fluence distribution, the patient geometry, the radiobiological properties of the patient and the fractionation schedule. In order to account for both measured and non-measured positioning uncertainties, the algorithm is based on a combination of dynamic and stochastic optimization techniques. Because of the difficulty in measuring all aspects of the intra- and interfractional variations in the patient geometry, such as internal organ displacements and deformations, these uncertainties are primarily accounted for in the treatment planning process by intensity modulation using stochastic optimization. The information about the deviations from the nominal fluence profiles and the nominal position of the patient relative to the beam that is obtained by portal imaging during treatment delivery, is used in a feedback loop to automatically adjust the profiles and the location of the patient for all subsequent treatments. Based on the treatment delivered in previous fractions, the algorithm furnishes optimal corrections for the remaining dose delivery both with regard to the fluence profile and its position relative to the patient. By dynamically refining the beam configuration from fraction to fraction, the algorithm generates an optimal sequence of treatments that very effectively reduces the influence of systematic and random set-up uncertainties to minimize and almost eliminate their overall effect on the treatment. Computer simulations have shown that the present algorithm leads to a significant increase in the probability of uncomplicated tumour control compared with the simple classical approach of adding fixed set-up margins to the internal target volume. (author)

  18. Identifying patients suitable for palliative care - a descriptive analysis of enquiries using a Case Management Process Model approach

    Directory of Open Access Journals (Sweden)

    Kuhn Ulrike

    2012-11-01

    Full Text Available Abstract Background In Germany, case management in a palliative care unit was first implemented in 2005 at the Department of Palliative Medicine at the University Hospital Cologne. One of the purposes of this case management is to deal with enquiries from patients and their relatives as well as medical professionals. Using the Case Management Process Model of the Case Management Society of America as a reference, this study analysed (a how this case management was used by different enquiring groups and (b how patients were identified for case management and for palliative care services. The first thousand enquiries were analysed considering patient variables, properties of the enquiring persons and the content of the consultations. Results Most enquiries to the case management were made by telephone. The majority of requests regarded patients with oncological disease (84.3 %. The largest enquiring group was composed of patients and relatives (40.8 %, followed by internal professionals of the hospital (36.1 %. Most of the enquiring persons asked for a patient’s admission to the palliative care ward (46.4 %. The second most frequent request was for consultation and advice (30.9 %, followed by requests for the palliative home care service (13.3 %. Frequent reasons for actual admissions were the need for the treatment of pain, the presence of symptoms and the need for nursing care. More than half of the enquiries concerning admission to the palliative care ward were followed by an admission. Conclusions Case management has been made public among the relevant target groups. Case management as described by the Case Management Process Model helps to identify patients likely to benefit from case management and palliative care services. In addition, with the help of case management palliative patients may be allocated to particular health care services.

  19. COLLABORATE©: a universal competency-based paradigm for professional case management, part i: introduction, historical validation, and competency presentation.

    Science.gov (United States)

    Treiger, Teresa M; Fink-Samnick, Ellen

    2013-01-01

    The purpose of this first of a three-article series is to provide context and justification for a new paradigm of case management built upon a value-driven foundation that Applicable to all health care sectors where case management is practiced. In moving forward, the one fact that rings true is there will be constant change in our industry. As the health care terrain shifts and new influences continually surface, there will be consequences for case management practice. These impacts require nimble clinical professionals in possession of recognized and firmly established competencies. They must be agile to frame (and reframe) their professional practice to facilitate the best possible outcomes for their patients. Case managers can choose to be Gumby or Pokey. This is exactly why the definition of a competency-based case management model's time has come, one sufficiently fluid to fit into any setting of care. The practice of case management transcends the vast array of representative professional disciplines and educational levels. A majority of current models are driven by business priorities rather than by the competencies critical to successful practice and quality patient outcomes. This results in a fragmented professional case management identity. While there is inherent value in what each discipline brings to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities, including a reflective clinical ladder.

  20. An Exploration of the Working Alliance in Mental Health Case Management

    Science.gov (United States)

    Kondrat, David C.; Early, Theresa J.

    2010-01-01

    The working alliance between clients and helpers has been identified as a common factor of treatment effectiveness, yet very little research has explored variables associated with working alliance between mental health case managers and their consumers. This study explored the potential covariates of working alliance within community mental health…

  1. Enhanced Case Management versus Substance Abuse Treatment Alone among Substance Abusers with Depression

    Science.gov (United States)

    Striley, Catherine W.; Nattala, Prasanthi; Ben Abdallah, Arbi; Dennis, Michael L.; Cottler, Linda B.

    2013-01-01

    This pilot study evaluated the effectiveness of enhanced case management for substance abusers with comorbid major depression, which was an integrated approach to care. One hundred and 20 participants admitted to drug treatment who also met Computerized Diagnostic Interview Schedule criteria for major depression at baseline were randomized to…

  2. A Randomized Trial of Probation Case Management for Drug-Involved Women Offenders

    Science.gov (United States)

    Guydish, Joseph; Chan, Monica; Bostrom, Alan; Jessup, Martha A.; Davis, Thomas B.; Marsh, Cheryl

    2011-01-01

    This article reports findings from a clinical trial of a probation case management (PCM) intervention for drug-involved women offenders. Participants were randomly assigned to PCM (n = 92) or standard probation (n = 91) and followed for 12 months using measures of substance abuse, psychiatric symptoms, social support, and service utilization.…

  3. Physical Activity in Individuals with Severe Mental Illness: Client versus Case Manager Ratings

    Science.gov (United States)

    Bezyak, Jill L.; Chan, Fong; Lee, Eun-Jeong; Catalano, Denise; Chiu, Chung-Yi

    2012-01-01

    The "Physical Activity Scale for Individuals With Physical Disabilities" was examined as a physical activity measure for people with severe mental illness. Case manager ratings were more closely related to body mass index than clients' ratings, challenging the accuracy of self-report physical activity measures for individuals with severe mental…

  4. 25 CFR 20.515 - What is required for case management?

    Science.gov (United States)

    2010-04-01

    ....515 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR HUMAN SERVICES FINANCIAL ASSISTANCE AND SOCIAL SERVICES PROGRAMS Child Assistance Foster Care § 20.515 What is required for case management? Social services workers must document regular contact with children and families in accordance...

  5. Effectiveness of post-discharge case management in general-medical outpatients: a randomized, controlled trial

    NARCIS (Netherlands)

    Latour, Corine H. M.; de Vos, Rien; Huyse, Frits J.; de Jonge, Peter; van Gemert, Liesbeth A. M.; Stalman, Wim A. B.

    2006-01-01

    This study was initiated to determine the impact of post-discharge, nurse-led, home-based case management intervention on the number of emergency readmissions, level of care utilization, quality of life, and psychological functioning. Patients discharged home from a general hospital (N=147) were

  6. Effectiveness of post-discharge case management in general-medical outpatients: A randomized, controlled trial

    NARCIS (Netherlands)

    Latour-Delfgaauw, C.H.M.; Vos, R.; Huyse, F.J.; de Jonge, P.; van Gemert, L.A.M.; Stalman, W.A.B.

    2006-01-01

    This study was initiated to determine the impact of post-discharge, nurse-led, home-based case management intervention on the number of emergency readmissions, level of care utilization, quality of life, and psychological functioning. Patients discharged home from a general hospital (N=147) were

  7. Nurse-led case management for ambulatory complex patients in general health care: A systematic review

    NARCIS (Netherlands)

    Latour-Delfgaauw, C.H.M.; van der Windt, D.A.W.M.; de Jonge, P.; Riphagen, II; Vos, R.; Huyse, F.J.; Stalman, W.A.B.

    2007-01-01

    Objective: The aim of this study was to summarize the available literature on the effectiveness of ambulatory nurse-led case management for complex patients in general health care. Method: We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and Cinahl. We included randomized

  8. Effectiveness of post-discharge case management in general-medical outpatients: A randomized, controlled trial

    NARCIS (Netherlands)

    Latour, C.H.M.; de Vos, R.; Huyse, F.J.; De Jonge, P.; van Gemert, L.A.M.; Stalman, W.A.B.

    2006-01-01

    This study was initiated to determine the impact of post- discharge, nurse- led, home- based case management intervention on the number of emergency readmissions, level of care utilization, quality of life, and psychological functioning. Patients discharged home from a general hospital (N = 147)

  9. Effectiveness of post-discharge case management in general-medical outpatients : A randomized, controlled trial

    NARCIS (Netherlands)

    Latour, Corine H. M.; de Vos, Rien; Huyse, Frits J.; de Jonge, Peter; van Gemert, Liesbeth A. M.; Stalman, Wim A. B.

    2006-01-01

    This study was initiated to determine the impact of post- discharge, nurse- led, home- based case management intervention on the number of emergency readmissions, level of care utilization, quality of life, and psychological functioning. Patients discharged home from a general hospital (N = 147)

  10. Risk assessment by client and case manager for shared decision making in outpatient forensic psychiatry

    NARCIS (Netherlands)

    van den Brink, Rob H. S.; Troquete, Nadine A. C.; Beintema, Harry; Mulder, Tamara; van Os, Titus W. D. P.; Schoevers, Robert A.; Wiersma, Durk

    2015-01-01

    Background: In outpatient forensic psychiatry, assessment of re-offending risk and treatment needs by case managers may be hampered by an incomplete view of client functioning. The client's appreciation of his own problem behaviour is not systematically used for these purposes. The current study

  11. Acute flaccid paralysis: a five–year review of cases managed by ...

    African Journals Online (AJOL)

    kemrilib

    A 5-year (1999-2004) review of acute flaccid paralysis (AFP) cases managed at the physiotherapy ... Sciatic nerve palsy accounted for majority (72.0%) of the AFP; only. 43.2% of the ... children with febrile illnesses is suggested. Importance of ...

  12. Case management in early psychosis intervention programme: Perspectives of clients and caregivers.

    Science.gov (United States)

    Wong, Horng Hien; Yong, Yee Huei; Shahwan, Shazana; Cetty, Laxman; Vaingankar, Janhavi; Hon, Charlene; Lee, Helen; Loh, Christopher; Abdin, Edimansyah; Subramaniam, Mythily

    2017-12-14

    This qualitative study explored the perspectives of clients and caregivers on case management provided by the Singapore Early Psychosis Intervention Programme (EPIP), with the intent to understand the salient aspects of case management from their perspective. Clients and their caregivers were recruited from the EPIP outpatient clinics. Focus group discussions (FGDs) were conducted at a community centre outside the hospital with 47 clients and 19 caregivers. Facilitators were experienced researchers who were not involved in the care of the clients and trained in qualitative research methodologies. All FGDs were audio recorded and transcribed verbatim with all participants' identifiers omitted to protect confidentiality. Qualitative data analysis was conducted using thematic analysis. There were 11 themes that emerged from the FGDs: therapeutic alliance, holistic monitoring, collaborative role with other care providers, counselling and guidance, crisis management, bridging role, client-centred care, client empowerment and strength building, psychoeducation/education on illness, support and problem solving. "Problem solving" surfaced only from the client FGDs; the remaining themes were common to both groups. The voices of clients and caregivers are important to EPIP case management service. This study has provided insights into their perspectives, understandings and lived experiences of case management and its impact on clients and caregivers. © 2017 The Authors Early Intervention in Psychiatry Published by John Wiley & Sons Australia, Ltd.

  13. Development and pilot of Case Manager: a virtual-patient experience for veterinary students.

    Science.gov (United States)

    Byron, Julie K; Johnson, Susan E; Allen, L Clare V; Brilmyer, Cheryl; Griffiths, Robert P

    2014-01-01

    There is an increasing demand in veterinary education to engage students, teach and reinforce clinical reasoning, and provide access anytime/anywhere to quality learning opportunities. In addition, accrediting bodies are asking for more concrete documentation of essential clinical-skills outcomes. Unfortunately, during the clinical year in a referral hospital setting, students are at the mercy of chance regarding the types of cases they will encounter and the opportunities they will have to participate. Patient- and case-simulation technology is becoming more popular as a way to achieve these objectives in human and veterinary medical education. Many of the current options available to the veterinary medical education community to develop virtual-patient cases are too time-consuming, cost prohibitive, or difficult for the instructor or learner to use. In response, we developed a learning tool, Case Manager, which is low-cost and user-friendly. Case Manager was designed to meet the demands of veterinary education by providing students with an opportunity to cultivate clinical reasoning skills and allowing for real-time student feedback. We launched a pilot test with 37 senior veterinary medical students as part of their Small Animal Internal Medicine clinical rotation. Students reported that Case Manager increased their engagement with the material, improved diagnostic and problem-solving skills, and broadened their exposure to a variety of cases. In addition, students felt that Case Manager was superior to a more traditional, less interactive case presentation format.

  14. Case Management Promotion of Social Media for the Elderly Who Live Alone.

    Science.gov (United States)

    Hashi, Ilham

    2016-01-01

    Professional case managers advocate patient access to necessary and appropriate services, while educating the patient and family and/or caregiver about resource availability within practice settings. The purpose of this article is to explain the role case managers can have to promote the use of social media by the elderly, as a means to decrease their loneliness and isolation. The promotion of the use of social media will take place in the community setting, involving willing and competent elderly patients who live alone. It is framed as one strategy to help combat loneliness. The primary target audiences for this initiative are case managers who work in the community, as they are the ones who have contact with this population. However, hospital case managers could also benefit, as they need to be aware of ways to help discharged elderly patients feel more connected to their community; the use of social media is one way to achieve this outcome. The elderly population experience changes brought on by their longer life. One of those changes or undesirable effects is an increase in social isolation and experiencing loneliness. There are many factors that contribute to loneliness and social isolation in the elderly such as a change in financial situations, death, divorce, or migration. Utilizing the capabilities of the internet, coupled with the use of social media (e.g., Facebook), can facilitate opening up a virtual world where the elderly can communicate with family and friends, make new friends, or occupy their time with the many interactive games that are available online. Case managers should increase their awareness to identify patients who are socially isolated; the outcome is to decrease the risk of developing a major depressive disorder. Community case managers might at times be the only professional health care givers who are visiting patients in their home; therefore, they should also be aware of the signs and symptoms of depression so they can encourage

  15. Health-related quality of life and satisfaction with case management in cancer survivors.

    Science.gov (United States)

    Hsu, Ya-Hui; Chai, Hsiu-Ying; Lin, Yu-Fen; Wang, Chao-Hui; Chen, Shu-Ching

    2017-12-01

    To (i) investigate the characteristics of health-related quality of life and satisfaction with case management and (ii) to identify factors associated with health-related quality of life in cancer survivors. The level of health-related quality of life can reflect treatment efficacy and satisfaction with cancer care. A cross-sectional study design was adopted. Subjects from the outpatient setting of a cancer centre in northern Taiwan were recruited by consecutive sampling. A set of questionnaires were employed, including a background information form, case management service satisfaction survey (CMSS) and The European Quality of Life Scale (EQ-5D). Descriptive statistics were used to examine levels of health-related quality of life and satisfaction with case management. Pearson's correlation was used to identify relationships between treatment characteristics, satisfaction with case management and health-related quality of life. Multiple stepwise regression was used to identify factors associated with health-related quality of life. A total of 252 cancer patients were recruited. The three lowest scores for items of health-related quality of life were mobility, self-care and usual activities. Cancer survivors with higher mobility, less pain and discomfort, and lower anxiety and depression were more likely to have better health-related quality of life. Mobility, pain and discomfort, and anxiety and depression are important predictive factors of high health-related quality of life in cancer survivors. In clinical care, patients' physical mobility, pain and discomfort, and anxiety and depression are important indicators of health-related quality of life. Case managers should include self-care and symptom management into survivorship care plans to improve health-related quality of life during survival after treatment concludes. © 2017 John Wiley & Sons Ltd.

  16. Quality of malaria case management in Malawi: results from a nationally representative health facility survey.

    Science.gov (United States)

    Steinhardt, Laura C; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

    2014-01-01

    Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients. In April-May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have

  17. Recruiting intensity

    OpenAIRE

    R. Jason Faberman

    2014-01-01

    To hire new workers, employers use a variety of recruiting methods in addition to posting a vacancy announcement. The intensity with which employers use these alternative methods can vary widely with a firm’s performance and with the business cycle. In fact, persistently low recruiting intensity helps to explain the sluggish pace of US job growth following the Great Recession.

  18. Evaluación de la efectividad de un programa de gestión de casos para pacientes esquizofrénicos en centros de salud mental / Assessment of the effectiveness of a case management programme for schizophrenic patients in mental health centres

    OpenAIRE

    Mas-Expósito, Laia

    2013-01-01

    [eng] The psychiatric deinstitutionalization leaded to an increase of community resources for persons with Severe Mental Illness (SMI). These resources include the so-called case management programs that aim to organize, coordinate and integrate the resources available for patient care through continuous contact with one or more key workers. The Mental Health Strategy of the Spanish National Health System (2007) recommends case management programs for the coordination, access and use of menta...

  19. Integrated community case management for childhood illnesses: explaining policy resistance in Kenya.

    Science.gov (United States)

    Juma, Pamela A; Owuor, Karen; Bennett, Sara

    2015-12-01

    There has been a re-emphasis recently on community health workers to provide child health care services including integrated community case management for childhood illness (iCCM). This research analysed iCCM policy development in Kenya and in particular the types of decision-making criteria used by Kenyan policy-makers in considering whether to advance iCCM policy. Data were collected through document reviews (n = 41) and semi-structured interviews (n = 19) with key stakeholders in iCCM policy including government officials, development partners, bilateral donors, and civil society organizations. Initial analysis was guided by the policy triangle with further analysis of factors affecting policy decision-making drawing upon a simple framework developed by Grindle and Thomas (Policy makers, policy choices and policy outcomes: the political economy of reform in developing countries. 1989; Policy Sci 22: :213-48.). Policy development for iCCM has been slow in Kenya, compared with other Sub-Saharan African countries. At the time of the study, the Government had just completed the Community Health Training Manual which incorporated iCCM as a module, but this was the only formal expression of iCCM in Kenya. We found technical considerations, notably concerns about community health workers dispensing antibiotics to be a key factor slowing iCCM policy development, but this also overlapped with bureaucratic considerations, such as how the development of community health worker cadres may affect clinicians, as well as initial concerns about how an integrated approach might affect vertically oriented programs. International actors through agreements such as the Millennium Development Goals helped to get child survival onto the national policy agenda and such actors were active promoters of iCCM policy change. However international funders had not committed funding to scale-up iCCM policy, and this probably constrained their influence over iCCM policy debate. Kenyan actors

  20. Anterior Myocardial Territory May Replace the Heart as Organ at Risk in Intensity-Modulated Radiotherapy for Left-Sided Breast Cancer

    International Nuclear Information System (INIS)

    Tan Wenyong; Liu Dong; Xue Chenbin; Xu Jiaozhen; Li Beihui; Chen Zhengwang; Hu Desheng; Wang Xionghong

    2012-01-01

    Purpose: We investigated whether the heart could be replaced by the anterior myocardial territory (AMT) as the organ at risk (OAR) in intensity-modulated radiotherapy (IMRT) of the breast for patients with left-sided breast cancer. Methods and Materials: Twenty-three patients with left-sided breast cancer who received postoperative radiation after breast-conserving surgery were studied. For each patient, we generated five IMRT plans including heart (H), left ventricle (LV), AMT, LV+AMT, and H+LV as the primary OARs, respectively, except both lungs and right breast, which corresponded to IMRT(H), IMRT(LV), IMRT(AMT), IMRT(LV+AMT), and IMRT(H+LV). For the planning target volumes and OARs, the parameters of dose–volume histograms were compared. Results: The homogeneity index, conformity index, and coverage index were not compromised significantly in IMRT(AMT), IMRT(LV) and IMRT(LV+ AMT), respectively, when compared with IMRT(H). The mean dose to the heart, LV, and AMT decreased 5.3–21.5% (p < 0.05), 19.9–29.5% (p < 0.05), and 13.3–24.5% (p < 0.05), respectively. Similarly, the low (e.g., V5%), middle (e.g., V20%), and high (e.g., V30%) dose-volume of the heart, LV, and AMT decreased with different levels. The mean dose and V10% of the right lung increased by 9.2% (p < 0.05) and 27.6% (p < 0.05), respectively, in IMRT(LV), and the mean dose and V5% of the right breast decreased significantly in IMRT(AMT) and IMRT(LV+AMT). IMRT(AMT) was the preferred plan and was then compared with IMRT(H+LV); the majority of dose–volume histogram parameters of OARs including the heart, LV, AMT, both lungs, and the right breast were not statistically different. However, the low dose-volume of LV increased and the middle dose-volume decreased significantly (p < 0.05) in IMRT(AMT). Also, those of the right lung (V10%, V15%) and right breast (V5%, V10%) decreased significantly (p < 0.05). Conclusions: The AMT may replace the heart as the OAR in left-sided breast IMRT after breast

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  2. Exploring the effect of at-risk case management compensation on hospital pay-for-performance outcomes: tools for change.

    Science.gov (United States)

    Granata, Randy L; Hamilton, Karen

    2015-01-01

    Acute care nurse case managers are charged with compliance oversight, managing throughput, and ensuring safe care transitions. Leveraging the roles of nurse case managers and social workers during care transitions translates into improved fiscal performance under the Affordable Care Act. This article aims to equip leaders in the field of case management with tools to facilitate the alignment of case management systems with hospital pay-for-performance measures. A quality improvement project was implemented at a hospital in south Alabama to examine the question: for acute care case managers, what is the effect of key performance indictors using an at-risk compensation model in comparison to past nonincentive models on hospital readmissions, lengths of stay, and patient satisfaction surrounding the discharge process. Inpatient acute care hospital. The implementation of an at-risk compensation model using key performance indicators, Lean Six Sigma methodology, and Creative Health Care Management's Relationship-Based Care framework demonstrated reduced length of stay, hospital readmissions, and improved patient experiences. Regulatory changes and new models of reimbursement in the acute care environment have created the perfect storm for case management leaders. Hospital fiscal performance is dependent on effective case management processes and the ability to optimize scarce resources. The quality improvement project aimed to further align case management systems and structures with hospital pay-for-performance measures. Tools for change were presented to assist leaders with the change acceleration process.

  3. Case Managers for High-Risk, High-Cost Patients as Agents and Street-Level Bureaucrats.

    Science.gov (United States)

    Swanson, Jeffrey; Weissert, William G

    2017-08-01

    Case management programs often designate a nurse or social worker to take responsibility for guiding care when patients are expected to be expensive or risk a major decline. We hypothesized that though an intuitively appealing idea, careful program design and faithful implementation are essential if case management programs are to succeed. We employed two theory perspectives, principal-agent framework and street-level bureaucratic theory to describe the relationship between program designers (principals) and case managers (agents/street-level bureaucrats) to review 65 case management studies. Most programs were successful in limited program-specific process and outcome goals. But there was much less success in cost-saving or cost-effectiveness-the original and overarching goal of case management. Cost results might be improved if additional ideas of agency and street-level theory were adopted, specifically, incentives, as well as "green tape," clear rules, guidelines, and algorithms relating to resource allocation among patients.

  4. Sound intensity

    DEFF Research Database (Denmark)

    Crocker, Malcolm J.; Jacobsen, Finn

    1998-01-01

    This chapter is an overview, intended for readers with no special knowledge about this particular topic. The chapter deals with all aspects of sound intensity and its measurement from the fundamental theoretical background to practical applications of the measurement technique.......This chapter is an overview, intended for readers with no special knowledge about this particular topic. The chapter deals with all aspects of sound intensity and its measurement from the fundamental theoretical background to practical applications of the measurement technique....

  5. Sound Intensity

    DEFF Research Database (Denmark)

    Crocker, M.J.; Jacobsen, Finn

    1997-01-01

    This chapter is an overview, intended for readers with no special knowledge about this particular topic. The chapter deals with all aspects of sound intensity and its measurement from the fundamental theoretical background to practical applications of the measurement technique.......This chapter is an overview, intended for readers with no special knowledge about this particular topic. The chapter deals with all aspects of sound intensity and its measurement from the fundamental theoretical background to practical applications of the measurement technique....

  6. Women's experiences of nurse case management on a gynaecological oncology unit in a Swiss tertiary hospital. A thematic analysis.

    Science.gov (United States)

    Grob, Silvia; Bläuer, Cornelia; Frei, Irena Anna

    2017-12-01

    Women with gynaecological cancer face various physical, social and emotional challenges concerning their health. Existing research shows that case management can improve patient satisfaction and reduce readmission rates. Although nurse case management was introduced on a gynaecological oncology unit in a Swiss university hospital in 2013, little is known about the experiences of female patients on a unit that uses this model of care. The aims were to explore women's experiences and to gain deeper understanding about hospital-based nurse case management on a gynaecological oncology unit and to qualitatively evaluate the concept of nurse case management. Sound research knowledge suggests that experiences are best explored with a qualitative research design. Ten participant interviews were conducted and inductively analysed between September 2014 and May 2015 as described by the thematic analysis method. Ethical approval was obtained, and the women signed a consent form. The first theme was named continuous relationship, with the nurse case manager as contact person and trusted partner. Study participants explained that friendliness and being present were essential qualities of nurse case management. Secondly, an essential support for women dealing with the situation of gynaecological cancer was described in the theme sharing information. The organisation of rehabilitation and other services by the nurse case management defined the third theme coordinating care. Trust was seen as the basis of the continuous relationship, marked by friendliness and presence of the nurse case manager. The helpful approach of persons practicing nurse case management made dealing with the situation of illness easier for women with gynaecological cancer. Coordination of information between the nurse case management and other healthcare services could be improved. Further evaluation is suggested to explore effects of the concept on family members. © 2017 Nordic College of Caring Science.

  7. Using the "Seven A's" assessment tool for developing competency in case management.

    Science.gov (United States)

    Gallagher, Louise P; Truglio-Londrigan, Marie

    2004-01-01

    In the latter part of the 20th century, healthcare reform sparked a transition in the nursing curriculum from acute care to primary and secondary care. Faculty responded to this challenge by redesigning curricula in creative ways. The transitional curriculum introduced community clinical experiences designed to challenge students to practice in diverse, nontraditional sites and in more independent ways. Such practice requires the nurse to function as designer, coordinator, and manager of patient care in addition to the traditional provider role. Additionally, the transitional curricula emphasized the roles of communicator, educator, facilitator, listener, and advocate to a greater degree. For students to achieve competence in the above roles, the curriculum must include learning activities that allow them to practice as case managers in the community. This paper presents the "Seven A's" as a framework for students to gain an understanding of and engage in the role and process of case management in the community.

  8. Private sector role, readiness and performance for malaria case management in Uganda, 2015.

    Science.gov (United States)

    Kaula, Henry; Buyungo, Peter; Opigo, Jimmy

    2017-05-25

    Several interventions have been put in place to promote access to quality malaria case management services in Uganda's private sector, where most people seek treatment. This paper describes evidence using a mixed-method approach to examine the role, readiness and performance of private providers at a national level in Uganda. These data will be useful to inform strategies and policies for improving malaria case management in the private sector. The ACTwatch national anti-malarial outlet survey was conducted concurrently with a fever case management study. The ACTwatch nationally representative anti-malarial outlet survey was conducted in Uganda between May 18th 2015 and July 2nd 2015. A representative sample of sub-counties was selected in 14 urban and 13 rural clusters with probability proportional to size and a census approach was used to identify outlets. Outlets eligible for the survey met at least one of three criteria: (1) one or more anti-malarials were in stock on the day of the survey; (2) one or more anti-malarials were in stock in the 3 months preceding the survey; and/or (3) malaria blood testing (microscopy or RDT) was available. The fever case management study included observations of provider-patient interactions and patient exit interviews. Data were collected between May 20th and August 3rd, 2015. The fever case management study was implemented in the private sector. Potential outlets were identified during the main outlet survey and included in this sub-sample if they had both artemisinin-based combination therapy (ACT) [artemether-lumefantrine (AL)], in stock on the day of survey as well as diagnostic testing available. A total of 9438 outlets were screened for eligibility in the ACTwatch outlet survey and 4328 outlets were found to be stocking anti-malarials and were interviewed. A total of 9330 patients were screened for the fever case management study and 1273 had a complete patient observation and exit interview. Results from the outlet

  9. Improving the effectiveness of sickness benefit case management through a public-private partnership?

    DEFF Research Database (Denmark)

    Larsen, Malene Rode; Aust, Birgit; Høgelund, Jan

    2017-01-01

    Background The aim of this study was to investigate whether a multidimensional public-private partnership intervention, focussing on improving the quality and efficiency of sickness benefit case management, reduced the sickness benefit duration and the duration until self-support. Methods We used...... a difference-in-difference (DID) design with six intervention municipalities and 12 matched control municipalities in Denmark. The study sample comprised 282,103 sickness benefit spells exceeding four weeks. The intervention group with 110,291 spells received the intervention, and the control group with 171......,812 spells received ordinary sickness benefit case management. Using register data, we fitted Cox proportional hazard ratio models, estimating hazard ratios (HR) and confidence intervals (CI). Results We found no joint effect of the intervention on the sickness benefit duration (HR 1.02, CI 0...

  10. The importance of work or productive activity in life care planning and case management

    Science.gov (United States)

    Reid, Christine; Riddick-Grisham, Susan

    2015-01-01

    Abstract INTRODUCTION: The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management. BACKGROUND: The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described. PURPOSE: The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on quality of life for people living with disabilities. CONCLUSION: Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities. PMID:26409330

  11. The importance of work or productive activity in life care planning and case management.

    Science.gov (United States)

    Reid, Christine; Riddick-Grisham, Susan

    2015-01-01

    The importance of work or productive activity for the well-being, community integration, and quality of life of people living with disabilities is addressed, with implications for life care planning and case management. The role of work or productive activity in our society, and consequences of deprivation if rehabilitation services do not address vocational effects of disabilities, is explored. A continuum of productivity options is introduced; types of vocational rehabilitation assessment processes and interventions are described. The role of vocational rehabilitation services in life care planning and case management is discussed, focusing on quality of life for people living with disabilities. Rehabilitation and health care professionals should understand the importance of work or other productive activity, and support the development of appropriate plans to address those needs among people who have disabilities.

  12. HIV/AIDS case management tasks and activities: the results of a functional analysis study.

    Science.gov (United States)

    Grube, B; Chernesky, R H

    2001-01-01

    Functional analysis, a variation of the time study technique, was used to examine how HIV/AIDS case managers in the tri-county region of New York State spend their time-the actual tasks and activities they choose to perform relative to the total universe of activities and tasks subsumed in the general category of case management. The picture developed was of a system operating primarily in a crisis mode, spending relatively brief amounts of time completing a range of activities and providing an extensive scope of services for or on behalf of clients. The bulk of the work was client centered, not administrative, and involved providing disease management and essential services (e.g., family and mental health). The implications of these findings are discussed, with particular attention paid to the potential influence of client profiles and worker demographics.

  13. Globalization of healthcare: case management in a 21st-century world.

    Science.gov (United States)

    Craig, Kathy; Beichl, Lisa

    2009-01-01

    This article explains the current state of the global healthcare market with respect to international medical travel (medical tourism) and worldwide provider sourcing. Emphasis is placed on the traditional twin pillars of oversight: program accreditation and branding affiliation. These are discussed for their main strength, which is their ability to operate at a system-strata level. This strength also represents a primary weakness from the international patient's perspective, which is the functional gap between systemic oversight and bedside surveillance. International case management (ICM) is identified as the right conduit of patient-level service delivery that fills the gap between system and bedside. The ICM professional is introduced and defined as the provider of patient-centered quality and safety improvements, who coordinates and collaborates using international network connections and culture-sensitive in-country communication skills. The article's information is useful for healthcare practitioners who want to learn about the global medical marketplace. Practitioners who are preparing to or who already have business enterprises associated with the global healthcare market will also find the information helpful. Explanations and content are useful to case management generalists, specialists, and business developers. The content is intended for uptake by interested parties within and outside the healthcare practice arena. All research and syntheses were executed by the authors. Sources included business correspondences, medical tourism literature, corporate Internet profiles, news releases, and healthcare industry investigative and monitoring agencies. Clinical competencies stem from the international practice experiences of one author (K. Craig). International health insurance, economics, and financing expertise stems from other author (L. Beichl). This article launches the platform for development of checklists, tools, and guidelines for international case

  14. The Gerontologist as a case manager: simulation of experiences in distinct and specific studies

    Directory of Open Access Journals (Sweden)

    Marcelo Piovezan

    2013-10-01

    Full Text Available In Case Management are identified the characteristics that involve elderly and their families by providing adequate planning to meet their needs. Case studies of three subjects were prepared containing relevant information to the preparation of action plans that have been divided into categories. The actions aim to promote quality of life of the aged, as well as of their families and caregivers. The work highlighted the possibility and need of insertion of the method to the Gerontologist performance.

  15. Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation

    Science.gov (United States)

    Langston, Anne; Weiss, Jennifer; Landegger, Justine; Pullum, Thomas; Morrow, Melanie; Kabadege, Melene; Mugeni, Catherine; Sarriot, Eric

    2014-01-01

    ABSTRACT Background: The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. Methods: The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes. Results: While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital. Conclusions: The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of i

  16. Description and outcomes of a Medicare case management program by nurses.

    Science.gov (United States)

    Allen, S A

    1999-01-01

    During the current environment of cost-cutting and restructuring, case management is viewed as a means of providing comprehensive, coordinated care while reducing costs. Studies of community-based case management have been disappointing. This study evaluates a Medicare service, Management and Evaluation of the Care Plan (MAE), as a model of nurses providing case management in the home. Three groups were compared: MAE (N = 176), non-MAE (N = 187) and newly discharged (N = 93). Utilization data was collected over one year. Overall, subjects were unmarried older women with three functional limitations, four medical diagnoses and averaged 43 home care visits and one hospitalization. MAE patients were older, had more functional and environmental limitations, less ADL independence, and a worse prognosis, yet used significantly less health care than non-MAE recipients did. Regression analysis was performed using group membership and hospital and home care utilization as dependent variables. Although the project was conducted at one site, overall the sample was similar to the national Medicare population.

  17. Challenges to improving case management of childhood pneumonia at health facilities in resource-limited settings.

    Science.gov (United States)

    Graham, Stephen M; English, Mike; Hazir, Tabish; Enarson, Penny; Duke, Trevor

    2008-05-01

    Effective case management is an important strategy to reduce pneumonia-related morbidity and mortality in children. Guidelines based on sound evidence are available but are used variably. This review outlines current guidelines for childhood pneumonia management in the setting where most child pneumonia deaths occur and identifies challenges for improved management in a variety of settings and different "at-risk" groups. These include appropriate choice of antibiotic, clinical overlap with other conditions, prompt and appropriate referral for inpatient care, and management of treatment failure. Management of neonates, and of HIV-infected or severely malnourished children is more complicated. The influence of co-morbidities on pneumonia outcome means that pneumonia case management must be integrated within strategies to improve overall paediatric care. The greatest potential for reducing pneumonia-related deaths in health facilities is wider implementation of the current guidelines built around a few core activities: training, antibiotics and oxygen. This requires investment in human resources and in equipment for the optimal management of hypoxaemia. It is important to provide data from a variety of epidemiological settings for formal cost-effectiveness analyses. Improvements in the quality of case management of pneumonia can be a vehicle for overall improvements in child health-care practices.

  18. Case management for frail older adults through tablet computers and Skype.

    Science.gov (United States)

    Berner, Jessica; Anderberg, Peter; Rennemark, Mikael; Berglund, Johan

    2016-12-01

    Frail older adults are high consumers of medical care due to their age and multiple chronic conditions. Regular contact with a case manager has been proven to increase well-being of frail older adults and reduce their number of health-care visits. Skype calls through tablet PCs can offer easier communication. This paper examines frail older adults' use of tablet computers and Skype, with their case managers. Interviews were conducted on 15 frail older adults. A content analysis was used to structure and analyze the data. The results indicate that tablet computers were experienced in a positive way for most frail older adults. Conflicting feelings did emerge, however, as to whether the frail elderly would adopt this in the long run. Skype needs to be tested further as to whether this is a good solution for communication with their case managers. Strong technical support and well-functioning technology are important elements to facilitate use. Using Skype and tablet PCs do have potential for frail older adults, but need to be tested further.

  19. Patient-clinician mobile communication: analyzing text messaging between adolescents with asthma and nurse case managers.

    Science.gov (United States)

    Yoo, Woohyun; Kim, Soo Yun; Hong, Yangsun; Chih, Ming-Yuan; Shah, Dhavan V; Gustafson, David H

    2015-01-01

    With the increasing penetration of digital mobile devices among adolescents, mobile texting messaging is emerging as a new channel for patient-clinician communication for this population. In particular, it can promote active communication between healthcare clinicians and adolescents with asthma. However, little is known about the content of the messages exchanged in medical encounters via mobile text messaging. Therefore, this study explored the content of text messaging between clinicians and adolescents with asthma. We collected a total of 2,953 text messages exchanged between 5 nurse case managers and 131 adolescents with asthma through a personal digital assistant. The text messages were coded using a scheme developed by adapting categories from the Roter Interaction Analysis System. Nurse case managers sent more text messages (n=2,639) than adolescents with asthma. Most messages sent by nurse case managers were targeted messages (n=2,475) directed at all adolescents with asthma, whereas there were relatively few tailored messages (n=164) that were created personally for an individual adolescent. In addition, both targeted and tailored messages emphasized task-focused behaviors over socioemotional behaviors. Likewise, text messages (n=314) sent by adolescents also emphasized task-focused over socioemotional behaviors. Mobile texting messaging has the potential to play an important role in patient-clinician communication. It promotes not only active interaction, but also patient-centered communication with clinicians. In order to achieve this potential, healthcare clinicians may need to focus on socioemotional communication as well as task-oriented communication.

  20. Information needs of case managers caring for persons living with HIV.

    Science.gov (United States)

    Schnall, Rebecca; Cimino, James J; Currie, Leanne M; Bakken, Suzanne

    2011-05-01

    The goals of this study were to explore the information needs of case managers who provide services to persons living with HIV (PLWH) and to assess the applicability of the Information Needs Event Taxonomy in a new population. The study design was observational with data collection via an online survey. Responses to open-ended survey questions about the information needs of case managers (n=94) related to PLWH of three levels of care complexity were categorized using the Information Needs Event Taxonomy. The most frequently identified needs were related to patient education resources (33%), patient data (23%), and referral resources (22%) accounting for 79% of all (N=282) information needs. Study limitations include selection bias, recall bias, and a relatively narrow focus of the study on case-manager information needs in the context of caring for PLWH. The study findings contribute to the evidence base regarding information needs in the context of patient interactions by: (1) supporting the applicability of the Information Needs Event Taxonomy and extending it through addition of a new generic question; (2) providing a foundation for the addition of context-specific links to external information resources within information systems; (3) applying a new approach for elicitation of information needs; and (4) expanding the literature regarding addressing information needs in community-based settings for HIV services.

  1. Implications of case managers' perceptions and attitude on safety of home-delivered care.

    Science.gov (United States)

    Jones, Sarahjane

    2015-12-01

    Perceptions on safety in community care have been relatively unexplored. A project that sought to understand the multiple perspectives on safety in the NHS case-management programme was carried out in relation to the structure, process, and outcome of care. This article presents a component of the nursing perspective that highlights an important element in the structure of nursing care that could potentially impede the nurses' ability to be fully effective and safe. A single case study of the case-management programme was undertaken. Three primary care organisations from three strategic health authorities participated, and three focus groups were conducted (one within each organisation). In total, 17 case management nurses participated. Data were audiotaped and transcribed verbatim and subjected to framework analysis. Nursing staff attitudes were identified as a structure of care that influence safety outcomes, particularly their perceptions of the care setting and the implications it has on their role and patient behaviour. Greater understanding of the expected role of the community nurse is necessary, and relevant training is required for nurses to be successful in empowering patients to perform more safely. In addition, efforts need to be made to improve patients' trust in the health-care system to prevent harm and promote more effective utilisation of resources.

  2. [Intensive medicine in Spain].

    Science.gov (United States)

    2011-03-01

    Intensive care medicine is a medical specialty that was officially established in our country in 1978, with a 5-year training program including two years of common core training followed by three years of specific training in an intensive care unit accredited for training. During this 32-year period, intensive care medicine has carried out an intense and varied activity, which has allowed its positioning as an attractive and with future specialty in the hospital setting. This document summarizes the history of the specialty, its current situation, the key role played in the programs of organ donation and transplantation of the National Transplant Organization (after more than 20 years of mutual collaboration), its training activities with the development of the National Plan of Cardiopulmonary Resuscitation, with a trajectory of more than 25 years, its interest in providing care based on quality and safety programs for the severely ill patient. It also describes the development of reference registries due to the need for reliable data on the care process for the most prevalent diseases, such as ischemic heart disease or ICU-acquired infections, based on long-term experience (more than 15 years), which results in the availability of epidemiological information and characteristics of care that may affect the practical patient's care. Moreover, features of its scientific society (SEMICYUC) are reported, an organization that agglutinates the interests of more than 280 ICUs and more than 2700 intensivists, with reference to the journal Medicina Intensiva, the official journal of the society and the Panamerican and Iberian Federation of Critical Medicine and Intensive Care Societies. Medicina Intensiva is indexed in the Thompson Reuters products of Science Citation Index Expanded (Scisearch(®)) and Journal Citation Reports, Science Edition. The important contribution of the Spanish intensive care medicine to the scientific community is also analyzed, and in relation to

  3. Health service providers in Somalia: their readiness to provide malaria case-management.

    Science.gov (United States)

    Noor, Abdisalan M; Rage, Ismail A; Moonen, Bruno; Snow, Robert W

    2009-05-13

    Studies have highlighted the inadequacies of the public health sector in sub-Saharan African countries in providing appropriate malaria case management. The readiness of the public health sector to provide malaria case-management in Somalia, a country where there has been no functioning central government for almost two decades, was investigated. Three districts were purposively sampled in each of the two self-declared states of Puntland and Somaliland and the south-central region of Somalia, in April-November 2007. A survey and mapping of all public and private health service providers was undertaken. Information was recorded on services provided, types of anti-malarial drugs used and stock, numbers and qualifications of staff, sources of financial support and presence of malaria diagnostic services, new treatment guidelines and job aides for malaria case-management. All settlements were mapped and a semi-quantitative approach was used to estimate their population size. Distances from settlements to public health services were computed. There were 45 public health facilities, 227 public health professionals, and 194 private pharmacies for approximately 0.6 million people in the three districts. The median distance to public health facilities was 6 km. 62.3% of public health facilities prescribed the nationally recommended anti-malarial drug and 37.7% prescribed chloroquine as first-line therapy. 66.7% of public facilities did not have in stock the recommended first-line malaria therapy. Diagnosis of malaria using rapid diagnostic tests (RDT) or microscopy was performed routinely in over 90% of the recommended public facilities but only 50% of these had RDT in stock at the time of survey. National treatment guidelines were available in 31.3% of public health facilities recommended by the national strategy. Only 8.8% of the private pharmacies prescribed artesunate plus sulphadoxine/pyrimethamine, while 53.1% prescribed chloroquine as first-line therapy. 31.4% of

  4. Evaluating malaria case management at public health facilities in two provinces in Angola.

    Science.gov (United States)

    Plucinski, Mateusz M; Ferreira, Manzambi; Ferreira, Carolina Miguel; Burns, Jordan; Gaparayi, Patrick; João, Lubaki; da Costa, Olinda; Gill, Parambir; Samutondo, Claudete; Quivinja, Joltim; Mbounga, Eliane; de León, Gabriel Ponce; Halsey, Eric S; Dimbu, Pedro Rafael; Fortes, Filomeno

    2017-05-03

    Malaria accounts for the largest portion of healthcare demand in Angola. A pillar of malaria control in Angola is the appropriate management of malaria illness, including testing of suspect cases with rapid diagnostic tests (RDTs) and treatment of confirmed cases with artemisinin-based combination therapy (ACT). Periodic systematic evaluations of malaria case management are recommended to measure health facility readiness and adherence to national case management guidelines. Cross-sectional health facility surveys were performed in low-transmission Huambo and high-transmission Uíge Provinces in early 2016. In each province, 45 health facilities were randomly selected from among all public health facilities stratified by level of care. Survey teams performed inventories of malaria commodities and conducted exit interviews and re-examinations, including RDT testing, of a random selection of all patients completing outpatient consultations. Key health facility readiness and case management indicators were calculated adjusting for the cluster sampling design and utilization. Availability of RDTs or microscopy on the day of the survey was 71% (54-83) in Huambo and 85% (67-94) in Uíge. At least one unit dose pack of one formulation of an ACT (usually artemether-lumefantrine) was available in 83% (66-92) of health facilities in Huambo and 79% (61-90) of health facilities in Uíge. Testing rates of suspect malaria cases in Huambo were 30% (23-38) versus 69% (53-81) in Uíge. Overall, 28% (13-49) of patients with uncomplicated malaria, as determined during the re-examination, were appropriately treated with an ACT with the correct dose in Huambo, compared to 60% (42-75) in Uíge. Incorrect case management of suspect malaria cases was associated with lack of healthcare worker training in Huambo and ACT stock-outs in Uíge. The results reveal important differences between provinces. Despite similar availability of testing and ACT, testing and treatment rates were lower in

  5. Health service providers in Somalia: their readiness to provide malaria case-management

    Directory of Open Access Journals (Sweden)

    Moonen Bruno

    2009-05-01

    Full Text Available Abstract Background Studies have highlighted the inadequacies of the public health sector in sub-Saharan African countries in providing appropriate malaria case management. The readiness of the public health sector to provide malaria case-management in Somalia, a country where there has been no functioning central government for almost two decades, was investigated. Methods Three districts were purposively sampled in each of the two self-declared states of Puntland and Somaliland and the south-central region of Somalia, in April-November 2007. A survey and mapping of all public and private health service providers was undertaken. Information was recorded on services provided, types of anti-malarial drugs used and stock, numbers and qualifications of staff, sources of financial support and presence of malaria diagnostic services, new treatment guidelines and job aides for malaria case-management. All settlements were mapped and a semi-quantitative approach was used to estimate their population size. Distances from settlements to public health services were computed. Results There were 45 public health facilities, 227 public health professionals, and 194 private pharmacies for approximately 0.6 million people in the three districts. The median distance to public health facilities was 6 km. 62.3% of public health facilities prescribed the nationally recommended anti-malarial drug and 37.7% prescribed chloroquine as first-line therapy. 66.7% of public facilities did not have in stock the recommended first-line malaria therapy. Diagnosis of malaria using rapid diagnostic tests (RDT or microscopy was performed routinely in over 90% of the recommended public facilities but only 50% of these had RDT in stock at the time of survey. National treatment guidelines were available in 31.3% of public health facilities recommended by the national strategy. Only 8.8% of the private pharmacies prescribed artesunate plus sulphadoxine/pyrimethamine, while 53

  6. Quality of inpatient pediatric case management for four leading causes of child mortality at six government-run Ugandan hospitals.

    Directory of Open Access Journals (Sweden)

    David Sears

    Full Text Available A better understanding of case management practices is required to improve inpatient pediatric care in resource-limited settings. Here we utilize data from a unique health facility-based surveillance system at six Ugandan hospitals to evaluate the quality of pediatric case management and the factors associated with appropriate care.All children up to the age of 14 years admitted to six district or regional hospitals over 15 months were included in the study. Four case management categories were defined for analysis: suspected malaria, selected illnesses requiring antibiotics, suspected anemia, and diarrhea. The quality of case management for each category was determined by comparing recorded treatments with evidence-based best practices as defined in national guidelines. Associations between variables of interest and the receipt of appropriate case management were estimated using multivariable logistic regression.A total of 30,351 admissions were screened for inclusion in the analysis. Ninety-two percent of children met criteria for suspected malaria and 81% received appropriate case management. Thirty-two percent of children had selected illnesses requiring antibiotics and 89% received appropriate antibiotics. Thirty percent of children met criteria for suspected anemia and 38% received appropriate case management. Twelve percent of children had diarrhea and 18% received appropriate case management. Multivariable logistic regression revealed large differences in the quality of care between health facilities. There was also a strong association between a positive malaria diagnostic test result and the odds of receiving appropriate case management for comorbid non-malarial illnesses - children with a positive malaria test were more likely to receive appropriate care for anemia and less likely for illnesses requiring antibiotics and diarrhea.Appropriate management of suspected anemia and diarrhea occurred infrequently. Pediatric quality

  7. [Influence of delta-sleep inducing peptide on the state of lysosomal membranes and intensity of lysosomal proteolysis in different rat tissues during physiological aging of the organism].

    Science.gov (United States)

    Kutilin, D S; Bondarenko, T I; Mikhaleva, I I

    2014-01-01

    It is shown that subcutaneous injection of exogenous delta-sleep inducing peptide (DSIP) to rats aged 2-24 months in a dose of 100 μg/kg animal body weight by courses of 5 consecutive days per month has a stabilizing effect on the state of lysosomal membranes in rat tissues (brain, heart muscle and liver) at different ontogenetic stages, and this effect is accompanied by increasing intensity of lysosomal proteolysis in these tissues.

  8. Emergency department case management: the dyad team of nurse case manager and social worker improve discharge planning and patient and staff satisfaction while decreasing inappropriate admissions and costs: a literature review.

    Science.gov (United States)

    Bristow, Darlene P; Herrick, Charlotte A

    2002-01-01

    A model of emergency department (ED) case management consisting of a social worker and a nurse case manager can prevent inappropriate admissions, improve discharge planning, decrease cost, and enhance patient satisfaction. The individual and combined roles of the dyad team of social worker and nurse case manager are discussed. A literature review includes how a case management dyad team of social worker and nurse case manager in the ED can decrease utilization of the ED for nonemergent visits, promote the use of community resources, and improve discharge planning to avoid excessive costs. The importance of the dyad team working with the interdisciplinary team in the ED, the primary care physician (PCP), and other community health care providers in order to provide a holistic approach to care is addressed. A discussion about the improvement of both patient and staff satisfaction demonstrates the results of case management strategies that support and advocate for patients to receive quality, cost-effective care across the health care continuum, while decreasing the use of the ED for nonemergent care.

  9. Intensive mobilities

    DEFF Research Database (Denmark)

    Vannini, Phillip; Bissell, David; Jensen, Ole B.

    with fieldwork conducted in Canada, Denmark and Australia to develop our understanding of the experiential politics of long distance workers. Rather than focusing on the extensive dimensions of mobilities that are implicated in patterns and trends, our paper turns to the intensive dimensions of this experience......This paper explores the intensities of long distance commuting journeys as a way of exploring how bodily sensibilities are being changed by the mobilities that they undertake. The context of this paper is that many people are travelling further to work than ever before owing to a variety of factors...... which relate to transport, housing and employment. Yet we argue that the experiential dimensions of long distance mobilities have not received the attention that they deserve within geographical research on mobilities. This paper combines ideas from mobilities research and contemporary social theory...

  10. Emission and chemistry of organic compounds from biomass burning: measurements from an iodide time-of-flight chemical ionization mass spectrometer (I- ToF-CIMS) during the FIREX FireLab 2016 intensive

    Science.gov (United States)

    Yuan, B.; Krechmer, J. E.; Warneke, C.; Coggon, M.; Koss, A.; Lim, C. Y.; Selimovic, V.; Gilman, J.; Lerner, B. M.; Stark, H.; Kang, H.; Jimenez, J. L.; Yokelson, R. J.; Liggio, J.; Roberts, J. M.; Kroll, J. H.; De Gouw, J. A.

    2017-12-01

    Biomass burning can emit large amounts of many different organic compounds to the atmosphere. The emission strengths of these emitted organic compounds and their subsequent atmospheric chemistry are not well known. In this study, we deployed a time-of-flight chemical ionization mass spectrometer using iodide as reagent ions (Iodide ToF-CIMS) to measure direct emissions of organic compounds during the FIREX laboratory 2016 intensive in the USDA Fire Sciences Lab in Missoula, MT. An interpretation of the I­- TOF-CIMS mass spectra from biomass burning emissions will be presented. The dependence of the emissions of selected organic compounds with fuel types, combustion efficiency and fuel chemical compositions will be discussed. The I- TOF-CIMS also measured aged biomass burning smoke from a small smog chamber and an oxidative flow reactor (OFR). The I- TOF-CIMS consistently observed much higher signals of highly oxygenated organic compounds in the aged biomass burning smoke than in fresh emissions, indicative of strong secondary formation of these organic compounds in biomass burning plumes.

  11. The Impact of Introducing Malaria Rapid Diagnostic Tests on Fever Case Management: A Synthesis of Ten Studies from the ACT Consortium.

    Science.gov (United States)

    Bruxvoort, Katia J; Leurent, Baptiste; Chandler, Clare I R; Ansah, Evelyn K; Baiden, Frank; Björkman, Anders; Burchett, Helen E D; Clarke, Siân E; Cundill, Bonnie; DiLiberto, Debora D; Elfving, Kristina; Goodman, Catherine; Hansen, Kristian S; Kachur, S Patrick; Lal, Sham; Lalloo, David G; Leslie, Toby; Magnussen, Pascal; Mangham-Jefferies, Lindsay; Mårtensson, Andreas; Mayan, Ismail; Mbonye, Anthony K; Msellem, Mwinyi I; Onwujekwe, Obinna E; Owusu-Agyei, Seth; Rowland, Mark W; Shakely, Delér; Staedke, Sarah G; Vestergaard, Lasse S; Webster, Jayne; Whitty, Christopher J M; Wiseman, Virginia L; Yeung, Shunmay; Schellenberg, David; Hopkins, Heidi

    2017-10-01

    Since 2010, the World Health Organization has been recommending that all suspected cases of malaria be confirmed with parasite-based diagnosis before treatment. These guidelines represent a paradigm shift away from presumptive antimalarial treatment of fever. Malaria rapid diagnostic tests (mRDTs) are central to implementing this policy, intended to target artemisinin-based combination therapies (ACT) to patients with confirmed malaria and to improve management of patients with nonmalarial fevers. The ACT Consortium conducted ten linked studies, eight in sub-Saharan Africa and two in Afghanistan, to evaluate the impact of mRDT introduction on case management across settings that vary in malaria endemicity and healthcare provider type. This synthesis includes 562,368 outpatient encounters (study size range 2,400-432,513). mRDTs were associated with significantly lower ACT prescription (range 8-69% versus 20-100%). Prescribing did not always adhere to malaria test results; in several settings, ACTs were prescribed to more than 30% of test-negative patients or to fewer than 80% of test-positive patients. Either an antimalarial or an antibiotic was prescribed for more than 75% of patients across most settings; lower antimalarial prescription for malaria test-negative patients was partly offset by higher antibiotic prescription. Symptomatic management with antipyretics alone was prescribed for fewer than 25% of patients across all scenarios. In community health worker and private retailer settings, mRDTs increased referral of patients to other providers. This synthesis provides an overview of shifts in case management that may be expected with mRDT introduction and highlights areas of focus to improve design and implementation of future case management programs.

  12. Patient–Clinician Mobile Communication: Analyzing Text Messaging Between Adolescents with Asthma and Nurse Case Managers

    Science.gov (United States)

    Kim, Soo Yun; Hong, Yangsun; Chih, Ming-Yuan; Shah, Dhavan V.; Gustafson, David H.

    2015-01-01

    Abstract Background: With the increasing penetration of digital mobile devices among adolescents, mobile texting messaging is emerging as a new channel for patient–clinician communication for this population. In particular, it can promote active communication between healthcare clinicians and adolescents with asthma. However, little is known about the content of the messages exchanged in medical encounters via mobile text messaging. Therefore, this study explored the content of text messaging between clinicians and adolescents with asthma. Materials and Methods: We collected a total of 2,953 text messages exchanged between 5 nurse case managers and 131 adolescents with asthma through a personal digital assistant. The text messages were coded using a scheme developed by adapting categories from the Roter Interaction Analysis System. Results: Nurse case managers sent more text messages (n=2,639) than adolescents with asthma. Most messages sent by nurse case managers were targeted messages (n=2,475) directed at all adolescents with asthma, whereas there were relatively few tailored messages (n=164) that were created personally for an individual adolescent. In addition, both targeted and tailored messages emphasized task-focused behaviors over socioemotional behaviors. Likewise, text messages (n=314) sent by adolescents also emphasized task-focused over socioemotional behaviors. Conclusions: Mobile texting messaging has the potential to play an important role in patient–clinician communication. It promotes not only active interaction, but also patient-centered communication with clinicians. In order to achieve this potential, healthcare clinicians may need to focus on socioemotional communication as well as task-oriented communication. PMID:25401324

  13. [Case management as a methodology for connecting the health and social care systems in Spain].

    Science.gov (United States)

    Garcés, Jorge; Ródenas, Francisco

    2015-10-01

    The aim of this paper is to present the assessment of a case management project, implemented with chronic patients in Valencia, for the integration of health and social care. This project is linked with the 'Sustainable Socio-Health Model'. Health department 06 in Valencia. The target groups were chronic patients of 65 years and over. A non-randomized non-blinded comparative study with an intervention and control group. The intervention consisted in the creation of an interdisciplinary case management team, the use of a common portfolio of resources, and its application to a pilot sample with an intervention period of 6-9 months. Diseases (ICD-9), functional capacity, use of health and social resources, satisfaction, unit cost services. There was an increase in the combined use of health and social resources in the intervention group, which included social day centers (21.8% in the intervention group compared to 9.8% in the control group), in coordination with primary care (suggested as the only health resource in 55.4% of cases). There was a decrease in the number of medical visits in the intervention group (43.6% versus 74.5% in the control group). Increased patient satisfaction (55.5% in the intervention group compared to 29.4% in the control group) was observed. At least an extra 4.4% of patients were treated using hospital resources without increasing costs. Case management using a common unique portfolio of health and social resources can improve the coordination of resources, increases patient satisfaction and increases the capacity of using of hospital resources. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  14. The political economy of a public health case management program's transition into medical homes.

    Science.gov (United States)

    Wells, Rebecca; Cilenti, Dorothy; Issel, L Michele

    2015-11-01

    Throughout the United States, public health leaders are experimenting with how best to integrate services for individuals with complex needs. To that end, North Carolina implemented a policy incorporating both local public health departments and other providers into medical homes for low income pregnant women and young children at risk of developmental delays. To understand how this transition occurred within local communities, a pre-post comparative case study was conducted. A total of 42 people in four local health departments across the state were interviewed immediately before the 2011 policy change and six months later: 32 professionals (24 twice) and 10 pregnant women receiving case management at the time of the policy implementation. We used constant comparative analysis of interview and supplemental data to identify three key consequences of the policy implementation. One, having medical homes increased the centrality of other providers relative to local health departments. Two, a shift from focusing on personal relationships toward medical efficiency diverged in some respects from both case managers' and mothers' goals. Three, health department staff re-interpreted state policies to fit their public health values. Using a political economy perspective, these changes are interpreted as reflecting shifts in public health's broader ideological environment. To a large extent, the state successfully induced more connection between health department-based case managers and external providers. However, limited provider engagement may constrain the implementation of the envisioned medical homes. The increased focus on medical risk may also undermine health departments' role in supporting health over time by attenuating staff relationships with mothers. This study helps clarify how state public health policy innovations unfold at local levels, and why front line practice may in some respects diverge from policy intent. Published by Elsevier Ltd.

  15. Triage of the autistic spectrum child utilizing the congruence of case management concepts and Orem's Nursing Theories.

    Science.gov (United States)

    Oliver, Catherine J

    2003-01-01

    The purpose of this project was to design and implement a case management framework for the benefit of children diagnosed with an autistic spectrum disorder (ASD). The process consisted of selecting two children exhibiting symptoms of an ASD and managing them across a continuum of care. Methodological structure was derived from case management standards of practice and Orem's Nursing Theories. Although some objectives sustained a slight delay because of variances, findings revealed successful outcomes based on progression toward measurable case management goals. The children were directed to appropriate school placements and habilitative therapies in an efficient manner. Their parents received support and education related to special needs children. The process yielded assurance that Orem's Nursing Theories and case management concepts articulate seamlessly within nursing care boundaries.

  16. Use of standardized multidimensional evaluation tools and the emergence of the case manager's professional identity in France.

    Science.gov (United States)

    Nugue, Mathilde; De Stampa, Matthieu; Couturier, Yves; Somme, Dominique

    2012-01-01

    In France, the national public health plan proposes a group of innovations including the initiation of case management for older adults in complex situations, particularly those with cognitive disorders. In this context, public authorities asked case managers to use a standardized multidimensional evaluation tool. The results of a qualitative study on the pertinence of such a tool relative to the emergence of this new professional field are described. Early use of an evaluation tool seems to be linked to the emergence of a new professional identity for recently recruited case managers. Factors determining the strength of this link are training tool standardization, computerization, and local structure's involvement. Our results contribute to identifying one of the ways by which professional identity can be changed to become a case manager.

  17. A Randomized Controlled Trial of Hospital-based Case Management in Cancer Care

    DEFF Research Database (Denmark)

    Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens

    2012-01-01

    BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital...... and out of hours were collected 9 months after recruitment and the data from the two groups were compared quarterly. RESULTS: CM was associated with an overall tendency towards more positive GP evaluations, which for 3 of 20 items reached statistical significance. Statistically significantly fewer GPs...

  18. Traumatic brain injury rehabilitation: case management and insurance-related issues.

    Science.gov (United States)

    Pressman, Helaine Tobey

    2007-02-01

    Traumatic brain injury (TBI) cases are medically complex, involving the physical, cognitive, behavioral, social, and emotional aspects of the survivor. Often catastrophic, these cases require substantial financial resources not only for the patient's survival but to achieve the optimal outcome of a functional life with return to family and work responsibilities for the long term. TBI cases involve the injured person, the family, medical professionals such as treating physicians, therapists, attorneys, the employer, community resources, and the funding source, usually an insurance company. Case management is required to facilitate achievement of an optimal result by collaborating with all parties involved, assessing priorities and options, coordinating services, and educating and communicating with all concerned.

  19. Development of a nurse case management service: a proposed business plan for rural hospitals.

    Science.gov (United States)

    Adams, Marsha Howell; Crow, Carolyn S

    2005-01-01

    The nurse case management service (NCMS) for rural hospitals is an entrepreneurial endeavor designed to provide rural patients with quality, cost-effective healthcare. This article describes the development of an NCMS. A detailed marketing and financial plan, a review of industry trends, and the legal structure and risks associated with the development of the venture are presented. The financial plan projects a minimum savings of 223,200 dollars for rural institutions annually. To improve quality and reduce cost for rural hospitals, the authors recommend implementation of an NCMS.

  20. Pro-ACT II: integrating utilization management, discharge planning, and nursing case management into the outcomes manager role.

    Science.gov (United States)

    Brett, J L; Bueno, M; Royal, N; Kendall-Sengin, K

    1997-02-01

    Building on redesign efforts that created case management, clinical care technicians, support service hosts, and pharmacy technician roles, this redesign focused on integrating case management, utilization management, and discharge planning functions into a new outcomes manager role. The authors describe the process of developing and implementing the new role and outline specific actions that eliminated redundancy and inefficiency. Results of the evaluation of the project are reviewed, including full-time equivalent and salary savings and employee and physician satisfaction improvements.

  1. The Role of Information Systems and Technology in Case Management: a case study in health and welfare insurance

    Directory of Open Access Journals (Sweden)

    Helen Richardson

    2003-05-01

    Full Text Available This study reports the role of information system and technology (IST in supporting case management at the Accident Compensation Corporation (ACC of New Zealand. Case management is a managerial approach that seeks to gain improved business performance by enhancing both employee and customer satisfaction. Despite millions of dollars spent annually by health, social, and insurance agencies in automating case management, little research has been conducted into the role of IST in this practice. The findings of this study show that for ACC, IST’s most valuable role is enhancing the relationship between client and case manager rather than replacing it for, even after the addition of IST, the most valuable knowledge continues to accrue from the face to face interaction of client and case manager. The findings also show two distinct phases to the development of case managers as knowledge workers. The first phase focuses on control of the processes and the second on the delivery and sharing of information resources.

  2. Health worker perceptions of integrating mobile phones into community case management of malaria in Saraya, Senegal.

    Science.gov (United States)

    Blanas, Demetri A; Ndiaye, Youssoupha; MacFarlane, Matthew; Manga, Isaac; Siddiqui, Ammar; Velez, Olivia; Kanter, Andrew S; Nichols, Kim; Hennig, Nils

    2015-05-01

    Although community case management of malaria increases access to life-saving care in isolated settings, it contends with many logistical challenges. Mobile phone health information technology may present an opportunity to address a number of these barriers. Using the wireless adaptation of the technology acceptance model, this study assessed availability, ease of use, usefulness, and job relevance of mobile phones by health workers in Saraya, Senegal. This study conducted seven key informant interviews with government health workers, and three focus groups and 76 surveys with lay health workers. Principal findings included that mobile phones are already widely available and used, and that participants valued using phones to address training, stock management, programme reporting, and transportation challenges. By documenting widespread use of mobile phones and health worker perceptions of their most useful applications, this paper provides a framework for their integration into the community case management of malaria programme in Saraya, Senegal. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. The role of interagency collaboration in "joined-up" case management.

    Science.gov (United States)

    Grace, Marty; Coventry, Louise; Batterham, Deb

    2012-03-01

    This article reports on research into the relationships that a group of case managers formed with local service providers in order to deliver integrated, "joined-up" services to young people experiencing homelessness and unemployment in the state of Victoria, Australia. Using a two-part customized survey tool, we explored the number and nature of relationships with other agencies. Two focus group discussions contributed to the interpretation of the survey findings. We found that these case managers maintained many relationships, mostly with housing and employment service providers. These relationships were predominantly cooperative in nature, and most could not easily be characterized as collaborative. Our research supports the view that, in an increasingly complex social service system, other forms of cooperation are usually appropriate for achieving the types of interorganizational relationships that are important to assist shared clients. Furthermore, this research supports the notion of a relationship continuum, finding that ratings of relationship elements were positively correlated with relationship type. This research indicates the importance of considering the pragmatic, contextual and situated practices that comprise interagency relationships, their fitness for purpose and the importance of cooperation for effective service provision.

  4. Nurse case management for pregnant women experiencing or at risk for abuse.

    Science.gov (United States)

    Curry, Mary Ann; Durham, Laurel; Bullock, Linda; Bloom, Tina; Davis, Jan

    2006-01-01

    To determine whether individualized nursing case management can decrease stress among pregnant women at risk for or in abusive relationships. A multisite randomized controlled trial. Two prenatal clinics in the Pacific Northwest and rural Midwest. 1,000 women who spoke English and were 13 to 23 weeks pregnant at time of recruitment. All intervention group women (N = 499) were offered an abuse video and had access to a nurse case manager 24/7. Additionally, participants at risk for or in abusive relationships received individualized nursing care management throughout the pregnancy. The most frequent nursing care management activities were providing support (38%) and assessing needs (32%). The nursing care management group received an average of 22 contacts, most (80%) by telephone and had a significant reduction in stress scores as measured by the Prenatal Psychosocial Profile. Compared to the control group, the differences were in the predicted direction, but not statistically different. A major finding was the choice by abused women to focus on basic needs and their pregnancies rather than the abuse, although all received safety planning. Pregnant women at risk for or in abusive relationships experience very stressful and complex lives. Nurses need to focus on the needs they identify, which may not be the abusive relationship.

  5. Effectiveness of Strengths-Based Case Management for People with Mental Health Problems in Hong Kong

    Directory of Open Access Journals (Sweden)

    Kevin Y. C. Hui

    2016-02-01

    Full Text Available This study examined the effectiveness of a 6-month strengths-based case management intervention with 45 Chinese participants with mental health problems in Hong Kong. Social workers provided service according to the strengths-based case management (SCM model developed at the University of Kansas. Changes in participants’ recovery components (Stage of Recovery Scale, mental health symptoms (GHQ, and satisfaction with life were assessed using a single group pretest and posttest design. Results suggest that participants had some improvement in their autonomy, hope, and overall well-being as well as satisfaction with life after receiving services. No significant improvements in the other recovery components and GHQ score were found. Significantly, a number of participants progressed from stages of being overwhelmed or struggling with disability to stages of living with or beyond disability. Strengths-based practice helped participants develop a transformed self which sees hope and possibility despite the vulnerabilities caused by their illness. Though further refinement and testing are vital, adoption of SCM in Hong Kong mental health services is promising.

  6. [Implementation and evaluation of case management in Catalonia: the ISP-SMD program].

    Science.gov (United States)

    Balsera Gómez, J; Rodríguez Medina, C; Caba Calvet, R; Vega Prada, R; Ruiz Ureña, H; Berruezo Ortiz, L; Clusa Gironella, D; Rodríguez Montes, M J; Haro Abad, J M

    2002-01-01

    The pilot study of the Individualized Service Program for people with Severe Mental Disorders (ISP-SMD) consists of the implementation of case management services in Catalonia. The ISP-SMD has been implemented in two health care sectors and will be expanded to the rest of Catalonia in the next years. The program serves people with persistent mental disorders who have serious social or family problems and/or who have inadequate mental health service use (high use of inpatient services, no use of community services). The ISP-SMD is a community intervention program that focuses its activities on direct care and coordination between services. Thirty patients have been included in the evaluation. The results of the pilot study have shown that, compared to the year before entering the program, the patients show better clinical status, they decrease their unmet need level, they have more appropriate use of health services and have lower treatment costs. Satisfaction of the patients, family members and professionals with the program is very high. It is possible to adapt and implement case management services in Catalonia. When implemented, they improve patient quality of life.

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

    Science.gov (United States)

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

    1991-10-01

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

  8. Response of saprotrophic microfungi degrading the fulvic fraction of soil organic matter to different n fertilization intensities, different plant species cover and elevated atmospheric CO2 concentration

    Czech Academy of Sciences Publication Activity Database

    Strnadová, Veronika; Hršelová, Hana; Kolařík, Miroslav; Gryndler, Milan

    2004-01-01

    Roč. 49, č. 5 (2004), s. 563-568 ISSN 0015-5632 R&D Projects: GA ČR GA526/03/0188; GA ČR GD206/03/H137 Institutional research plan: CEZ:AV0Z5020903 Keywords : saprotrophic microfungi * soil organic matter Subject RIV: EE - Microbiology, Virology Impact factor: 1.034, year: 2004

  9. Evaluation of case management of uncomplicated malaria in Haiti: a national health facility survey, 2012.

    Science.gov (United States)

    Landman, Keren Z; Jean, Samuel E; Existe, Alexandre; Akom, Eniko E; Chang, Michelle A; Lemoine, Jean Frantz; Mace, Kimberly E

    2015-10-09

    Malaria is a public health concern in Haiti, although there are limited data on its burden and case management. National malaria guidelines updated in 2012 recommend treatment with chloroquine and primaquine. In December 2012, a nationally-representative cross-sectional survey of health facilities (HFs) was conducted to determine malaria prevalence among febrile outpatients and malaria case management quality at baseline before scale-up of diagnostics and case management training. Among all 833 HFs nationwide, 30 were selected randomly, in proportion to total HFs per region, for 2-day evaluations. Survey teams inventoried HF material and human resources. Outpatients of all ages were screened for temperature >37.5 °C or history of fever; those without severe symptoms were consented and enrolled. Providers evaluated and treated enrolled patients according to HF standards; the survey teams documented provider-ordered diagnostic tests and treatment decisions. Facility-based test results [microscopy and malaria rapid diagnostic tests (RDTs)] were collected from HF laboratories. Blood smears for gold-standard microscopy, and dried blood spots for polymerase chain reaction (PCR) were obtained. Malaria diagnostic capacity, defined as completing a test for an enrolled patient or having adequate resources for RDTs or microscopy, was present in 11 (37 %) HFs. Among 459 outpatients screened, 257 (56 %) were febrile, of which 193 (75 %) were eligible, and 153 (80 %) were enrolled. Among 39 patients with facility-level malaria test results available on the survey day, 11 (28 %) were positive, of whom 6 (55 %) were treated with an anti-malarial. Twenty-seven (95 %) of the 28 patients testing negative were not treated with an anti-malarial. Of 114 patients without test results available, 35 (31 %) were presumptively treated for malaria. Altogether, 42 patients were treated with an anti-malarial, one (2 %) according to Haiti's 2012 guidelines. Of 140 gold-standard smears, none

  10. Scrub Typhus - A Major Cause of Pediatric Intensive Care Admission and Multiple Organ Dysfunction Syndrome: A Single-Center Experience from India.

    Science.gov (United States)

    Giri, Prabahs Prasun; Roy, Joydeb; Saha, Agnisekhar

    2018-02-01

    Scrub typhus has been globally recognized as an emerging infectious disease contributing significantly to pyrexia of unknown origin (PUO) and a potential cause of multiorgan dysfunction syndrome (MODS). We studied the incidence of scrub typhus as a cause of pediatric intensive care unit (PICU) admission and MODS in our hospital and its clinical and laboratory characteristics to measure the incidence of MODS caused by scrub typhus. This study was done in a pediatric teaching hospital in Kolkata, India. Records of patients admitted with PUO from March 2012 to December 2015 were reviewed. Rathi-Goodman-Aghai scoring system was used to identify potential ST patients and confirmed by serological testing. Clinical characteristics, laboratory findings, and treatment response were noted of those needing PICU admissions. Ninety-seven cases of scrub typhus have been identified during that period. PICU admission was needed in 30 of them (31%) which contributed 8.43% of total PICU admissions. Among these 30 patients, 16 (53%) developed MODS which contributed 18.29% of total MODS admitted in PICU. Septic shock was the most common manifestation in as many as 18 (60%) patients followed by encephalopathy in 13 (43%). Patients were treated with either doxycycline alone or in combination with azithromycin. Mean time to complete defervescence was 32 h after first dose of doxycycline. The outcome was excellent without a single mortality. Scrub typhus is an important cause of MODS in this part of the world, especially in fevers associated with features as identified and not responding to conventional antibiotics.

  11. New Copolymers Containing Charge Carriers for Organic Devices with ITO Films Treated by UV-Ozone Using High Intensity Discharge Lamp

    Directory of Open Access Journals (Sweden)

    Emerson Roberto SANTOS

    2009-02-01

    Full Text Available For electroluminescent devices new copolymers were synthesized using a Suzuki cross-coupling reaction based on monomers (fluorine-alt-phenylene in conjugation with quinoline-alt-phenylene units. They were characterized by 1H NMR, 13C NMR and FTIR. TGA measurements indicated that the copolymers have good thermal properties and no weight loss was observed up to 250 °C. The UV-Vis spectra were characterized by absorptions from the fluorene-alt-phenylene and quinoline-alt-phenylene segments in the backbone, while their photoluminescence (PL spectra dominated by emissions from the fluorene excimer. For devices assembly ITO films were treated using a High Intensity Discharge Lamp (HPMVL without outer bulb presenting high ozone concentration than that conventional germicidal lamp. The device with ITO treated revealed significant decrease of threshold voltage (or turn-on voltage compared by untreated with I-V curves. This decrease can be related by water and carbon dioxide extracted on surface after UV-Ozone treatment revealed by DRIFT measurements.

  12. The net effects of the Project NetWork return-to-work case management experiment on participant earnings, benefit receipt, and other outcomes.

    Science.gov (United States)

    Kornfeld, R; Rupp, K

    2000-01-01

    The Social Security Administration (SSA) initiated Project NetWork in 1991 to test case management as a means of promoting employment among persons with disabilities. The demonstration, which targeted Social Security Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) applicants and recipients, offered intensive outreach, work-incentive waivers, and case management/referral services. Participation in Project NetWork was voluntary. Volunteers were randomly assigned to the "treatment" group or the "control" group. Those assigned to the treatment group met individually with a case or referral manager who arranged for rehabilitation and employment services, helped clients develop an individual employment plan, and provided direct employment counseling services. Volunteers assigned to the control group could not receive services from Project NetWork but remained eligible for any employment assistance already available in their communities. For both treatment and control groups, the demonstration waived specific DI and SSI program rules considered to be work disincentives. The experimental impact study thus measures the incremental effects of case and referral management services. The eight demonstration sites were successful in implementing the experimental design roughly as planned. Project NetWork staff were able to recruit large numbers of participants and to provide rehabilitation and employment services on a substantial scale. Most of the sites easily reached their enrollment targets and were able to attract volunteers with demographic characteristics similar to those of the entire SSI and DI caseload and a broad range of moderate and severe disabilities. However, by many measures, volunteers were generally more "work-ready" than project eligible in the demonstration areas who did not volunteer to receive NetWork services. Project NetWork case management increased average annual earnings by $220 per year over the first 2 years following

  13. An evidence-based approach to case management model selection for an acute care facility: is there really a preferred model?

    Science.gov (United States)

    Terra, Sandra M

    2007-01-01

    This research seeks to determine whether there is adequate evidence-based justification for selection of one acute care case management model over another. Acute Inpatient Hospital. This article presents a systematic review of published case management literature, resulting in classification specific to terms of level of evidence. This review examines the best available evidence in an effort to select an acute care case management model. Although no single case management model can be identified as preferred, it is clear that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and to form a foundation for the efficacy of hospital case management practice. Although no single case management model can be identified as preferred, this systematic review demonstrates that adequate evidence-based literature exists to acknowledge key factors driving the acute care model and forming a foundation for the efficacy of hospital case management practice. Distinctive aspects of case management frameworks can be used to guide the development of an acute care case management model. The study illustrates: * The effectiveness of case management when there is direct patient contact by the case manager regardless of disease condition: not only does the quality of care increase but also length of stay (LOS) decreases, care is defragmented, and both patient and physician satisfaction can increase. * The preferred case management models result in measurable outcomes that can directly relate to, and demonstrate alignment with, organizational strategy. * Acute care management programs reduce cost and LOS, and improve outcomes. * An integrated case management program that includes social workers, as well as nursing, is the most effective acute care management model. * The successful case management model will recognize physicians, as well as patients, as valued customers with whom partnership can positively affect financial outcomes in terms of

  14. Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Jonathan Stokes

    Full Text Available An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care 'at-risk' of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis.We carried out a systematic review and meta-analysis of the effectiveness of case management for 'at-risk' patients in primary care. Six bibliographic databases were searched using terms for 'case management', 'primary care', and a methodology filter (Cochrane EPOC group. Effectiveness compared to usual care was measured across a number of relevant outcomes: Health--self-assessed health status, mortality; Cost--total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately, and; Satisfaction--patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14. A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36 and long-term (0.35, 0.04 to 0.66. Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial 'strength' of primary care.This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and

  15. Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Stokes, Jonathan; Panagioti, Maria; Alam, Rahul; Checkland, Kath; Cheraghi-Sohi, Sudeh; Bower, Peter

    2015-01-01

    An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care 'at-risk' of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis. We carried out a systematic review and meta-analysis of the effectiveness of case management for 'at-risk' patients in primary care. Six bibliographic databases were searched using terms for 'case management', 'primary care', and a methodology filter (Cochrane EPOC group). Effectiveness compared to usual care was measured across a number of relevant outcomes: Health--self-assessed health status, mortality; Cost--total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately), and; Satisfaction--patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14). A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36) and long-term (0.35, 0.04 to 0.66). Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial 'strength' of primary care. This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and considered also the

  16. Nurse case-manager vs multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study.

    Science.gov (United States)

    Majumdar, S R; Johnson, J A; Bellerose, D; McAlister, F A; Russell, A S; Hanley, D A; Garg, S; Lier, D A; Maksymowych, W P; Morrish, D W; Rowe, B H

    2011-01-01

    Few outpatients with fractures are treated for osteoporosis in the years following fracture. In a randomized pilot study, we found a nurse case-manager could double rates of osteoporosis testing and treatment compared with a proven efficacious quality improvement strategy directed at patients and physicians (57% vs 28% rates of appropriate care). Few patients with fractures are treated for osteoporosis. An intervention directed at wrist fracture patients (education) and physicians (guidelines, reminders) tripled osteoporosis treatment rates compared to controls (22% vs 7% within 6 months of fracture). More effective strategies are needed. We undertook a pilot study that compared a nurse case-manager to the multifaceted intervention using a randomized trial design. The case-manager counseled patients, arranged bone mineral density (BMD) tests, and prescribed treatments. We included controls from our first trial who remained untreated for osteoporosis 1-year post-fracture. Primary outcome was bisphosphonate treatment and secondary outcomes were BMD testing, appropriate care (BMD test-treatment if bone mass low), and costs. Forty six patients untreated 1-year after wrist fracture were randomized to case-manager (n = 21) or multifaceted intervention (n = 25). Median age was 60 years and 68% were female. Six months post-randomization, 9 (43%) case-managed patients were treated with bisphosphonates compared with 3 (12%) multifaceted intervention patients (relative risk [RR] 3.6, 95% confidence intervals [CI] 1.1-11.5, p = 0.019). Case-managed patients were more likely than multifaceted intervention patients to undergo BMD tests (81% vs 52%, RR 1.6, 95%CI 1.1-2.4, p = 0.042) and receive appropriate care (57% vs 28%, RR 2.0, 95%CI 1.0-4.2, p = 0.048). Case-management cost was $44 (CDN) per patient vs $12 for the multifaceted intervention. A nurse case-manager substantially increased rates of appropriate testing and treatment for osteoporosis in

  17. Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients

    DEFF Research Database (Denmark)

    Fenny, Ama P; Hansen, Kristian S; Enemark, Ulrika

    2014-01-01

    of health insurance on the quality of case management for patients with uncomplicated malaria, ascertaining any significant differences in treatment between insured and non-insured patients. METHOD: A structured questionnaire was used to collect data from 523 respondents diagnosed with malaria....... This is especially the case for parasitological confirmation of all suspected malaria patients before treatment with an antimalarial as currently recommended for the effective management of malaria in the country. The results show that about 16 percent of total sample were parasitologically tested. Effective......INTRODUCTION: The National Health Insurance Act, 2003 (Act 650) established the National Health Insurance Scheme (NHIS) in Ghana with the aim of increasing access to health care and improving the quality of basic health care services for all citizens. The main objective is to assess the effect...

  18. Special Needs Adoption and Foster Exigencies (SAFE: A Model for Case Managers

    Directory of Open Access Journals (Sweden)

    Kristen Linton

    2014-05-01

    Full Text Available Children with special needs disproportionately receive child welfare services in out-of-home placements, such as foster and adoptive homes. This theoretical model has been developed to describe or explain exigencies of adoptive and foster families of children with special needs (n = 82. A web content analysis, including theme, feature, link, exchange, and language analyses, of online discussion forums of adoptive and foster parents of children with special needs using a phenomenological framework was conducted. Inductive and quantitative web content analyses were conducted on themes. Parenting concerns were clustered into two main themes, disability and placement issues, and focused on children’s pre and post placement needs. A phenomenological analysis resulted in the development of the Special Needs Adoption and Foster Exigencies (SAFE, which outlines exigencies of adoptive and foster parents of children with special needs during engagement, assessment, and intervention phases of case management.

  19. Juvenile Probation Officer Self-Assessed Mental Health Competency as a Predictor of Case Management Practices.

    Science.gov (United States)

    Holloway, Evan D; Cruise, Keith R; Downs, Sarah M; Monahan, Patrick O; Aalsma, Matthew C

    2017-07-01

    Justice-involved youth endorse high rates of mental health problems. Juvenile probation is the most common disposition in the justice system and juvenile probation officers (JPOs) are crucial for connecting justice-involved youth with appropriate care. We examined the role of mental health competency on the use of self-report case management strategy types (deterrence, restorative justice, and treatment) by JPOs and whether jurisdiction-level differences were relevant. Results suggest that mental health competency predicted use of restorative justice and treatment strategies and all three strategy types varied at the county level. The role of mental health competency in use of treatment strategies is relevant to connecting justice-involved youth to mental health care. Furthermore, a substantial amount of the variance predicting the use of all three strategies was accounted for at the county level.

  20. Economic Evaluation of Community-Based Case Management of Patients Suffering From Chronic Obstructive Pulmonary Disease

    DEFF Research Database (Denmark)

    Sørensen, Sabrina Storgaard; Pedersen, Kjeld Møller; Weinreich, Ulla Møller

    2017-01-01

    Objectives: To analyse the cost effectiveness of community-based case management for patients suffering from chronic obstructive pulmonary disease (COPD). Methods: The study took place in the third largest municipality in Denmark and was conducted as a randomised controlled trial with 12 months...... was the incremental cost-effectiveness ratio (ICER) as cost per quality-adjusted life year (QALY) from the perspective of the healthcare sector. Costs were valued in British Pounds (£) at price level 2016. Scenario analyses and probabilistic sensitivity analyses were conducted in order to assess uncertainty...... of the ICER estimate. Results: The intervention resulted in a QALY improvement of 0.0146 (95% CI −0.0216; 0.0585), and a cost increase of £494 (95% CI −1778; 2766) per patient. No statistically significant difference was observed either in costs or effects. The ICER was £33,865 per QALY gained. Scenario...

  1. Primary immunodeficiency disease: a model for case management of chronic diseases.

    Science.gov (United States)

    Burton, Janet; Murphy, Elyse; Riley, Patty

    2010-01-01

    Patient-centered chronic care management is a new model for the management of rare chronic diseases such as primary immunodeficiency disease (PIDD). This approach emphasizes helping patients become experts on the management of their disease as informed, involved, and interactive partners in healthcare decisions with providers. Because only a few patients are affected by rare illnesses, these patients are forced to become knowledgeable about their disease and therapies and to seek treatment from a healthcare team, which includes physicians and nurse specialists who are equipped to manage the complexity of the disease and its comorbidities. Importantly, therapy for PIDD can be self-administered at home, which has encouraged the transition toward a proactive stance that is at the heart of patient-centered chronic care management. We discuss the evolution of therapy, the issues with the disease, and challenges with its management within the framework of other chronic disease management programs. Suggestions and rationale to move case management of PIDD forward are presented with the intent that sharing our experiences will improve process and better manage outcomes in this patient population. The patient-centered model for the management of PIDD is applicable to the primary care settings, where nurse case managers assist patients through education, support them and their families, and facilitate access to community resources in an approach, which has been described as "guided care." The model also applies specifically to immunology centers where patients receive treatment or instruction on its self-administration at home. Patient-centered management of PIDD, with its emphasis on full involvement of patients in their treatment, has the potential to improve compliance with treatment, and thus patient outcomes, as well as patients' quality of life. The patient-centered model expands the traditional model of chronic disease management, which relies on evidence

  2. Effective coverage and systems effectiveness for malaria case management in sub-Saharan African countries.

    Directory of Open Access Journals (Sweden)

    Katya Galactionova

    Full Text Available Scale-up of malaria preventive and control interventions over the last decade resulted in substantial declines in mortality and morbidity from the disease in sub-Saharan Africa and many other parts of the world. Sustaining these gains will depend on the health system performance. Treatment provides individual benefits by curing infection and preventing progression to severe disease as well as community-level benefits by reducing the infectious reservoir and averting emergence and spread of drug resistance. However many patients with malaria do not access care, providers do not comply with treatment guidelines, and hence, patients do not necessarily receive the correct regimen. Even when the correct regimen is administered some patients will not adhere and others will be treated with counterfeit or substandard medication leading to treatment failures and spread of drug resistance. We apply systems effectiveness concepts that explicitly consider implications of health system factors such as treatment seeking, provider compliance, adherence, and quality of medication to estimate treatment outcomes for malaria case management. We compile data for these indicators to derive estimates of effective coverage for 43 high-burden Sub-Saharan African countries. Parameters are populated from the Demographic and Health Surveys and other published sources. We assess the relative importance of these factors on the level of effective coverage and consider variation in these health systems indicators across countries. Our findings suggest that effective coverage for malaria case management ranges from 8% to 72% in the region. Different factors account for health system inefficiencies in different countries. Significant losses in effectiveness of treatment are estimated in all countries. The patterns of inter-country variation suggest that these are system failures that are amenable to change. Identifying the reasons for the poor health system performance and

  3. Patients' experiences of a multidisciplinary team-led community case management programme: a qualitative study.

    Science.gov (United States)

    Gowing, Alice; Dickinson, Claire; Gorman, Tom; Robinson, Louise; Duncan, Rachel

    2016-09-09

    To explore the views and experiences of patients on the care they have received while enrolled on the Northumberland High Risk Patient Programme (NHRPP). This programme involved case finding of frail patients using a multidisciplinary team (MDT)-led community case management programme, and support of patients through care planning and regular reviews using primary, community, secondary and social care professionals. A qualitative study using semistructured interviews, which were digitally recorded, transcribed and subject to thematic analysis. Community patients receiving primary care in the county of Northumberland, England. 23 participants took part, of which 16 were patients enrolled on the NHRPP, and 7 carers. GP practices were selected purposively by size, deprivation and location, and patients identified and invited by General Practitioners to participate. 4 main themes emerged from the data: awareness and understanding of the NHRPP, confidence in the primary healthcare team, limitations of home care and the active role of being a patient. Despite having a low level of awareness of the details of the NHRPP, participants did think that its broad aim made sense. Participants discussed their high level of satisfaction with their care and access to team members. However, some limitations of alternatives to hospital care were identified, including the need to consider psychological as well as medical needs, the importance of overnight care and the needs of those without informal carers. Finally, participants discussed the active nature of being a patient under the NHRPP if they were to contribute fully to planning and managing their own care. This study has identified that a programme of MDT-led case management was generally very well received by patients and their families. However, a number of factors were identified that could improve the implementation of the programme and further research needs to be undertaken to address these. Published by the BMJ

  4. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    Science.gov (United States)

    van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Vissers, Kris C; Deliens, Luc; Jansen, Wim J J; Francke, Anneke L

    2016-01-01

    To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. Cross-sectional questionnaire study. Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses. © 2015 John Wiley & Sons Ltd.

  5. Occupational therapy consultation for case managers in community mental health: exploring strategies to improve job satisfaction and self-efficacy.

    Science.gov (United States)

    Chapleau, Ann; Seroczynski, A D; Meyers, Susan; Lamb, Kristen; Haynes, Susan

    2011-01-01

    The purpose of this study was 2-fold: (1) to examine to what extent case managers' job satisfaction and self-efficacy were impacted by the addition of an occupational therapy consultation model and (2) to identify factors that both positively and negatively impacted the occupational therapy consultation services. The study was conducted at a mental health community support program in a local homeless center. In a 2-year study, a mixed-methods design was used to study changes over time in job satisfaction and perceived self-efficacy among 14 case managers who received ongoing occupational therapy consultation. Job satisfaction and self-efficacy data were obtained using standardized questionnaires. Qualitative data related to factors impacting the consultation program were obtained using open-ended written questions, focus groups, and individual interviews. Statistically significant differences in job satisfaction and perceptions of self-efficacy were found 18 months into the study, when case managers were more actively seeking occupational therapy consultation services and were reporting improved client outcomes from occupational therapy intervention. In addition, themes related to both positive and negative factors impacting the occupational therapy consultation program were identified and provided useful data for development of future consultation services. IMPLICATION FOR CASE MANAGEMENT PRACTICE: Results suggest that ongoing training and professional support for case managers who are paraprofessionals and/or new to mental health practice may improve job satisfaction and efficacy. Occupational therapy consultation may be helpful in developing services for health promotion, including self-care management, cognitive assessments, activity-based programming, and home safety evaluation and modification. In addition, new graduates and paraprofessional case managers working with clients who are high utilizers of services may benefit from smaller caseloads and support

  6. The intersection of software and strengths: Using internet technology and case management software to assist Strength-Based Practice.

    Science.gov (United States)

    Clark, Michael D; Brien, Dale W

    2016-01-01

    The focus of this investigation is the helping professionals working within American Indian and Alaska Native (AI/AN) communities. This article looks at how innovative technology-in the form of automated case management software and Internet connectivity-can assist effective implementation of Strength-based Practice and agency services within tribal courts and the many other helping agencies that serve AI/AN populations. We seek to expand practice knowledge by reviewing the benefits that this software and Internet connectivity can offer to agency operations and exploring how they can assist case management services.

  7. Recidivism of Offenders with Mental Illness Released from Prison to an Intensive Community Treatment Program

    Science.gov (United States)

    Theurer, Gregory; Lovell, David

    2008-01-01

    An intensive case management treatment program for mentally ill offenders (MIOs) is outlined, and subsequent recidivism of participants is evaluated. Features of the program and its development are discussed. Sixty-four (64) participants released from state prison between 1998 and 2003 were matched with a group of MIOs released earlier on eight…

  8. An adaptive case management system to support integrated care services: Lessons learned from the NEXES project.

    Science.gov (United States)

    Cano, Isaac; Alonso, Albert; Hernandez, Carme; Burgos, Felip; Barberan-Garcia, Anael; Roldan, Jim; Roca, Josep

    2015-06-01

    Extensive deployment and sustainability of integrated care services (ICS) constitute an unmet need to reduce the burden of chronic conditions. The European Union project NEXES (2008-2013) assessed the deployment of four ICS encompassing the spectrum of severity of chronic patients. The current study aims to (i) describe the open source Adaptive Case Management (ACM) system (Linkcare®) developed to support the deployment of ICS at the level of healthcare district; (ii) to evaluate its performance; and, (iii) to identify key challenges for regional deployment of ICS. We first defined a conceptual model for ICS management and execution composed of five main stages. We then specified an associated logical model considering the dynamic runtime of ACM. Finally, we implemented the four ICS as a physical model with an ICS editor to allow professionals (case managers) to play active roles in adapting the system to their needs. Instances of ICS were then run in Linkcare®. Four ICS provided a framework for evaluating the system: Wellness and Rehabilitation (W&R) (number of patients enrolled in the study (n)=173); Enhanced Care (EC) in frail chronic patients to prevent hospital admissions, (n=848); Home Hospitalization and Early Discharge (HH/ED) (n=2314); and, Support to remote diagnosis (Support) (n=7793). The method for assessment of telemedicine applications (MAST) was used for iterative evaluation. Linkcare® supports ACM with shared-care plans across healthcare tiers and offers integration with provider-specific electronic health records. Linkcare® successfully contributed to the deployment of the four ICS: W&R facilitated long-term sustainability of training effects (p<0.01) and active life style (p<0.03); EC showed significant positive outcomes (p<0.05); HH/ED reduced on average 5 in-hospital days per patient with a 30-d re-admission rate of 10%; and, Support, enhanced community-based quality forced spirometry testing (p<0.01). Key challenges for regional deployment

  9. Effectiveness of multidisciplinary team case management: difference-in-differences analysis.

    Science.gov (United States)

    Stokes, Jonathan; Kristensen, Søren Rud; Checkland, Kath; Bower, Peter

    2016-04-15

    To evaluate a multidisciplinary team (MDT) case management intervention, at the individual (direct effects of intervention) and practice levels (potential spillover effects). Difference-in-differences design with multiple intervention start dates, analysing hospital admissions data. In secondary analyses, we stratified individual-level results by risk score. Single clinical commissioning group (CCG) in the UK's National Health Service (NHS). At the individual level, we matched 2049 intervention patients using propensity scoring one-to-one with control patients. At the practice level, 30 practices were compared using a natural experiment through staged implementation. Practice Integrated Care Teams (PICTs), using MDT case management of high-risk patients together with a summary record of care versus usual care. Primary measures of intervention effects were accident and emergency (A&E) visits; inpatient non-elective stays, 30-day re-admissions; inpatient elective stays; outpatient visits; and admissions for ambulatory care sensitive conditions. Secondary measures included inpatient length of stay; total cost of secondary care services; and patient satisfaction (at the practice level only). At the individual level, we found slight, clinically trivial increases in inpatient non-elective admissions (+0.01 admissions per patient per month; 95% CI 0.00 to 0.01. Effect size (ES): 0.02) and 30-day re-admissions (+0.00; 0.00 to 0.01. ES: 0.03). We found no indication that highest risk patients benefitted more from the intervention. At the practice level, we found a small decrease in inpatient non-elective admissions (-0.63 admissions per 1000 patients per month; -1.17 to -0.09. ES: -0.24). However, this result did not withstand a robustness check; the estimate may have absorbed some differences in underlying practice trends. The intervention does not meet its primary aim, and the clinical significance and cost-effectiveness of these small practice-level effects is debatable

  10. Case management in oncology rehabilitation (CAMON: The effect of case management on the quality of life in patients with cancer after one year of ambulant rehabilitation. A study protocol for a randomized controlled clinical trial in oncology rehabilitation

    Directory of Open Access Journals (Sweden)

    Bardheci Katarina

    2011-04-01

    Full Text Available Abstract Background Cancer diseases and their therapies have negative effects on the quality of life. The aim of this study is to assess the effectiveness of case management in a sample of oncological outpatients with the intent of rehabilitation after cancer treatment. Case management wants to support the complex information needs of the patients in addition to the segmented structure of the health care system. Emphasis is put on support for self-management in order to enhance health - conscious behaviour, learning to deal with the burden of the illness and providing the opportunity for regular contacts with care providers. We present a study protocol to investigate the efficacy of a case management in patients following oncology rehabilitation after cancer treatment. Methods The trial is a multicentre, two-arm randomised controlled study. Patients are randomised parallel in either 'usual care' plus case management or 'usual care' alone. Patients with all types of cancer can be included in the study, if they have completed the therapy with chemo- and/or radiotherapy/surgery with curative intention and are expected to have a survival time >1 year. To determine the health-related quality of life the general questionnaire FACT G is used. The direct correlation between self-management and perceived self-efficacy is measured with the Jerusalem & Schwarzer questionnaire. Patients satisfaction with the care received is measured using the Patient Assessment of Chronic Illness Care 5 As (PACIC-5A. Data are collected at the beginning of the trial and after 3, 6 and 12 months. The power analysis revealed a sample size of 102 patients. The recruitment of the centres began in 2009. The inclusion of patients began in May 2010. Discussion Case management has proved to be effective regarding quality of life of patients with chronic diseases. When it comes to oncology, case management is mainly used in cancer treatment, but it is not yet common in the

  11. Comparison of PCR/electron spray ionization-time-of-flight-mass spectrometry versus traditional clinical microbiology for active surveillance of organisms contaminating high-use surfaces in a burn intensive care unit, an orthopedic ward and healthcare workers.

    Science.gov (United States)

    Yun, Heather C; Kreft, Rachael E; Castillo, Mayra A; Ehrlich, Garth D; Guymon, Charles H; Crouch, Helen K; Chung, Kevin K; Wenke, Joseph C; Hsu, Joseph R; Spirk, Tracy L; Costerton, J William; Mende, Katrin; Murray, Clinton K

    2012-10-10

    Understanding nosocomial pathogen transmission is restricted by culture limitations. Novel platforms, such as PCR-based electron spray ionization-time-of-flight-mass spectrometry (ESI-TOF-MS), may be useful as investigational tools. Traditional clinical microbiology (TCM) and PCR/ESI-TOF-MS were used to recover and detect microorganisms from the hands and personal protective equipment of 10 burn intensive care unit (ICU) healthcare workers providing clinical care at a tertiary care military referral hospital. High-use environmental surfaces were assessed in 9 burn ICU and 10 orthopedic patient rooms. Clinical cultures during the study period were reviewed for pathogen comparison with investigational molecular diagnostic methods. From 158 samples, 142 organisms were identified by TCM and 718 by PCR/ESI-TOF-MS. The molecular diagnostic method detected more organisms (4.5 ± 2.1 vs. 0.9 ± 0.8, p < 0.01) from 99% vs. 67% of samples (p < 0.01). TCM detected S. aureus in 13 samples vs. 21 by PCR/ESI-TOF-MS. Gram-negative organisms were less commonly identified than gram-positive by both methods; especially by TCM. Among all detected bacterial species, similar percentages were typical nosocomial pathogens (18-19%) for TCM vs. PCR/ESI-TOF-MS. PCR/ESI-TOF-MS also detected mecA in 112 samples, vanA in 13, and KPC-3 in 2. MecA was associated (p < 0.01) with codetection of coagulase negative staphylococci but not S. aureus. No vanA was codetected with enterococci; one KPC-3 was detected without Klebsiella spp. In this pilot study, PCR/ESI-TOF-MS detected more organisms, especially gram-negatives, compared to TCM, but the current assay format is limited by the number of antibiotic resistance determinants it covers. Further large-scale assessments of PCR/ESI-TOF-MS for hospital surveillance are warranted.

  12. Comparison of PCR/Electron spray Ionization-Time-of-Flight-Mass Spectrometry versus Traditional Clinical Microbiology for active surveillance of organisms contaminating high-use surfaces in a burn intensive care unit, an orthopedic ward and healthcare workers

    Directory of Open Access Journals (Sweden)

    Yun Heather C

    2012-10-01

    Full Text Available Abstract Background Understanding nosocomial pathogen transmission is restricted by culture limitations. Novel platforms, such as PCR-based electron spray ionization-time-of-flight-mass spectrometry (ESI-TOF-MS, may be useful as investigational tools. Methods Traditional clinical microbiology (TCM and PCR/ESI-TOF-MS were used to recover and detect microorganisms from the hands and personal protective equipment of 10 burn intensive care unit (ICU healthcare workers providing clinical care at a tertiary care military referral hospital. High-use environmental surfaces were assessed in 9 burn ICU and 10 orthopedic patient rooms. Clinical cultures during the study period were reviewed for pathogen comparison with investigational molecular diagnostic methods. Results From 158 samples, 142 organisms were identified by TCM and 718 by PCR/ESI-TOF-MS. The molecular diagnostic method detected more organisms (4.5 ± 2.1 vs. 0.9 ± 0.8, p S. aureus in 13 samples vs. 21 by PCR/ESI-TOF-MS. Gram-negative organisms were less commonly identified than gram-positive by both methods; especially by TCM. Among all detected bacterial species, similar percentages were typical nosocomial pathogens (18-19% for TCM vs. PCR/ESI-TOF-MS. PCR/ESI-TOF-MS also detected mecA in 112 samples, vanA in 13, and KPC-3 in 2. MecA was associated (p S. aureus. No vanA was codetected with enterococci; one KPC-3 was detected without Klebsiella spp. Conclusions In this pilot study, PCR/ESI-TOF-MS detected more organisms, especially gram-negatives, compared to TCM, but the current assay format is limited by the number of antibiotic resistance determinants it covers. Further large-scale assessments of PCR/ESI-TOF-MS for hospital surveillance are warranted.

  13. Measuring Physical Activity Intensity

    Medline Plus

    Full Text Available ... Compartir For more help with what counts as aerobic activity, watch this video: Windows Media Player, 4: ... ways to understand and measure the intensity of aerobic activity: relative intensity and absolute intensity. Relative Intensity ...

  14. The quality of the working alliance between chronic psychiatric patients and their case managers: process and outcomes

    NARCIS (Netherlands)

    M. Grypdonck; prof Berno van Meijel; M. de Leeuw

    2012-01-01

    The concept of a working alliance is rooted in psychotherapy and has been studied extensively in that field. Much less research has been conducted into working alliances between chronic psychiatric patients and their case managers. The aim of this review was to identify what is known about the

  15. A sense of security: Spouses’ experiences of participating in an orthopaedic case management intervention (the SICAM-trial)

    DEFF Research Database (Denmark)

    Bøttcher Berthelsen, Connie; Kristensson, Jimmie

    2017-01-01

    The aim of the study was to explore and describe spouses' experiences of participating in a case management intervention during older patients' fast-track programme having total hip replacement as well as which intervention elements they found useful. Data were collected through qualitative...

  16. Acceptability by community health workers in Senegal of combining community case management of malaria and seasonal malaria chemoprevention

    DEFF Research Database (Denmark)

    Tine, Roger Ck; Ndiaye, Pascal; Ndour, Cheikh T

    2013-01-01

    Community case management of malaria (CCMm) and seasonal malaria chemoprevention (SMC) are anti-malarial interventions that can lead to substantial reduction in malaria burden acting in synergy. However, little is known about the social acceptability of these interventions. A study was undertaken...... to assess whether combining the interventions would be an acceptable approach to malaria control for community health workers (CHWs)....

  17. Navigating the Road to Recovery: Assessment of the Coordination, Communication, and Financing of the Disaster Case Management Pilot in Louisiana.

    Science.gov (United States)

    Acosta, Joie; Chandra, Anita; Feeney, Kevin Carter

    2011-01-01

    In 2009, individuals heavily affected by Hurricanes Katrina and Rita were still in need of social services. The Federal Emergency Management Agency (FEMA) provided funding to the Louisiana Recovery Authority to implement the Disaster Case Management Pilot (DCMP) in order to help people still living in FEMA temporary housing units in April 2009 move to permanent and secure housing and access services. Despite concerted effort by participating agencies, the implementation of the DCMP was fraught with challenges. As a result, the pilot could not be implemented as intended, leaving the needs of many clients not fully met. This article shares details of a study that documents some of the key challenges in coordination, communication, and financing of the program and offers recommendations for future state and FEMA implementation of disaster case management. In light of these challenges, the authors recommend that federal and state governments review the systems used to identify and locate residents in need of disaster case management; these systems performed poorly in the DCMP, making it difficult to appropriately plan services. The stop and start of recovery initiatives led to serious discontinuities in client recovery, so the authors also recommend that federal and state governments consider a single, longer-term recovery initiative that seamlessly acknowledges the stages of human recovery. Improvements in how federal and state governments identify and locate affected residents, consider needs and vulnerabilities in planning, and ensure continuity of services are critical to ensure high-quality disaster case management.

  18. Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management

    Directory of Open Access Journals (Sweden)

    Marlene M. de Vries

    2015-12-01

    Full Text Available In the Western Cape Province of South Africa (ZA a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD. FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI techniques and the Community Reinforcement Approach (CRA. Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD.

  19. Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management

    Science.gov (United States)

    de Vries, Marlene M.; Joubert, Belinda; Cloete, Marise; Roux, Sumien; Baca, Beth A.; Hasken, Julie M.; Barnard, Ronel; Buckley, David; Kalberg, Wendy O.; Snell, Cudore L.; Marais, Anna-Susan; Seedat, Soraya; Parry, Charles D. H.; May, Philip A.

    2015-01-01

    In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM) was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI) techniques and the Community Reinforcement Approach (CRA). Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD. PMID:26703708

  20. [Psychiatric case management. Chronic Disease Management application experience in a public Mental Health Service].

    Science.gov (United States)

    Pompili, Enrico; Silvestrini, Cristiana; Nicolò, Giuseppe; Pitino, Annalisa; Bernabei, Laura

    2014-01-01

    Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient. Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study. Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study. There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.

  1. Approaches to child protection case management for cases involving people with disabilities.

    Science.gov (United States)

    Lightfoot, Elizabeth B; LaLiberte, Traci L

    2006-04-01

    This exploratory study examines the delivery of child protection services by county child protection agencies involving cases with a family member with a disability. Telephone surveys were conducted with the directors or their designees of 89% of the child protection agencies in a Midwestern state. Respondents were asked about the policies and/or procedures for approaching cases involving a person with a disability and the barriers and strengths agencies have in serving people with disabilities. Only 6.7% of respondents reported their agency had a written policy related to serving persons with a disability. There were 18 different approaches to serving clients with a disability within child protection, with the most common being informally teaming for information, dual case assignment, and teaming with an outside consultant. Five counties had specialty workers who were experts in both child protection and disability. Barriers reported varied between rural and non-rural counties, with the most important barriers being lack of resources, lack of knowledge regarding disabilities, systems conflicts, and rural issues, such as lack of providers and lack of transportation. Strengths included accessing and coordinating services, individualizing services, good collaboration and creativity. While few county agencies had any written policies, both formal and informal collaboration is happening at the individual level. The lack of standardization in providing services indicates a need for more attention to issues regarding disability within child protection, including more training for workers, the development of models of collaborative case management and the removal of systemic barriers.

  2. Describing a nurse case manager intervention to empower low-income men with prostate cancer.

    Science.gov (United States)

    Maliski, Sally L; Clerkin, Barbara; Litwin, Mark S

    2004-01-01

    Describe and categorize nurse case manager (NCM) interventions for low-income, uninsured men with prostate cancer. Descriptive, retrospective record review. Statewide free prostate cancer treatment program in which each patient is assigned an NCM. 7 NCMs who developed interventions based on empowerment through increasing self-efficacy. NCM entries were extracted and coded from 10 electronic patient records, line by line, to reveal initial themes. Themes were grouped under categories. Investigators then reviewed and expanded these categories and their descriptions and postulated linkages. Linkages and relationships among categories were empirically verified with the original data. NCM entries from another 20 records were prepared in the same manner as the original records. Modifications were made until the categories contained all of the data and no new categories emerged. Categories were verified for content validity with the NCMs and reviewed for completeness and representation. NCM interventions. Categories of NCM interventions emerged as assessment, coordination, advocacy, facilitation, teaching, support, collaborative problem solving, and keeping track. Categories overlapped and supported each other. NCMs tailored interventions by combining categories for each patient. The skillful tailoring and execution of intervention strategies depended on the knowledge, experience, and skill that each NCM brought to the clinical situation. NCM categories were consistent with the tenets of the self-efficacy theory. The model, based on NCM interventions, provides a guide for the care of underserved men with prostate cancer. Components of the model need to be tested.

  3. Disability management: the application of preventive measures, health promotion and case management in Italy.

    Science.gov (United States)

    La Torre, G; De Giusti, M; Mannocci, A; De Waure, C; Agostinelli, A; Schena, S; Capelli, G; Ricciardi, W; Boccia, A; Damiani, G; von Pinoci, M; Fanton, C; Federico, B

    2009-03-01

    Disability Management can be defined as a practice to improve workers' health and to reduce the impact and costs of disability. The aim of the study was to estimate the diffusion of DM in Italian companies. A survey was conducted using a questionnaire, the Worksite Disability Management Audit. The questionnaire was structured into five parts addressing the following domains: 1) characteristics of the company; 2) health promotion activities; 3) preventive measures; 4) case management; 5) disability management. We selected public and private companies and collected information by direct interview. Twenty companies entered the survey. Twelve Companies (60%) indicated that health promotion programs and sensibilisation campaigns are usually carried out. The presence of an individual who provided workplace safety indications and materials was stated by 19 companies (95%). Periodical medical examinations are carried out by 19 companies (95%); 16 (80%) have an evaluation process for ergonomics concerns. Risk assessment and analysis are performed by all companies and the security procedures and policies are updated at least once in a year in 40% of cases. Health status monitoring of injured workers is performed in eight (40%) of the companies, while Disability Management is present as a whole in only three companies. This survey highlights that Disability Management is not undertaken in most companies and that, where applied, there is still confusion and disorganization about ways to promote health and manage workers' illness and disability. Hence, there is still the need to promote an all-inclusive evaluation and management of workers' safety, illness and disabilities.

  4. Task shifting of HIV/AIDS case management to Community Health Service Centers in urban China: a qualitative policy analysis.

    Science.gov (United States)

    Ma, Fuchang; Lv, Fan; Xu, Peng; Zhang, Dapeng; Meng, Sining; Ju, Lahong; Jiang, Huihui; Ma, Liping; Sun, Jiangping; Wu, Zunyou

    2015-07-02

    The growing number of people living with HIV/AIDS (PLWHA) in China points to an increased need for case management services of HIV/AIDS. This study sought to explore the challenges and enablers in shifting the HIV/AIDS case management services from Centers for Disease Control and Prevention (CDCs) to Community Health Service Centers (CHSCs) in urban China. A qualitative method based on the Health Policy Triangle (HPT) framework was employed to gain in-depth insights into four elements of the task shifting strategy. This included a review on published literature and health policy documents, 15 focus group discussions (FGDs) and 30 in-depth interviews (IDIs) with four types of key actors from three cities in China. A total of 78 studies and 17 policy files at the national, municipal and local levels were obtained and reviewed comprehensively. Three semi-structured interview guides were used to explore key actors' views on shifting the HIV/AIDS case management services to CHSCs. It is necessary and feasible for CHSCs to engage in case management services for PLWHA in local communities. The increasing number of PLWHA and shortage of qualified health professionals in CDCs made shifting case management services downwards to CHSCs an urgent agenda. CHSCs' wide distribution, technical capacity, accessibility and current practice enabled them to carry out case management services for PLWHA. However our findings indicated several challenges in this task shifting process. Those challenges included lack of specific policy and stable financial support for CHSCs, inadequate manpower, relatively low capacity for health service delivery, lack of coordination among sectors, PLWHA's fear for discrimination and privacy disclosure in local communities, which may compromise the effectiveness and sustainability of those services. Shifting the HIV/AIDS case management services from CDCs to CHSCs is a new approach to cope with the rising number of PLWHA in China, but it should be

  5. Effects of dietary additives (potassium diformate/organic acids) as well as influences of grinding intensity (coarse/fine) of diets for weaned piglets experimentally infected with Salmonella Derby or Escherichia coli.

    Science.gov (United States)

    Taube, V A; Neu, M E; Hassan, Y; Verspohl, J; Beyerbach, M; Kamphues, J

    2009-06-01

    The aim of this study was to examine whether and to what extent the addition of potassium diformate (pdf) or free organic acids (fpa) to the diet and the grinding intensity might affect the course of infection and the passage of orally applied Salmonella and Escherichia coli in pigs. Experiments were carried out using 80 reared piglets allotted to four groups. Pigs were fed pelleted diets ad libitum (except during a 15 h feed-withholding-period before infection). The control diet contained finely ground cereals (2 mm screen). To two test diets (also finely ground) 1.2% pdf, 0.9% organic acids (75% formic and 25% propionic acid, fpa) respectively were added. The fourth diet (without acids) was based on coarsely ground cereals (6-mm screen). After experimental infection alternately with S. Derby or E. coli, the course of infection was examined (rectal swab technique). Pigs were sacrificed 4-5 h after a further oral application of approximately 10(9)-10(10) CFU S. Derby or E. coli to determine the counts of Salmonella or E. coli in chyme (classical culture methods). Adding pdf or fpa to the diet led to reduced Salmonella shedding and resulted in significantly lower counts of Salmonella and E. coli in the stomach content indicating an improved efficacy of the stomach barrier. In the distal parts of the digestive tract, the effect was less obvious concerning counts of E. coli, whereas counts of Salmonella were reduced markedly as well. The diet based on coarsely ground cereals failed to demonstrate positive effects concerning infection and passage of orally applied bacteria as well, but this diet was also pelleted and showed unintentionally, comparable amounts of fine particles. Results obtained in this study allow the recommendation of using pdf or organic acids as additives when dietary measures against Salmonella or E. coli in pigs are required.

  6. Understanding the challenges to implementing case management for people with dementia in primary care in England: a qualitative study using Normalization Process Theory.

    Science.gov (United States)

    Bamford, Claire; Poole, Marie; Brittain, Katie; Chew-Graham, Carolyn; Fox, Chris; Iliffe, Steve; Manthorpe, Jill; Robinson, Louise

    2014-11-08

    Case management has been suggested as a way of improving the quality and cost-effectiveness of support for people with dementia. In this study we adapted and implemented a successful United States' model of case management in primary care in England. The results are reported elsewhere, but a key finding was that little case management took place. This paper reports the findings of the process evaluation which used Normalization Process Theory to understand the barriers to implementation. Ethnographic methods were used to explore the views and experiences of case management. Interviews with 49 stakeholders (patients, carers, case managers, health and social care professionals) were supplemented with observation of case managers during meetings and initial assessments with patients. Transcripts and field notes were analysed initially using the constant comparative approach and emerging themes were then mapped onto the framework of Normalization Process Theory. The primary focus during implementation was on the case managers as isolated individuals, with little attention being paid to the social or organizational context within which they worked. Barriers relating to each of the four main constructs of Normalization Process Theory were identified, with a lack of clarity over the scope and boundaries of the intervention (coherence); variable investment in the intervention (cognitive participation); a lack of resources, skills and training to deliver case management (collective action); and limited reflection and feedback on the case manager role (reflexive monitoring). Despite the intuitive appeal of case management to all stakeholders, there were multiple barriers to implementation in primary care in England including: difficulties in embedding case managers within existing well-established community networks; the challenges of protecting time for case management; and case managers' inability to identify, and act on, emerging patient and carer needs (an essential, but

  7. Multi-faceted case management: reducing compensation costs of musculoskeletal work injuries in Australia.

    Science.gov (United States)

    Iles, Ross Anthony; Wyatt, M; Pransky, G

    2012-12-01

    This study aimed to determine whether a multi-faceted model of management of work related musculoskeletal disorders reduced compensation claim costs and days of compensation for injured workers. An intervention including early reporting, employee centred case management and removal of barriers to return to work was instituted in 16 selected companies with a combined remuneration over $337 million. Outcomes were evaluated by an administrative dataset from the Victorian WorkCover Authority database. A 'quasi experimental' pre-post design was employed with 492 matched companies without the intervention used as a control group and an average of 21 months of post-intervention follow-up. Primary outcomes were average number of days of compensation and average cost of claims. Secondary outcomes were total medical costs and weekly benefits paid. Information on 3,312 claims was analysed. In companies where the intervention was introduced the average cost of claims was reduced from $6,019 to $3,913 (estimated difference $2,329, 95 % CI $1,318-$3,340) and the number of days of compensation decreased from 33.5 to 14.1 (HR 0.77, 95 % CI 0.67-0.88). Medical costs and weekly benefits costs were also lower after the intervention (p costs were noted across industry types, injury location and most employer sizes. The model of claims management investigated was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid in weekly benefits. Further research should investigate whether the intervention improves non-financial outcomes in the return to work process.

  8. Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists

    Directory of Open Access Journals (Sweden)

    Fabiana Kotovicz

    2018-01-01

    Full Text Available Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin. Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. Results: Four overarching themes regarding health care for refugee patients were identified: 1 difficulty balancing the dynamic of autonomy versus support for refugees; 2 educational needs of refugee families outpacing available resources; 3 challenges for refugees developing trust; and 4 diversity of cultures, education levels, and experiences among refugee families. Language barriers in accessing health care services and insufficient time to meet educational needs of refugees were major challenges outside of the clinic visit setting. Poor health literacy and difficulties communicating health needs and building trust within the interactive triad of refugee, physician, and interpreter impacted clinic visits. Conclusions: Refugee patients and other participants in refugee care work to navigate a complicated path to equitable health care for a vulnerable population. Continued pursuit of strategies that increase time allocation, education, and support for all parties are needed as we seek to improve health outcomes for newly arrived refugee families.

  9. Optimizing reactive responses to outbreaks of immunizing infections: balancing case management and vaccination.

    Directory of Open Access Journals (Sweden)

    Petra Klepac

    Full Text Available For vaccine-preventable infections, immunization generally needs to be supplemented by palliative care of individuals missed by the vaccination. Costs and availability of vaccine doses and palliative care vary by disease and by region. In many situations, resources for delivery of palliative care are independent of resources required for vaccination; however we also need to consider the conservative scenario where there is some trade-off between efforts, which is of potential relevance for resource-poor settings. We formulate an SEIR model that includes those two control strategies--vaccination and palliative care. We consider their relative merit and optimal allocation in the context of a highly efficacious vaccine, and under the assumption that palliative care may reduce transmission. We investigate the utility of a range of mixed or pure strategies that can be implemented after an epidemic has started, and look for rule-of-thumb principles of how best to reduce the burden of disease during an acute outbreak over a spectrum of vaccine-preventable infections. Intuitively, we expect the best strategy to initially focus on vaccination, and enhanced palliative care after the infection has peaked, but a number of plausible realistic constraints for control result in important qualifications on the intervention strategy. The time in the epidemic when one should switch strategy depends sensitively on the relative cost of vaccine to palliative care, the available budget, and R0. Crucially, outbreak response vaccination may be more effective in managing low-R0 diseases, while high R0 scenarios enhance the importance of routine vaccination and case management.

  10. The ‘community’ in community case management of childhood illnesses in Malawi

    Directory of Open Access Journals (Sweden)

    Wanga Z. Zembe-Mkabile

    2016-01-01

    Full Text Available Background: Malawi has achieved a remarkable feat in reducing its under-5 mortality in time to meet its MDG 4 target despite high levels of poverty, low female literacy rates, recurrent economic crises, a severe shortage of human resources for health, and poor health infrastructure. The country's community-based delivery platform (largely headed by Health Surveillance Assistants, or HSAs has been well established since the 1960s, although their tasks and responsibilities have evolved from surveillance to health promotion and prevention, and more recently to include curative services. However, the role of and the form that community involvement takes in community-based service delivery in Malawi is unclear. Design: A qualitative rapid appraisal approach was utilised to explore the role of community involvement in the HSA programme in Malawi to better understand how the various community providers intersect to support the delivery of integrated community case management by HSAs. Twelve focus group discussions and 10 individual interviews were conducted with HSAs, HSA supervisors, mothers, members of village health committees (VHCs, senior Ministry of Health officials, district health teams, and implementing partners. Results: Our findings reveal that HSAs are often deployed to areas outside of their village of residence as communities are not involved in selecting their own HSAs in Malawi. Despite this lack of involvement in selection, the high acceptance of the HSAs by community members and community accountability structures such as VHCs provide the programme with legitimacy and credibility. Conclusions: This study provides insight into how community involvement plays out in the context of a government-managed professionalised community service delivery platform. It points to the need for further research to look at the impact of removing the role of HSA selection and deployment from the community and placing it at the central level.

  11. Applying the Case Management CourTools: Finding from an Urban Trial Court

    Directory of Open Access Journals (Sweden)

    Collins E. Ijoma

    2012-06-01

    Full Text Available The National Center for State Courts (NCSC recently promulgated 10 trial court performance measures, referred to as CourTools. Measures 2, 3, 4, and 5 provide a methodology by which court managers can examine their management and processing of cases. The measures include clearance rate (measure 2, time to disposition (measure 3, age of active pending caseload (measure 4, and trial date certainty (measure 5. The objective of this research was threefold. The first aim was to assess the viability of using the case management measures to examine case processing trends in a New Jersey (NJ urban trial court. Each measure was reviewed to determine the tool’s applicability to the criminal division of the court. The second objective (pursued as a parallel to the first was to present the findings in the same context as the CourTools’ framework to determine its practicality. The final goal was to serve as a platform for other courts on the national and international level that do not yet use performance measures. These courts, diverse as they are, may use the methodologies and findings of this case study as a reference and guide to develop their own program to measure the court’s productivity and efficiency. To that end, this case study sought to answer the following questions in determining the applicability of the CourTools to the selected court and by extension, its potential for more universal application to other court systems. First, what is the relevance of measurements to the courts and why is it important, if at all? Second, what are the CourTools? Third, can the measurement model be applied to an actual court and if so, how is it executed and illustrated in practice? Finally, what are the implications of the findings for the court in question, as well as, other courts that seek to incorporate the CourTools to measure performance?

  12. Policy challenges facing integrated community case management in Sub-Saharan Africa.

    Science.gov (United States)

    Bennett, Sara; George, Asha; Rodriguez, Daniela; Shearer, Jessica; Diallo, Brahima; Konate, Mamadou; Dalglish, Sarah; Juma, Pamela; Namakhoma, Ireen; Banda, Hastings; Chilundo, Baltazar; Mariano, Alda; Cliff, Julie

    2014-07-01

    To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  13. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study.

    NARCIS (Netherlands)

    Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.

    2016-01-01

    Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case

  14. Informal care givers’ experiences with support in primary palliative care when a case manager is involved: a descriptive study in the Netherlands.

    NARCIS (Netherlands)

    Plas, A.G.M. van der; Francke, A.L.; Deliens, L.; Jansen, W.J.J.; Vissers, K.C.; Onwuteaka-Philipsen, B.D.

    2017-01-01

    Introduction: Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal care givers. The case manager provides support in addition to the care provided by the home care nurse and

  15. Reductions in Transmission Risk Behaviors in HIV-Positive Clients Receiving Prevention Case Management Services: Findings from a Community Demonstration Project

    Science.gov (United States)

    Gasiorowicz, Mari; Llanas, Michelle R.; DiFranceisco, Wayne; Benotsch, Eric G.; Brondino, Michael J.; Catz, Sheryl L.; Hoxie, Neil J.; Reiser, William J.; Vergeront, James M.

    2005-01-01

    Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV…

  16. A prospective study on the characteristics and subjects of pediatric palliative care case management provided by a hospital based palliative care team

    NARCIS (Netherlands)

    Jagt-van Kampen, Charissa T.; Kars, Marijke C.; Colenbrander, Derk A.; Bosman, Diederik K.; Grootenhuis, Martha A.; Caron, Huib N.; Schouten-van Meeteren, Antoinette Y. N.

    2017-01-01

    Case management is a subject of interest within pediatric palliative care. Detailed descriptions of the content of this type of case management are lacking. We aim to describe the contents of care provided, utilization of different disciplines, and times of usage of a pediatric palliative care case

  17. Prevention of hospital payment errors and implications for case management: a study of nine hospitals with a high proportion of short-term admissions over time.

    Science.gov (United States)

    Hightower, Rebecca E

    2008-01-01

    medical advice) occurring during the baseline and remeasurement time frames was examined. The baseline period consisted of 1 month's claims-the complete month just prior to the start of approved project activities. Remeasurement was performed by each hospital and reported to the Quality Improvement Organization on a monthly basis following implementation of the hospital's quality improvement plan. Each hospital was required to provide a monthly remeasurement report by indicator until it had met its stated goal(s) for improvement for 2 consecutive months; therefore, each hospital completed its required monthly reporting for a specific indicator in a different month. Results were calculated for the following indicators: INDICATOR 1: Proportion of unnecessary short-term admissions = number of unnecessary short-term inpatient admissions/total short-term inpatient admissions in time frame. INDICATOR 2: Proportion of errors in billed treatment setting, that is, outpatient observation billed as inpatient = number of errors in billed treatment setting/total short-term admissions in time frame.Six of the 9 hospitals were able to accomplish reduction of their error rates within 6 months from the beginning of the study. The seventh hospital reached its goals in the 7th month, with the 2 remaining hospitals making progress toward their goals by the conclusion of the study. 1 Case managers must be up-to-date with payor requirements regarding medical record documentation for medical necessity of services and timing of inpatient admission, e.g., for Medicare, the date and time of the written physician's order for admission to the inpatient care setting is the date and time of inpatient admission. 2 The balancing of clinical decisions and financial considerations required of case managers in hospital settings remains an ongoing challenge. 3 Senior leadership must be engaged in ensuring the success of the case management program by providing the resources required. 4 Managers of case

  18. Longitudinal associations between case management and supportive services use among black and Latina HIV-positive women in New York City.

    Science.gov (United States)

    Halkitis, Perry N; Kupprat, Sandra A; Mukherjee, Preetika Pandey

    2010-01-01

    The literature analyzing the relationship between case management and supportive service use longitudinally among African American and Latina HIV-positive women is limited. This retrospective analysis of participant case management, supportive service, and medical charts sought to examine both descriptive and relational data on use of case management and supportive services over a 2-year period from 2002 to 2005 and to analyze moderating person- level or institution-level factors. The analyzed case management, supportive service, and medical charts revealed that participants interacted with their case manager four times and received 3.6 supportive services per month. Transportation, primary healthcare/medical specialists, and support groups were the services most used, with rates ranging from 70% to 80%. Using hierarchical linear modeling (HLM), the unconditional growth models showed that case management and supportive service use patterns remained constant over the 24-month period. Additionally, the multivariate unconditional model suggests a significant positive relationship between case management and supportive services. No moderation was indicated in the association between case management and supportive service use by person-level (e.g., mental illness, substance use) and institution-level (i.e., service delivery model) factors. Participants use supportive and case management services in a similar manner based on individual need. This synergistic relationship suggests that increases in either may result in retaining women in care. Implications for service delivery point to the need for skills building training for case managers, outreach workers, or system navigators to assist with short-term goals of establishing rapport and maintaining the client relationship, as this may lead to HIV-positive women accessing services. Additionally, outreach and engagement strategies need to be developed for those who typically underuse these services.

  19. Clinical Characteristics of the Suicide Attempters Who Refused to Participate in a Suicide Prevention Case Management Program

    OpenAIRE

    Park, Soyoung; Choi, Kyoung Ho; Oh, Youngmin; Lee, Hae-Kook; Kweon, Yong-Sil; Lee, Chung Tai; Lee, Kyoung-Uk

    2015-01-01

    Case management interventions for suicide attempters aimed at helping adjust their social life to prevent reattempts have high nonparticipation and dropout rates. We analyzed the clinical characteristics of the group who refused to participate in the suicide prevention program in Korea. A total of 489 patients with a suicide attempt who visited Uijeongbu St. Mary's Hospital, the Catholic University of Korea, from December 2009 to December 2013 were analyzed. All patients were divided into the...

  20. Development and feasibility of smartphone application for cognitive-behavioural case management of individuals with early psychosis.

    Science.gov (United States)

    Kim, Sung-Wan; Lee, Ga-Young; Yu, Hye-Young; Jung, Eun-I; Lee, Ju-Yeon; Kim, Seon-Young; Kim, Jae-Min; Shin, Il-Seon; Yoon, Jin-Sang

    2017-05-18

    This article describes the development of the smartphone application for cognitive-behavioural case management of young individuals with early psychosis and examines the acceptance and potential clinical benefits of this application through a pilot survey. Gwangju Bukgu-Community Mental Health Center developed and launched a smartphone application (Heal Your Mind [HYM]) for cognitive-behavioural case management and symptom monitoring. The HYM application for clients includes 6 main modules including thought record, symptom record, daily life record, official notices, communication and scales. The key module is the "thought record" for self-directed cognitive-behavioural treatment. When the client writes and sends the self-cognitive-behavioural therapy sheet to the case manager, the latter receives a notification and can provide feedback in real time. We conducted a survey to investigate the acceptance and feasibility of this approach among young clients with early psychosis. A total of 24 clients with early psychosis participated in this survey. More than 80% of participants reported that it was easy to learn to use this application, and no one described this application as very complicated or reported that they needed a long time to learn how to use it. About 80% of participants were satisfied with this application, and 70% reported that they received help as a result of using this application. This study suggests that this smartphone application is useful for young individuals with early psychosis and that it may contribute to the development of both young customer- and case manager-friendly systems for this clinical population. © 2017 John Wiley & Sons Australia, Ltd.

  1. Navigating the Road to Recovery: Assessment of the Coordination, Communication, and Financing of the Disaster Case Management Pilot in Louisiana

    OpenAIRE

    Acosta, Joie; Chandra, Anita; Feeney, Kevin Carter

    2011-01-01

    In 2009, individuals heavily affected by Hurricanes Katrina and Rita were still in need of social services. The Federal Emergency Management Agency (FEMA) provided funding to the Louisiana Recovery Authority to implement the Disaster Case Management Pilot (DCMP) in order to help people still living in FEMA temporary housing units in April 2009 move to permanent and secure housing and access services. Despite concerted effort by participating agencies, the implementation of the DCMP was fraugh...

  2. Policy entrepreneurs and structural influence in integrated community case management policymaking in Burkina Faso.

    Science.gov (United States)

    Shearer, Jessica C

    2015-12-01

    Policy entrepreneurs are individuals who attempt to influence the policy process and its outcomes through their opportunistic or incremental actions. Their success in the policy-making process has been associated with the convergence of four factors: behavioural traits; institutional factors; network position and political capital. Policy entrepreneurs have received little study in low- and middle-income country policy research despite observations of individualized decision-making, informal institutions and the unequal distribution and exercise of power in policymaking. This article aims to identify whether policy entrepreneurs were present in the policy process around integrated community case management (iCCM) in Burkina Faso, whether they were successful in achieving policy change, and whether success or failure can be explained using existing policy entrepreneur frameworks from high-income polities. This mixed methods policy study collected data from in-depth qualitative interviews and social network surveys of actors involved in iCCM policymaking [known locally as C-integrated management of childhood illness (IMCI)]; data were analysed based on the framework categories. Interview data pointed to one key individual who played a significant role in the inclusion of pneumonia treatment into the country's iCCM policy, an issue that had been a point of contention between government policy elites and development partners. Social network data confirmed that this actor was strategically located in the policy network to be able to reach the most other actors and to be able to control the flow of information. Although some development partner actors were as strategically located, none had the same level of authority or trust as was imbued by being a member of the government civil service. The entrepreneur's mid-level rank in the health ministry may have encouraged him/her to invest political capital and take risks that would not have been feasible or attractive to a

  3. Policy entrepreneurs and structural influence in integrated community case management policymaking in Burkina Faso

    Science.gov (United States)

    2015-01-01

    Policy entrepreneurs are individuals who attempt to influence the policy process and its outcomes through their opportunistic or incremental actions. Their success in the policy-making process has been associated with the convergence of four factors: behavioural traits; institutional factors; network position and political capital. Policy entrepreneurs have received little study in low- and middle-income country policy research despite observations of individualized decision-making, informal institutions and the unequal distribution and exercise of power in policymaking. This article aims to identify whether policy entrepreneurs were present in the policy process around integrated community case management (iCCM) in Burkina Faso, whether they were successful in achieving policy change, and whether success or failure can be explained using existing policy entrepreneur frameworks from high-income polities. This mixed methods policy study collected data from in-depth qualitative interviews and social network surveys of actors involved in iCCM policymaking [known locally as C-integrated management of childhood illness (IMCI)]; data were analysed based on the framework categories. Interview data pointed to one key individual who played a significant role in the inclusion of pneumonia treatment into the country’s iCCM policy, an issue that had been a point of contention between government policy elites and development partners. Social network data confirmed that this actor was strategically located in the policy network to be able to reach the most other actors and to be able to control the flow of information. Although some development partner actors were as strategically located, none had the same level of authority or trust as was imbued by being a member of the government civil service. The entrepreneur’s mid-level rank in the health ministry may have encouraged him/her to invest political capital and take risks that would not have been feasible or attractive to

  4. Quality of uncomplicated malaria case management in Ghana among insured and uninsured patients.

    Science.gov (United States)

    Fenny, Ama P; Hansen, Kristian S; Enemark, Ulrika; Asante, Felix A

    2014-07-24

    The National Health Insurance Act, 2003 (Act 650) established the National Health Insurance Scheme (NHIS) in Ghana with the aim of increasing access to health care and improving the quality of basic health care services for all citizens. The main objective is to assess the effect of health insurance on the quality of case management for patients with uncomplicated malaria, ascertaining any significant differences in treatment between insured and non-insured patients. A structured questionnaire was used to collect data from 523 respondents diagnosed with malaria and prescribed malaria drugs from public and private health facilities in 3 districts across Ghana's three ecological zones. Collected information included initial examinations performed on patients (temperature, weight, age, blood pressure and pulse); observations of malaria symptoms by trained staff, laboratory tests conducted and type of drugs prescribed. Insurance status of patients, age, gender, education level and occupation were asked in the interviews. Of the 523 patients interviewed, only 40 (8%) were uninsured. Routine recording of the patients' age, weight, and temperature was high in all the facilities. In general, assessments needed to identify suspected malaria were low in all the facilities with hot body/fever and headache ranking the highest and convulsion ranking the lowest. Parasitological assessments in all the facilities were also very low. All patients interviewed were prescribed ACTs which is in adherence to the drug of choice for malaria treatment in Ghana. However, there were no significant differences in the quality of malaria treatment given to the uninsured and insured patients. Adherence to the standard protocol of malaria treatment is low. This is especially the case for parasitological confirmation of all suspected malaria patients before treatment with an antimalarial as currently recommended for the effective management of malaria in the country. The results show that about 16

  5. Unmet service needs evaluated by case managers among disabled patients on hemodialysis in Japan

    Directory of Open Access Journals (Sweden)

    Sugisawa H

    2018-03-01

    Full Text Available Hidehiro Sugisawa,1 Toshio Shinoda,2 Yumiko Shimizu,3 Tamaki Kumagai,4 Hiroaki Sugisaki,5 Seiji Ohira6,† 1Department of Gerontology, Graduate School of Gerontology, J. F. Oberlin University, Tokyo, 2Department of Medical Care Technology, Faculty of Medical and Health Science, Tsukuba International University, Tsuchiura, 3Department of Community Health Nursing, The Jikei University School of Nursing, Chofu, 4Department of Fundamental Nursing, Graduate School of Nursing, Osaka City University, Osaka, 5Hachioji Azumacho Clinic, Hachioji, Tokyo, 6Sapporo Kita Clinic, Sapporo, Hokkai-do, Japan †Professor Dr. Seiji Ohira passed away on September 5, 2017 Background: This study aimed to investigate the levels of unmet needs for home and ­community-based services (HCBS evaluated by case managers (CMs among disabled patients on hemodialysis (DPHD and to examine factors related to unmet needs. Unmet needs for HCBS were defined as situations in which patients do not use or underuse HCBS despite needing them. Candidates for the factors relating to unmet needs for HCBS included three dimensions: predisposing, enabling, and need factors.Methods: Self-administrated questionnaires were collected from 391 CMs of DPHD certified with long-term care insurance. These were introduced by the dialysis facilities that a member of the Japanese Association of Dialysis Physicians belonged to. CMs were asked questions about their management of each individual case. HCBS included home help, visiting nursing, daycare, and short stay.Results: The prevalence of unmet needs for each HCBS ranged from 32% for home help to 48% for short stay. Barriers to service usage in the patients were associated with unmet needs for all four services. The patients with more severe cognitive malfunction were more likely to have unmet needs for visiting nursing and short stay. Heavier burden with caregiving was associated with more likelihood of unmet needs for home help and short stay

  6. Quality of care in integrated community case management services in Bugoye, Uganda: a retrospective observational study.

    Science.gov (United States)

    Miller, James S; English, Lacey; Matte, Michael; Mbusa, Rapheal; Ntaro, Moses; Bwambale, Shem; Kenney, Jessica; Siedner, Mark J; Reyes, Raquel; Lee, Patrick T; Mulogo, Edgar; Stone, Geren S

    2018-02-27

    Village health workers (VHWs) in five villages in Bugoye subcounty (Kasese District, Uganda) provide integrated community case management (iCCM) services, in which VHWs evaluate and treat malaria, pneumonia, and diarrhoea in children under 5 years of age. VHWs use a "Sick Child Job Aid" that guides them through the evaluation and treatment of these illnesses. A retrospective observational study was conducted to measure the quality of iCCM care provided by 23 VHWs in 5 villages in Bugoye subcounty over a 2-year period. Patient characteristics and clinical services were summarized using existing aggregate programme data. Lot quality assurance sampling of individual patient records was used to estimate adherence to the iCCM algorithm, VHW-level quality (based on adherence to the iCCM protocol), and change over time in quality of care (using generalized estimating equations regression modelling). For each of 23 VHWs, 25 patient visits were randomly selected from a 2-year period after iCCM care initiation. In these visits, 97% (150) of patients with diarrhoea were treated with oral rehydration and zinc, 95% (216) of patients with pneumonia were treated with amoxicillin, and 94% (240) of patients with malaria were treated with artemisinin-based combination therapy or rectal artesunate. However, only 44% (44) of patients with a negative rapid test for malaria were appropriately referred to a health facility. Overall, 75% (434) of patients received all the correct evaluation and management steps. Only 9 (39%) of the 23 VHWs met the pre-determined LQAS threshold for high-quality care over the 2-year observation period. Quality of care increased significantly in the first 6 months after initiation of iCCM services (p = 0.003), and then plateaued during months 7-24. Quality of care was high for uncomplicated malaria, pneumonia and diarrhoea. Overall quality of care was lower, in part because VHWs often did not follow the guidelines to refer patients with fever who tested

  7. Effect of case management on neonatal mortality due to sepsis and pneumonia

    Directory of Open Access Journals (Sweden)

    Black Robert

    2011-04-01

    Full Text Available Abstract Background Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST. Methods We conducted systematic searches of multiple databases to identify relevant studies with mortality data. Standardized abstraction tables were used and study quality assessed by adapted GRADE criteria. Meta-analyses were undertaken where appropriate. For interventions with biological plausibility but low quality evidence, a Delphi process was undertaken to estimate effectiveness. Results Searches of 2876 titles identified 7 studies. Among these, 4 evaluated oral antibiotics for neonatal pneumonia in non-randomised, concurrently controlled designs. Meta-analysis suggested reductions in all-cause neonatal mortality (RR 0.75 95% CI 0.64- 0.89; 4 studies and neonatal pneumonia-specific mortality (RR 0.58 95% CI 0.41- 0.82; 3 studies. Two studies (1 RCT, 1 observational study, evaluated community-based neonatal care packages including injectable antibiotics and reported mortality reductions of 44% (RR= 0.56, 95% CI 0.41-0.77 and 34% (RR =0.66, 95% CI 0.47-0.93, but the interpretation of these results is complicated by co-interventions. A third, clinic-based, study reported a case-fatality ratio of 3.3% among neonates treated with injectable antibiotics as outpatients. No studies were identified evaluating injectable antibiotics alone for neonatal pneumonia. Delphi consensus (median from 20 respondents effects on sepsis-specific mortality were 30% reduction for oral antibiotics, 65% for injectable antibiotics and 75% for injectable antibiotics on pneumonia-specific mortality. No trials were

  8. Nationwide implementation of integrated community case management of childhood illness in Rwanda

    Science.gov (United States)

    Mugeni, Catherine; Levine, Adam C; Munyaneza, Richard M; Mulindahabi, Epiphanie; Cockrell, Hannah C; Glavis-Bloom, Justin; Nutt, Cameron T; Wagner, Claire M; Gaju, Erick; Rukundo, Alphonse; Habimana, Jean Pierre; Karema, Corine; Ngabo, Fidele; Binagwaho, Agnes

    2014-01-01

    ABSTRACT Background: Between 2008 and 2011, Rwanda introduced integrated community case management (iCCM) of childhood illness nationwide. Community health workers in each of Rwanda's nearly 15,000 villages were trained in iCCM and equipped for empirical diagnosis and treatment of pneumonia, diarrhea, and malaria; for malnutrition surveillance; and for comprehensive reporting and referral services. Methods: We used data from the Rwanda health management information system (HMIS) to calculate monthly all-cause under-5 mortality rates, health facility use rates, and community-based treatment rates for childhood illness in each district. We then compared a 3-month baseline period prior to iCCM implementation with a seasonally matched comparison period 1 year after iCCM implementation. Finally, we compared the actual changes in all-cause child mortality and health facility use over this time period with the changes that would have been expected based on baseline trends in Rwanda. Results: The number of children receiving community-based treatment for diarrhea and pneumonia increased significantly in the 1-year period after iCCM implementation, from 0.83 cases/1,000 child-months to 3.80 cases/1,000 child-months (P = .01) and 0.25 cases/1,000 child-months to 5.28 cases/1,000 child-months (P<.001), respectively. On average, total under-5 mortality rates declined significantly by 38% (P<.001), and health facility use declined significantly by 15% (P = .006). These decreases were significantly greater than would have been expected based on baseline trends. Conclusions: This is the first study to demonstrate decreases in both child mortality and health facility use after implementing iCCM of childhood illness at a national level. While our study design does not allow for direct attribution of these changes to implementation of iCCM, these results are in line with those of prior studies conducted at the sub-national level in other low-income countries. PMID:25276592

  9. Measuring Physical Activity Intensity

    Medline Plus

    Full Text Available ... 45 David, Age 65 Harold, Age 67 Data & Statistics Facts About Physical Activity Data, Trends and Maps ... relative intensity and absolute intensity. Relative Intensity The level of effort required by a person to do ...

  10. Insights to Building a Succesful E-filing Case Management Service: U.S. Federal Court Experience

    Directory of Open Access Journals (Sweden)

    J. Michael Greenwood

    2012-06-01

    Full Text Available The U.S. Federal Courts Case Management/Electronic Case Files (CM/ECF service is a very successful court automation system deployed throughout the country that integrated case management, electronic court case records and documents, and the electronic transmission and service of court records via the Internet. The authors briefly explain the history of automation development and indicators of success in these courts. The primary focus of the article is (a on what capabilities and functions should be integrated into any modern court electronic filing and case management service; and (b on insights as to key technical components, fundamental project guidelines, technical objectives, and non-technical principles and implementation techniques that were critical to achieving success. The ultimate CM/ECF goals that have been achieved are (1 that the entire U.S. federal court community (court, lawyers, government, public are comfortable in totally relying on this service, and (2 that CM/ECF is the official record eliminating the traditional paper record.

  11. Understanding the drivers of interprofessional collaborative practice among HIV primary care providers and case managers in HIV care programmes.

    Science.gov (United States)

    Mavronicolas, Heather A; Laraque, Fabienne; Shankar, Arti; Campbell, Claudia

    2017-05-01

    Care coordination programmes are an important aspect of HIV management whose success depends largely on HIV primary care provider (PCP) and case manager collaboration. Factors influencing collaboration among HIV PCPs and case managers remain to be studied. The study objective was to test an existing theoretical model of interprofessional collaborative practice and determine which factors play the most important role in facilitating collaboration. A self-administered, anonymous mail survey was sent to HIV PCPs and case managers in New York City. An adapted survey instrument elicited information on demographic, contextual, and perceived social exchange (trustworthiness, role specification, and relationship initiation) characteristics. The dependent variable, perceived interprofessional practice, was constructed from a validated scale. A sequential block wise regression model specifying variable entry order examined the relative importance of each group of factors and of individual variables. The analysis showed that social exchange factors were the dominant drivers of collaboration. Relationship initiation was the most important predictor of interprofessional collaboration. Additional influential factors included organisational leadership support of collaboration, practice settings, and frequency of interprofessional meetings. Addressing factors influencing collaboration among providers will help public health programmes optimally design their structural, hiring, and training strategies to foster effective social exchanges and promote collaborative working relationships.

  12. French intensive truck garden

    Energy Technology Data Exchange (ETDEWEB)

    Edwards, T D

    1983-01-01

    The French Intensive approach to truck gardening has the potential to provide substantially higher yields and lower per acre costs than do conventional farming techniques. It was the intent of this grant to show that there is the potential to accomplish the gains that the French Intensive method has to offer. It is obvious that locally grown food can greatly reduce transportation energy costs but when there is the consideration of higher efficiencies there will also be energy cost reductions due to lower fertilizer and pesticide useage. As with any farming technique, there is a substantial time interval for complete soil recovery after there have been made substantial soil modifications. There were major crop improvements even though there was such a short time since the soil had been greatly disturbed. It was also the intent of this grant to accomplish two other major objectives: first, the garden was managed under organic techniques which meant that there were no chemical fertilizers or synthetic pesticides to be used. Second, the garden was constructed so that a handicapped person in a wheelchair could manage and have a higher degree of self sufficiency with the garden. As an overall result, I would say that the garden has taken the first step of success and each year should become better.

  13. Nursing case management, peer coaching, and hepatitis a and B vaccine completion among homeless men recently released on parole: randomized clinical trial.

    Science.gov (United States)

    Nyamathi, Adeline; Salem, Benissa E; Zhang, Sheldon; Farabee, David; Hall, Betsy; Khalilifard, Farinaz; Leake, Barbara

    2015-01-01

    Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample. A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention. Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from

  14. Setting global research priorities for integrated community case management (iCCM: Results from a CHNRI (Child Health and Nutrition Research Initiative exercise

    Directory of Open Access Journals (Sweden)

    Kerri Wazny

    2014-11-01

    Full Text Available Aims: to systematically identify global research gaps and resource priorities for integrated community case management (iCCM. Methods: an iCCM Child Health and Nutrition Research Initiative (CHNRI Advisory Group, in collaboration with the Community Case Management Operational Research Group (CCM ORG identified experts to participate in a CHNRI research priority setting exercise. These experts generated and systematically ranked research questions for iCCM. Research questions were ranked using a “Research Priority Score” (RPS and the “Average Expert Agreement” (AEA was calculated for every question. Our groups of experts were comprised of both individuals working in Ministries of Health or Non Governmental Organizations (NGOs in low– and middle–income countries (LMICs and individuals working in high–income countries (HICs in academia or NGO headquarters. A Spearman's Rho was calculated to determine the correlation between the two groups' research questions' ranks. Results: The overall RPS ranged from 64.58 to 89.31, with a median score of 81.43. AEA scores ranged from 0.54 to 0.86. Research questions involving increasing the uptake of iCCM services, research questions concerning the motivation, retention, training and supervision of Community Health Workers (CHWs and concerning adding additional responsibilities including counselling for infant and young child feeding (IYCF and treatment of severe acute malnutrition (SAM ranked highly. There was weak to moderate, statistically significant, correlation between scores by representatives of high–income countries and those working in–country or regionally (Spearman's ρ = 0.35034, P < 0.01. Conclusions: Operational research to determine optimal training, supervision and modes of motivation and retention for the CHW is vital for improving iCCM, globally, as is research to motivate caregivers to take advantage of iCCM services. Experts working in–country or regionally in

  15. Intensidade da cercosporiose da alface em cultivos convencionais e orgânicos em Pernambuco Intensity of Cercospora leaf spot of lettuce in conventional and organic farming systems in State of Pernambuco, Brazil

    Directory of Open Access Journals (Sweden)

    Andréa Maria André Gomes

    2006-09-01

    Full Text Available Foram realizados levantamentos da intensidade da cercosporiose da alface, causada por Cercospora longissima, em 25 plantios manejados no sistema convencional e 25 no sistema orgânico, em dois períodos de plantio, janeiro-abril (I e junho-setembro (II de 2002, no estado de Pernambuco. A prevalência da doença foi elevada (> 88% em todas as situações avaliadas. Nas áreas de cultivo convencional a severidade da cercosporiose variou de 0,0 a 16,9%, enquanto em cultivos orgânicos de 0,0 a 22,5%. Nos dois sistemas de cultivo a severidade da doença foi significativamente mais elevada no período I, quando a precipitação pluviométrica foi quase três vezes superior ao período II. No entanto, somente no período II foram constatadas diferenças significativas na severidade da doença entre os sistemas de cultivo, sendo superior no sistema orgânico. Não foram constatadas correlações significativas entre os níveis de severidade da cercosporiose nas áreas de plantio nos dois períodos avaliados, dentro de cada sistema de cultivo.Surveys of the intensity of cercospora leaf spot of lettuce caused by Cercospora longissima were performed in 25 conventional and 25 organic farming areas in 2 planting periods, January-April (I and June-September (II 2002, in State of Pernambuco (Brazil. Disease prevalence was high (> 88% in all evaluated situations. Disease severity ranged from 0.0 to 16.9% in conventional farming areas and from 0.0 to 22.5% in organic farming areas. In both systems, disease severity was significantly higher in period I when precipitation was almost 3 times higher to that in period II. However, only in period II, significant differences in disease severity were found between farming systems, with high values in the organic system. There were no significant correlations among disease severity levels in the areas in both evaluated periods inside each farming system.

  16. Does the impact of case management vary in different subgroups of multimorbidity? Secondary analysis of a quasi-experiment.

    Science.gov (United States)

    Stokes, Jonathan; Kristensen, Søren Rud; Checkland, Kath; Cheraghi-Sohi, Sudeh; Bower, Peter

    2017-08-03

    Health systems must transition from catering primarily to acute conditions, to meet the increasing burden of chronic disease and multimorbidity. Case management is a popular method of integrating care, seeking to accomplish this goal. However, the intervention has shown limited effectiveness. We explore whether the effects of case management vary in patients with different types of multimorbidity. We extended a previously published quasi-experiment (difference-in-differences analysis) with 2049 propensity matched case management intervention patients, adding an additional interaction term to determine subgroup effects (difference-in-difference-in-differences) by different conceptualisations of multimorbidity: 1) Mental-physical comorbidity versus others; 2) 3+ chronic conditions versus 5 versus others. Outcome measures included a variety of secondary care utilisation and cost measures. The majority of conceptualisations suggested little to no difference in effect between subgroups. Where results were significant, the vast majority of effect sizes identified in either direction were very small. The trend across the majority of the results appeared to show very slight increases of admissions with treatment for the most complex patients (highest risk). The exceptions to this, patients with a Charlson index >5 may benefit slightly more from case management with decreased ACSC admissions (effect size (ES): −0.06) and inpatient re-admissions (30 days, ES: −0.05), and patients with only cardiovascular/metabolic cluster conditions may benefit slightly more with decreased inpatient non-elective admissions (ES: −0.12). Only the three significant estimates for the musculoskeletal disorder cluster met the minimum requirement for at least a ‘small’ effect. Two of these estimates in particular were very large. This cluster represented only 0.5% of the total patients analysed, however, so is hugely vulnerable to the effects of outliers, and makes us very cautious of

  17. Case management of malaria fever in Cambodia: results from national anti-malarial outlet and household surveys

    Directory of Open Access Journals (Sweden)

    Littrell Megan

    2011-10-01

    Full Text Available Abstract Background Continued progress towards global reduction in morbidity and mortality due to malaria requires scale-up of effective case management with artemisinin-combination therapy (ACT. The first case of artemisinin resistance in Plasmodium falciparum was documented in western Cambodia. Spread of artemisinin resistance would threaten recent gains in global malaria control. As such, the anti-malarial market and malaria case management practices in Cambodia have global significance. Methods Nationally-representative household and outlet surveys were conducted in 2009 among areas in Cambodia with malaria risk. An anti-malarial audit was conducted among all public and private outlets with the potential to sell anti-malarials. Indicators on availability, price and relative volumes sold/distributed were calculated across types of anti-malarials and outlets. The household survey collected information about management of recent "malaria fevers." Case management in the public versus private sector, and anti-malarial treatment based on malaria diagnostic testing were examined. Results Most public outlets (85% and nearly half of private pharmacies, clinics and drug stores stock ACT. Oral artemisinin monotherapy was found in pharmacies/clinics (9%, drug stores (14%, mobile providers (4% and grocery stores (2%. Among total anti-malarial volumes sold/distributed nationally, 6% are artemisinin monotherapies and 72% are ACT. Only 45% of people with recent "malaria fever" reportedly receive a diagnostic test, and the most common treatment acquired is a drug cocktail containing no identifiable anti-malarial. A self-reported positive diagnostic test, particularly when received in the public sector, improves likelihood of receiving anti-malarial treatment. Nonetheless, anti-malarial treatment of reportedly positive cases is low among people who seek treatment exclusively in the public (61% and private (42% sectors. Conclusions While data on the anti

  18. Assessing the link between implementation fidelity and health outcomes for a trial of intensive case management by community health workers: a mixed methods study protocol.

    Science.gov (United States)

    Schmidt, Barbara; Watt, Kerrianne; McDermott, Robyn; Mills, Jane

    2017-07-17

    Better systems of care are required to address chronic disease in Indigenous people to ensure they can access all their care needs. Health research has produced evidence about effective models of care and chronic disease strategies to address Indigenous health, however the transfer of research findings into routine clinical practice has proven challenging. Complex interventions, such as those related to chronic disease, have many components that are often poorly implemented and hence rarely achieve implementation fidelity. Implementation fidelity is "the degree to which programs are implemented as intended by the program developer". Knowing if an intervention was implemented as planned is fundamental to knowing what has contributed to the success of an intervention. The aim of this study is to adapt the implementation fidelity framework developed by Keith et al. and apply it to the intervention implemented in phase 1 of the Getting Better at Chronic Care in North Queensland study. The objectives are to quantify the level of implementation fidelity achieved during phase 1 of the study, measure the association between implementation fidelity and health outcomes and to explore the features of the primary health care system that contributed to improved health outcomes. A convergent parallel mixed methods study design will be used to develop a process for assessing implementation fidelity. Information collected via a questionnaire and routine data generated during phase 1 of the study will be used to explain the context for the intervention in each site and develop an implementation fidelity score for each component of the intervention. A weighting will be applied to each component of the intervention to calculate the overall implementation score for each participating community. Statistical analysis will assess the level of association between implementation fidelity scores and health outcomes. Health services research seeks to find solutions to social and technical problems to improve health outcomes. The development of a tool and methodology for assessing implementation fidelity in the Indigenous primary health care context will help address some of the barriers to the translation of research into practice. ACTRN12610000812099 : 29.9.2010.

  19. Frequência e intensidade de poda em pomar jovem de laranjeiras 'Valência' sob manejo orgânico Frequency and intensity of pruning young 'Valencia' orange trees in orchards under organic culture system

    Directory of Open Access Journals (Sweden)

    Emiliano Santarosa

    2010-10-01

    Full Text Available Este trabalho teve por objetivo avaliar o efeito da frequência e intensidade de poda sobre a produção e qualidade dos frutos da laranjeira 'Valência', enxertada sobre Poncirus trifoliata, em pomar jovem, sob sistema de manejo orgânico. O plantio foi realizado em agosto de 2001, em espaçamento de 5,0x2,5m, em Montenegro, Rio Grande do Sul (RS. Os tratamentos testados foram: A - Testemunha (sem poda; B - Poda anual de 15%; C - Poda bienal de 15%; D - Poda bienal de 30%; e E - Poda trienal de 30% do volume da copa. O delineamento experimental foi de blocos ao acaso, sendo quatro repetições e quatro plantas por parcela. Nas safras de 2006, 2007 e 2008, foram avaliados: número, massa total de frutos e massa média dos frutos, teor de sólidos solúveis totais (SST, acidez total titulável (ATT e relação SST/AT do suco dos frutos. Em pomares jovens, com menos de sete anos de idade, durante três safras consecutivas, verificou-se que as podas de frutificação não alteram a produção acumulada, nem a qualidade físico-química dos frutos, mas reduzem a produção no ano subsequente à execução da poda.This study evaluated the influence of frequency and intensity of pruning on young orchards, with organic management system, on the yield and fruit quality of 'Valencia' oranges. The trees were budded on Poncirus trifoliata rootstock and implanted in August, 2001, in Montenegro-RS. The pruning tested was: A - control, without pruning; B - annual pruning of 15%; C - biennial pruning of 15%; D - biennial pruning of 30% and E - three-year 30% pruning of the canopy volume. The experiment had a randomized complete-block design, with four-trees plots and four replications. The total fruit mass production was registered and the average weight fruit in the crops 2006, 2007 and 2008 was determined. The fruit quality, total soluble solids (TSS, total acids concentration (TTA and ratio (TSS/TTA were assessed. In orchards with fewer than seven years old

  20. A comprehensive grid to evaluate case management's expected effectiveness for community-dwelling frail older people: results from a multiple, embedded case study.

    Science.gov (United States)

    Van Durme, Thérèse; Schmitz, Olivier; Cès, Sophie; Anthierens, Sibyl; Maggi, Patrick; Delye, Sam; De Almeida Mello, Johanna; Declercq, Anja; Macq, Jean; Remmen, Roy; Aujoulat, Isabelle

    2015-06-18

    Case management is a type of intervention expected to improve the quality of care and therefore the quality of life of frail, community-dwelling older people while delaying institutionalisation in nursing homes. However, the heterogeneity, multidimensionality and complexity of these interventions make their evaluation by the means of classical approaches inadequate. Our objective was twofold: (i) to propose a tool allowing for the identification of the key components that explain the success of case management for this population and (ii) to propose a typology based on the results of this tool. The process started with a multiple embedded case study design in order to identify the key components of case management. Based on the results of this first step, data were collected among 22 case management interventions, in order to evaluate their expected effectiveness. Finally, multiple correspondence analyses was conducted to propose a typology of case management. The overall approach was informed by Wagner's Chronic Care Model and the theory of complexity. The study identified a total of 23 interacting key components. Based on the clustering of response patterns of the 22 case management projects included in our study, three types of case management programmes were evidenced, situated on a continuum from a more "socially-oriented" type towards a more "clinically-oriented" type of case management. The type of feedback provided to the general practitioner about both the global geriatric assessment and the result of the intervention turned out to be the most discriminant component between the types. The study design allowed to produce a tool that can be used to distinguish between different types of case management interventions and further evaluate their effect on frail older people in terms of the delaying institutionalisation, functional and cognitive status, quality of life and societal costs.

  1. Experiences of nurse case managers within a central discharge planning role of collaboration between physicians, patients and other healthcare professionals: A sociocultural qualitative study.

    Science.gov (United States)

    Thoma, Jorun E; Waite, Marion A

    2018-03-01

    To gain knowledge of nurse case managers' experiences within the German acute care context of collaboration with patients and physicians in a discharge planning role; further to learn about patients' assignment to the management of the nurse case managers; and explicitly to explore critical incidences of interactions between nurse case managers, patients and healthcare practitioner in discharge planning to understand the factor that contributes to effective collaboration. The defined role of nurse case managers in many contexts is a patient-centred responsibility for a central task of discharge management of patients with complex physical and social needs. Some studies have indicated that the general impact of the role reduces readmission rates. Given the necessity to work interprofessionally to achieve a safe discharge, little is known about how nurse case managers achieve this collaboratively. A qualitative case study within a German teaching hospital of nurse case managers (N = 8). Data were collected through semi-structured interviews prompted by a critical incident technique and rigorously analysed through the lenses of sociocultural theory. Consistent object being worked upon was a safe and effective discharge from hospital with a focus on patient advocacy. Significant themes were a self-value or recognition by others of professional expertise, reciprocal value on the capabilities of others thorough relational expertise and negotiation with patients and an identification of case trajectories. More continuity of nurse case managers' care and management, clarity of role and transparency to peers, physicians and other professionals would be beneficial in ensuring appropriate referral of complex patients to nurse case managers responsibility. Clearer role description and benefit realisation of the nurse case managers could be achieved by interventions that are interprofessional and focus on the tasks that matter from a collaborative perspective. This could lead

  2. Case management for the treatment of patients with major depression in general practices – rationale, design and conduct of a cluster randomized controlled trial – PRoMPT (Primary care Monitoring for depressive Patient's Trial [ISRCTN66386086] – Study protocol

    Directory of Open Access Journals (Sweden)

    Krauth Christian

    2005-10-01

    Full Text Available Abstract Background Depression is a disorder with high prevalence in primary health care and a significant burden of illness. The delivery of health care for depression, as well as other chronic illnesses, has been criticized for several reasons and new strategies to address the needs of these illnesses have been advocated. Case management is a patient-centered approach which has shown efficacy in the treatment of depression in highly organized Health Maintenance Organization (HMO settings and which might also be effective in other, less structured settings. Methods/Design PRoMPT (PRimary care Monitoring for depressive Patients Trial is a cluster randomised controlled trial with General Practice (GP as the unit of randomisation. The aim of the study is to evaluate a GP applied case-management for patients with major depressive disorder. 70 GPs were randomised either to intervention group or to control group with the control group delivering usual care. Each GP will include 10 patients suffering from major depressive disorder according to the DSM-IV criteria. The intervention group will receive treatment based on standardized guidelines and monthly telephone monitoring from a trained practice nurse. The nurse investigates the patient's status concerning the MDD criteria, his adherence to GPs prescriptions, possible side effects of medication, and treatment goal attainment. The control group receives usual care – including recommended guidelines. Main outcome measure is the cumulative score of the section depressive disorders (PHQ-9 from the German version of the Prime MD Patient Health Questionnaire (PHQ-D. Secondary outcome measures are the Beck-Depression-Inventory, self-reported adherence (adapted from Moriskey and the SF-36. In addition, data are collected about patients' satisfaction (EUROPEP-tool, medication, health care utilization, comorbidity, suicide attempts and days out of work. The study comprises three assessment times: baseline

  3. Cost of antimicrobial treatment in patients infected with multidrug-resistant organisms in the Intensive Care Unit Costo de la terapia antimicrobiana en pacientes infectados con microorganismos multirresistentes en la Unidad de Cuidados Intensivos

    Directory of Open Access Journals (Sweden)

    Fabiana Xavier Cartaxo Salgado

    2011-12-01

    Full Text Available This study aims to compare the costs of antimicrobial drugs used in the treatment of patients infected with multidrug-resistant organisms (MDRO or those not infected with this type of organisms in an intensive care unit (ICU. It is a retrospective comparative case-control study, performed in a public hospital in the capital city of Brazil, comprising the years 2007, 2008 and 2009. Information on age, sex, length of hospitalization, clinical outcome, antimicrobial drugs, microorganisms and microbial sensitivity to antibiotics was collected. Spearman and Mann-Whitney tests were used for statistical analysis. The level of significance was set at p El presente estudio tuvo como objetivo comparar los costos del tratamiento con fármacos antimicrobianos para las infecciones debidas a organismos multirresistentes (OMDR versus aquellas debidas a gérmenes no multirresistentes, en la Unidad de Cuidados Intensivos (UCI de un hospital público de Brasilia, Distrito Federal. Fue un estudio retrospectivo, de casos y controles y abarcó un período de tres años (2007, 2008, 2009. Se recolectó información sobre edad, sexo, tiempo de internación, resultados clínicos, antimicrobianos usados, microorganismos aislados y su sensibilidad a los antibióticos. Se utilizaron en el análisis estadístico las pruebas de Spearman y de Mann-Whitney, con p < 0.05. La muestra consistió en 401 pacientes con media de edad de 51.36 años (± 19.68, siendo 226 varones (56.4%. En cuanto al tiempo de internación, un 32.9% de los pacientes permanecieron más de 20 días, con 195 altas y 206 óbitos. El tratamiento antimicrobiano costó US$ 1113 221.55 en los tres años, siendo éste mayor para los que presentaron OMDR que para los que no los presentaron (p = 0.01. Se comprobó la presencia de, por lo menos, un microorganismo multirresistente en el 54.6% de los pacientes. La infección intrahospitalaria con OMDR y el elevado costo del tratamiento de los pacientes infectados

  4. Persistently better treatment planning results of intensity-modulated (IMRT) over conformal radiotherapy (3D-CRT) in prostate cancer patients with significant variation of clinical target volume and/or organs-at-risk

    International Nuclear Information System (INIS)

    Fenoglietto, Pascal; Laliberte, Benoit; Allaw, Ali; Ailleres, Norbert; Idri, Katia; Hay, Meng Huor; Moscardo, Carmen Llacer; Gourgou, Sophie; Dubois, Jean-Bernard; Azria, David

    2008-01-01

    Purpose: To compare the dose coverage of planning and clinical target volume (PTV, CTV), and organs-at-risk (OAR) between intensity-modulated (3D-IMRT) and conventional conformal radiotherapy (3D-CRT) before and after internal organ variation in prostate cancer. Methods and materials: We selected 10 patients with clinically significant interfraction volume changes. Patients were treated with 3D-IMRT to 80 Gy (minimum PTV dose of 76 Gy, excluding rectum). Fictitious, equivalent 3D-CRT plans (80 Gy at isocenter, with 95% isodose (76 Gy) coverage of PTV, with rectal blocking above 76 Gy) were generated using the same planning CT data set ('CT planning'). The plans were then also applied to a verification CT scan ('CT verify') obtained at a different moment. PTV, CTV, and OAR dose coverage were compared using non-parametric tests statistics for V95, V90 (% of the volume receiving ≥95 or 90% of the dose) and D50 (dose to 50% of the volume). Results: Mean V95 of the PTV for 'CT planning' was 94.3% (range, 88-99) vs 89.1% (range, 84-94.5) for 3D-IMRT and 3D-CRT (p = 0.005), respectively. Mean V95 of the CTV for 'CT verify' was 97% for both 3D-IMRT and 3D-CRT. Mean D50 of the rectum for 'CT planning' was 26.8 Gy (range, 22-35) vs 43.5 Gy (range, 33.5-50.5) for 3D-IMRT and 3D-CRT (p = 0.0002), respectively. For 'CT verify', this D50 was 31.1 Gy (range, 16.5-44) vs 44.2 Gy (range, 34-55) for 3D-IMRT and 3D-CRT (p = 0.006), respectively. V95 of the rectum was 0% for both plans for 'CT planning', and 2.3% (3D-IMRT) vs 2.1% (3D-CRT) for 'CT verify' (p = non-sig.). Conclusion: Dose coverage of the PTV and OAR was better with 3D-IMRT for each patient and remained so after internal volume changes

  5. Dosimetric Comparison of Intensity-Modulated Radiotherapy Plans, With or Without Anterior Myocardial Territory and Left Ventricle as Organs at Risk, in Early-Stage Left-Sided Breast Cancer Patients

    International Nuclear Information System (INIS)

    Tan Wenyong; Wang Xiaohong; Qiu Dasheng; Liu Dong; Jia Shaohui; Zeng Fanyu; Chen Zhengwang; Li Beihui; Xu Jiaozhen; Wei Lai; Hu Desheng

    2011-01-01

    Purpose: We evaluated heart sparing using an intensity-modulated radiotherapy (IMRT) plan with the left ventricle (LV) and/or the anterior myocardial territory (AMT) as additional organs at risk (OARs). Methods and Materials: A total of 10 patients with left-sided breast cancer were selected for dosimetric planning. Both lungs, the right breast, heart, LV, and AMT were defined as OARs. We generated one tangential field plan and four IMRT plans for each patient. We examined the dose–volume histogram parameters of the planning target volume and OARs. Results: Compared with the tangential field plan, the mean dose to the heart in the IMRT plans did not show significant differences; however, the dose to the AMT and LV decreased by 18.7–45.4% and 10.8–37.4%, respectively. The maximal dose to the heart decreased by 18.6–35.3%, to the AMT by 22.0–45.1%, and to the LV by 23.5–45.0%, And the relative volumes of the heart (V ≥12 ), AMT (V >11 ) and LV (V >10 ) decreased significantly with different levels, respectively. The volume of the heart, AMT, LV, both lungs, and right breast receiving ≥5 Gy showed a significant increase. Compared with the IMRT (H) plan, the mean dose to the heart, AMT, and LV decreased by 17.5–21.5%, 25.2–29.8%, and 22.8–29.8% and the maximal dose by 13.6–20.6%, 23.1–29.6%, and 17.3–29.1%, respectively. The IMRT plans for both lungs and the right breast showed no significant differences. Conclusions: The IMRT plans with the addition of the AMT and/or LV as OARs considerably increased heart sparing. We recommend including the LV as an additional OAR in such plans.

  6. Resistance patterns and outcomes in intensive care unit (ICU)-acquired pneumonia. Validation of European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms.

    Science.gov (United States)

    Martin-Loeches, Ignacio; Torres, Antonio; Rinaudo, Mariano; Terraneo, Silvia; de Rosa, Francesca; Ramirez, Paula; Diaz, Emili; Fernández-Barat, Laia; Li Bassi, Gian Luigi; Ferrer, Miquel

    2015-03-01

    Bacterial resistance has become a major public health problem. To validate the definition of multidrug-resistant organisms (MDRO) based on the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification. Prospective, observational study in six medical and surgical Intensive-Care-Units (ICU) of a University hospital. Three-hundred-and-forty-three patients with ICU-acquired pneumonia (ICUAP) were prospectively enrolled, 140 patients had no microbiological confirmation (41%), 82 patients (24%) developed ICUAP for non-MDRO, whereas 121 (35%) were MDROs. Non-MDRO, MDRO and no microbiological confirmation patients did not present either a significant different previous antibiotic use (p 0.18) or previous hospital admission (p 0.17). Appropriate antibiotic therapy was associated with better ICU survival (105 [92.9%] vs. 74 [82.2%]; p = 0.03). An adjusted multivariate regression logistic analysis identified that only MDRO had a higher ICU-mortality than non-MDRO and no microbiological confirmation patients (OR 2.89; p < 0.05; 95% CI for Exp [β]. 1.02-8.21); Patients with MDRO ICUAP remained in ICU for a longer period than MDRO and no microbiological confirmation respectively (p < 0.01) however no microbiological confirmation patients had more often antibiotic consumption than culture positive ones. Patients who developed ICUAP due to MDRO showed a higher ICU-mortality than non-MDRO ones and use of ICU resources. No microbiological confirmation patients had more often antibiotic consumption than culture positive patients. Risk factors for MDRO may be important for the selection of initial antimicrobial therapy, in addition to local epidemiology. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

  7. Preliminary evaluation of a "formulation-driven cognitive behavioral guided self-help (fCBT-GSH)" for crisis and transitional case management clients.

    Science.gov (United States)

    Naeem, Farooq; Johal, Rupinder K; Mckenna, Claire; Calancie, Olivia; Munshi, Tariq; Hassan, Tariq; Nasar, Amina; Ayub, Muhammad

    2017-01-01

    Cognitive behavioral therapy (CBT) is found to be effective for common mental disorders and has been delivered in self-help and guided self-help formats. Crisis and transitional case management (TCM) services play a vital role in managing clients in acute mental health crises. It is, therefore, an appropriate setting to try CBT in guided self-help format. This was a preliminary evaluation of a formulation-driven cognitive behavioral guided self-help. Thirty-six (36) consenting participants with a diagnosis of nonpsychotic illness, attending crisis and the TCM services in Kingston, Canada, were recruited in this study. They were randomly assigned to the guided self-help plus treatment as usual (TAU) (treatment group) or to TAU alone (control group). The intervention was delivered over 8-12 weeks. Assessments were completed at baseline and 3 months after baseline. The primary outcome was a reduction in general psychopathology, and this was done using Clinical Outcomes in Routine Evaluation - Outcome Measure. The secondary outcomes included a reduction in depression, measured using the Hospital Anxiety and Depression Scale, and reduction in disability, measured using the World Health Organization Disability Assessment Schedule 2.0. Participants in the treatment group showed statistically significant improvement in overall psychopathology ( P crisis and TCM clients and can be effective in improving mental health, when compared with TAU. This is the first report of a trial of guided self-help for clients attending crisis and TCM services.

  8. Preliminary evaluation of a “formulation-driven cognitive behavioral guided self-help (fCBT-GSH” for crisis and transitional case management clients

    Directory of Open Access Journals (Sweden)

    Naeem F

    2017-03-01

    Full Text Available Farooq Naeem,1,2 Rupinder K Johal,1 Claire Mckenna,1 Olivia Calancie,1 Tariq Munshi,1,2 Tariq Hassan,1 Amina Nasar,3 Muhammad Ayub1 1Department of Psychiatry, Queen’s University, Kingston, ON, Canada; 2Addiction and Mental Health Services – Kingston, Frontenac, Lennox & Addington (AMHS-KFLA, Kingston, ON, Canada; 3Services Institute of Medical Sciences, Lahore, Pakistan Background: Cognitive behavioral therapy (CBT is found to be effective for common mental disorders and has been delivered in self-help and guided self-help formats. Crisis and transitional case management (TCM services play a vital role in managing clients in acute mental health crises. It is, therefore, an appropriate setting to try CBT in guided self-help format.Methods: This was a preliminary evaluation of a formulation-driven cognitive behavioral guided self-help. Thirty-six (36 consenting participants with a diagnosis of nonpsychotic illness, attending crisis and the TCM services in Kingston, Canada, were recruited in this study. They were randomly assigned to the guided self-help plus treatment as usual (TAU (treatment group or to TAU alone (control group. The intervention was delivered over 8–12 weeks. Assessments were completed at baseline and 3 months after baseline. The primary outcome was a reduction in general psychopathology, and this was done using Clinical Outcomes in Routine Evaluation – Outcome Measure. The secondary outcomes included a reduction in depression, measured using the Hospital Anxiety and Depression Scale, and reduction in disability, measured using the World Health Organization Disability Assessment Schedule 2.0.Findings: Participants in the treatment group showed statistically significant improvement in overall psychopathology (P<0.005, anxiety and depression (P<0.005, and disability (P<0.005 at the end of the trial compared with TAU group. Conclusion: A formulation-driven cognitive behavioral guided self-help was feasible for the crisis

  9. Towards eliminating malaria in high endemic countries: the roles of community health workers and related cadres and their challenges in integrated community case management for malaria: a systematic review.

    Science.gov (United States)

    Sunguya, Bruno F; Mlunde, Linda B; Ayer, Rakesh; Jimba, Masamine

    2017-01-03

    Human resource for health crisis has impaired global efforts against malaria in highly endemic countries. To address this, the World Health Organization (WHO) recommended scaling-up of community health workers (CHWs) and related cadres owing to their documented success in malaria and other disease prevention and management. Evidence is inconsistent on the roles and challenges they encounter in malaria interventions. This systematic review aims to summarize evidence on roles and challenges of CHWs and related cadres in integrated community case management for malaria (iCCM). This systematic review retrieved evidence from PubMed, CINAHL, ISI Web of Knowledge, and WHO regional databases. Terms extracted from the Boolean phrase used for PubMed were also used in other databases. The review included studies with Randomized Control Trial, Quasi-experimental, Pre-post interventional, Longitudinal and cohort, Cross-sectional, Case study, and Secondary data analysis. Because of heterogeneity, only narrative synthesis was conducted for this review. A total of 66 articles were eligible for analysis out of 1380 studies retrieved. CHWs and related cadre roles in malaria interventions included: malaria case management, prevention including health surveillance and health promotion specific to malaria. Despite their documented success, CHWs and related cadres succumb to health system challenges. These are poor and unsustainable finance for iCCM, workforce related challenges, lack of and unsustainable supply of medicines and diagnostics, lack of information and research, service delivery and leadership challenges. Community health workers and related cadres had important preventive, case management and promotive roles in malaria interventions. To enable their effective integration into the health systems, the identified challenges should be addressed. They include: introducing sustainable financing on iCCM programmes, tailoring their training to address the identified gaps

  10. Systematic literature review of integrated community case management and the private sector in Africa: Relevant experiences and potential next steps.

    Science.gov (United States)

    Awor, Phyllis; Miller, Jane; Peterson, Stefan

    2014-12-01

    Despite substantial investments made over the past 40 years in low income countries, governments cannot be viewed as the principal health care provider in many countries. Evidence on the role of the private sector in the delivery of health services is becoming increasingly available. In this study, we set out to determine the extent to which the private sector has been utilized in providing integrated care for sick children under 5 years of age with community-acquired malaria, pneumonia or diarrhoea. We reviewed the published literature for integrated community case management (iCCM) related experiences within both the public and private sector. We searched PubMed and Google/Google Scholar for all relevant literature until July 2014. The search terms used were "malaria", "pneumonia", "diarrhoea", "private sector" and "community case management". A total of 383 articles referred to malaria, pneumonia or diarrhoea in the private sector. The large majority of these studies (290) were only malaria related. Most of the iCCM-related studies evaluated introduction of only malaria drugs and/or diagnostics into the private sector. Only one study evaluated the introduction of drugs and diagnostics for malaria, pneumonia and diarrhoea in the private sector. In contrast, most iCCM-related studies in the public sector directly reported on community case management of 2 or more of the illnesses. While the private sector is an important source of care for children in low income countries, little has been done to harness the potential of this sector in improving access to care for non-malaria-associated fever in children within the community. It would be logical for iCCM programs to expand their activities to include the private sector to achieve higher population coverage. An implementation research agenda for private sector integrated care of febrile childhood illness needs to be developed and implemented in conjunction with private sector intervention programs.

  11. The effects of combining Web-based eHealth with telephone nurse case management for pediatric asthma control: a randomized controlled trial.

    Science.gov (United States)

    Gustafson, David; Wise, Meg; Bhattacharya, Abhik; Pulvermacher, Alice; Shanovich, Kathleen; Phillips, Brenda; Lehman, Erik; Chinchilli, Vernon; Hawkins, Robert; Kim, Jee-Seon

    2012-07-26

    Asthma is the most common pediatric illness in the United States, burdening low-income and minority families disproportionately and contributing to high health care costs. Clinic-based asthma education and telephone case management have had mixed results on asthma control, as have eHealth programs and online games. To test the effects of (1) CHESS+CM, a system for parents and children ages 4-12 years with poorly controlled asthma, on asthma control and medication adherence, and (2) competence, self-efficacy, and social support as mediators. CHESS+CM included a fully automated eHealth component (Comprehensive Health Enhancement Support System [CHESS]) plus monthly nurse case management (CM) via phone. CHESS, based on self-determination theory, was designed to improve competence, social support, and intrinsic motivation of parents and children. We identified eligible parent-child dyads from files of managed care organizations in Madison and Milwaukee, Wisconsin, USA, sent them recruitment letters, and randomly assigned them (unblinded) to a control group of treatment as usual plus asthma information or to CHESS+CM. Asthma control was measured by the Asthma Control Questionnaire (ACQ) and self-reported symptom-free days. Medication adherence was a composite of pharmacy refill data and medication taking. Social support, information competence, and self-efficacy were self-assessed in questionnaires. All data were collected at 0, 3, 6, 9, and 12 months. Asthma diaries kept during a 3-week run-in period before randomization provided baseline data. Of 305 parent-child dyads enrolled, 301 were randomly assigned, 153 to the control group and 148 to CHESS+CM. Most parents were female (283/301, 94%), African American (150/301, 49.8%), and had a low income as indicated by child's Medicaid status (154/301, 51.2%); 146 (48.5%) were single and 96 of 301 (31.9%) had a high school education or less. Completion rates were 127 of 153 control group dyads (83.0%) and 132 of 148 CHESS

  12. Service guidelines based on Resource Utilization Groups Version III for Home Care provide decision-making support for case managers.

    Science.gov (United States)

    Collister, Barbara; Stein, Glenda; Katz, Deborah; DeBruyn, Joan; Andrusiw, Linda; Cloutier, Sheila

    2012-01-01

    Increasing costs and budget reductions combined with increasing demand from our growing, aging population support the need to ensure that the scarce resources allocated to home care clients match client needs. This article details how Integrated Home Care for the Calgary Zone of Alberta Health Services considered ethical and economic principles and used data from the Resident Assessment Instrument for Home Care (RAI-HC) and case mix indices from the Resource Utilization Groups Version III for Home Care (RUG-III/HC) to formulate service guidelines. These explicit service guidelines formalize and support individual resource allocation decisions made by case managers and provide a consistent and transparent method of allocating limited resources.

  13. [Implementation and (cost-)effectiveness of case management for people with dementia and their informal caregivers: results of the COMPAS study].

    Science.gov (United States)

    van Mierlo, Lisa D; MacNeil-Vroomen, Janet; Meiland, Franka J M; Joling, Karlijn J; Bosmans, Judith E; Dröes, Rose Marie; Moll van Charante, Eric P; de Rooij, Sophia E J A; van Hout, Hein P J

    2016-12-01

    Different forms of case management for dementia have emerged over the past few years. In the COMPAS study (Collaborative dementia care for patients and caregivers study), two prominent Dutch case management forms were studied: the linkage and the integrated care form. Evaluation of the (cost)effectiveness of two dementia case management forms compared to usual care as well as factors that facilitated or impeded their implementation. A mixed methods design with a) a prospective, observational controlled cohort study with 2 years follow-up among 521 dyads of people with dementia and their primary informal caregiver with and without case management; b) interviews with 22 stakeholders on facilitating and impeding factors of the implementation and continuity of the two case management models. Outcome measures were severity and frequency of behavioural problems (NPI) for the person with dementia and mental health complaints (GHQ-12) for the informal caregiver, total met and unmet care needs (CANE) and quality adjusted life years (QALYs). Outcomes showed a better quality of life of informal caregivers in the integrated model compared to the linkage model. Caregivers in the control group reported more care needs than those in both case management groups. The independence of the case management provider in the integrated model facilitated the implementation, while the rivalry between multiple providers in the linkage model impeded the implementation. The costs of care were lower in the linkage model (minus 22 %) and integrated care model (minus 33 %) compared to the control group. The integrated care form was (very) cost-effective in comparison with the linkage form or no case management. The integrated care form is easy to implement.

  14. Influence of health systems in malaria case management as part of malaria control in Tanzania

    OpenAIRE

    Masanja, Irene M.

    2013-01-01

    The World Health Organization report in 2007, declared that, it will not be possible to achieve national and international health goals without greater investments in health systems. It is a known fact that today, the advancement in science has led to a better understanding of aetiologies and risk factors of most diseases burden in the world. However, the capacity to deliver these innovations to the population that needs them the most is severely handicapped by fragile and poor health systems...

  15. Measuring Physical Activity Intensity

    Medline Plus

    Full Text Available ... using relative intensity, people pay attention to how physical activity affects their heart rate and breathing. The talk test is a simple way to measure relative intensity. ...

  16. Measuring Physical Activity Intensity

    Medline Plus

    Full Text Available ... Older Adults Overcoming Barriers Measuring Physical Activity Intensity Target Heart Rate & Estimated Maximum Heart Rate Perceived Exertion ( ... a heavy backpack Other Methods of Measuring Intensity Target Heart Rate and Estimated Maximum Heart Rate Perceived ...

  17. Measuring Physical Activity Intensity

    Medline Plus

    Full Text Available ... Share Compartir For more help with what counts as aerobic activity, watch this video: Windows Media Player, ... The table below lists examples of activities classified as moderate-intensity or vigorous-intensity based upon the ...

  18. Measuring Physical Activity Intensity

    Medline Plus

    Full Text Available ... for a breath. Absolute Intensity The amount of energy used by the body per minute of activity. ... or vigorous-intensity based upon the amount of energy used by the body while doing the activity. ...

  19. Iowa Intensive Archaeological Survey

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — This shape file contains intensive level archaeological survey areas for the state of Iowa. All intensive Phase I surveys that are submitted to the State Historic...

  20. Rainfed intensive crop systems

    DEFF Research Database (Denmark)

    Olesen, Jørgen E

    2014-01-01

    This chapter focuses on the importance of intensive cropping systems in contributing to the world supply of food and feed. The impact of climate change on intensive crop production systems is also discussed.......This chapter focuses on the importance of intensive cropping systems in contributing to the world supply of food and feed. The impact of climate change on intensive crop production systems is also discussed....

  1. Programas de continuidad de cuidados: éxitos, fracasos y retos futuros Case management programs: successes, failures and future challenges

    Directory of Open Access Journals (Sweden)

    Ana González Rodríguez

    2011-12-01

    Full Text Available Los programas de continuidad de cuidados surgen a finales de los años 70 en EEUU, en respuesta a los problemas detectados durante del proceso de desintitucionalización de los hospitales psiquiátricos. Desde entonces, se han extendido por todo el mundo, con variaciones y peculiaridades según las regiones, convirtiéndose en piedra angular de la atención a las personas con enfermedad mental grave y persistente. En este artículo se revisa el origen de estos programas, su desarrollo a lo largo de más de treinta años, la filosofía que los ha guiado en su devenir, así como los éxitos y fracasos en su desarrollo.The case management programs arise in the late 70's in the U.S., in response to problems identified during the process of deinstitutionalization of psychiatric hospitals. Since then, the case management and the assertive community treatment programs have spread throughout the world, with variations and particularities in different regions, becoming the cornerstone of the community care for people with severe and persistent mental illness. This article reviews the origins of these programs in U.S., their development for over thirty years around the world, the philosophy and objectives that have guided its evolution, as well as successes and failures in their development.

  2. [Study protocol of a prevention of recurrent suicidal behaviour program based on case management (PSyMAC)].

    Science.gov (United States)

    Sáiz, Pilar A; Rodríguez-Revuelta, Julia; González-Blanco, Leticia; Burón, Patricia; Al-Halabí, Susana; Garrido, Marlen; García-Alvarez, Leticia; García-Portilla, Paz; Bobes, Julio

    2014-01-01

    Prevention of suicidal behaviour is a public health priority in the European Union. A previous suicide attempt is the best risk predictor for future attempts, as well as completed suicides. The primary aim of this article is to describe a controlled study protocol designed for prevention of recurrent suicidal behaviour that proposes case management, and includes a psychoeducation program, as compared with the standard intervention (PSyMAC). Patients admitted from January 2011 to June 2013 to the emergency room of the Hospital Universitario Central de Asturias were evaluated using a protocol including sociodemographic, psychiatric, and psychosocial assessment. Patients were randomly assigned to either a group receiving continuous case management including participation in a psychoeducation program (experimental group), or a control group receiving standard care. The primary objective is to examine whether or not the period of time until recurrent suicidal behaviour in the experimental group is significantly different from that of the control group. PSyMAC proposes low cost and easily adaptable interventions to the usual clinical setting that can help to compensate the shortcoming of specific action protocols and suicidal behaviour prevention programs in our country. The evaluation of PSyMAC results will determine their real effectivity as a case-magament program to reduce suicidal risk. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.

  3. National scale-up of integrated community case management in rural Ethiopia: implementation and early lessons learned.

    Science.gov (United States)

    2014-10-01

    Although under-five mortality in Ethiopia has decreased 67% in the past two decades, many, children still die from preventable or treatable conditions, mainly pneumonia, newborn problems, diarrhea, malaria and malnutrition. Most of these deaths can be avoided with timely and appropriate care, but access to and use of treatment remains inadequate. Community health workers, appropriately trained, supervised, and supplied with essen- tial equipment and medicines, can deliver case management or referral to most sick children. In 2010, Ethiopia added pneumonia to diarrhea, malaria and severe acute malnutrition, targeted for treatment in the integrated community case management (iCCM) strategy. This article describes the national scale-up of iCCM implementation and early lessons learned. We reviewed data related to iCCM program inputs and processes from reports, minutes, and related documents from January 2010 through July 2013. We describe introduction and scale-up through eight health system components. The government and partners trained and supplied 27,116 of the total 32,000 Health Extension Workers and mentored 80% of them to deliver iCCM services to over one million children. The government led a strong-iCCM partnership that attracted development partners in implementation, monitoring, evaluation, and research. Service utilization and weak supply chain remain-major challenges. Strong MOH leadership, policy support, and national partnerships helped successful national iCCM scale-up and should help settle remaining challenges.

  4. Experiences of working from a freestanding position as a case manager when supporting clients in the Swedish welfare system.

    Science.gov (United States)

    Klockmo, Carolina; Marnetoft, Sven-Uno

    2016-06-01

    The Swedish state uses a case management function known as Personligt Ombud (PO). The role as PO differs from the traditional professional roles. It has a freestanding position in the welfare system. The aim of this study was to investigate POs' experiences of working from a freestanding position when supporting clients. Telephone interviews were conducted with 22 POs across Sweden. The interviews were recorded, transcribed, and analyzed by latent qualitative content analysis. The findings were reflected in three categories - freedom-promoted flexibility, surfing through a complex welfare system, and working for legitimacy. POs developed a holistic view to both the client as well as to the welfare system. POs experienced solely representing the client, which is a positive feature because part of the POs' role is advocating for the clients rights. The PO service differs from the PO service from other existing case management models and may need to develop strategies for decision-making and support in their own role. For example, they may use group supervision teams or 'reflective teams'. The freestanding position may also entail problems in terms of lack of legitimacy. It is important for POs to develop good platforms with the surrounding actors among others things to improve the co-ordination process. It could be interesting if the PO model would be tested in other countries that have a fragmented welfare system. The PO model may also be useful to other 'target groups' who are in need of co-ordinated rehabilitation services.

  5. Parenting competence, social support, and self-esteem in teen mothers case managed by public health nurses.

    Science.gov (United States)

    Herrmann, M M; Van Cleve, L; Levisen, L

    1998-12-01

    The purpose of this descriptive study was to determine whether self-esteem, parenting competence, and social support for teenage mothers changed over the first 18 months of parenting when case managed by a public health nurse (PHN). A sample of 56 first-time teen mothers from a health department parenting project agreed to participate in the study. PHN case managers collected data close to the birth of the infants and at 6, 12, and 18 months. Demographic findings of teen mothers showed that the majority were below expected grade level, over half lived with parents, and over half were children of teen mothers. Outcome findings related to the infants revealed no delays in development as measured on the Denver Development Screening Test, adequate follow-up for identified health problems, and a high percentage of the children with up-to-date with immunizations. The research question findings showed a statistically significant drop in self esteem for the teens between birth and 6 months, and in social support between 6 and 18 months. No other findings were significant, but some trends appeared when the sample was divided by ethnicity, suggesting a need for closer follow-up for certain groups. Implications for public health nursing and nursing education are included.

  6. Machine Learning for Social Services: A Study of Prenatal Case Management in Illinois.

    Science.gov (United States)

    Pan, Ian; Nolan, Laura B; Brown, Rashida R; Khan, Romana; van der Boor, Paul; Harris, Daniel G; Ghani, Rayid

    2017-06-01

    To evaluate the positive predictive value of machine learning algorithms for early assessment of adverse birth risk among pregnant women as a means of improving the allocation of social services. We used administrative data for 6457 women collected by the Illinois Department of Human Services from July 2014 to May 2015 to develop a machine learning model for adverse birth prediction and improve upon the existing paper-based risk assessment. We compared different models and determined the strongest predictors of adverse birth outcomes using positive predictive value as the metric for selection. Machine learning algorithms performed similarly, outperforming the current paper-based risk assessment by up to 36%; a refined paper-based assessment outperformed the current assessment by up to 22%. We estimate that these improvements will allow 100 to 170 additional high-risk pregnant women screened for program eligibility each year to receive services that would have otherwise been unobtainable. Our analysis exhibits the potential for machine learning to move government agencies toward a more data-informed approach to evaluating risk and providing social services. Overall, such efforts will improve the efficiency of allocating resource-intensive interventions.

  7. Stochastic conditional intensity processes

    DEFF Research Database (Denmark)

    Bauwens, Luc; Hautsch, Nikolaus

    2006-01-01

    model allows for a wide range of (cross-)autocorrelation structures in multivariate point processes. The model is estimated by simulated maximum likelihood (SML) using the efficient importance sampling (EIS) technique. By modeling price intensities based on NYSE trading, we provide significant evidence......In this article, we introduce the so-called stochastic conditional intensity (SCI) model by extending Russell’s (1999) autoregressive conditional intensity (ACI) model by a latent common dynamic factor that jointly drives the individual intensity components. We show by simulations that the proposed...... for a joint latent factor and show that its inclusion allows for an improved and more parsimonious specification of the multivariate intensity process...

  8. The Danish Intensive Care Database

    Directory of Open Access Journals (Sweden)

    Christiansen CF

    2016-10-01

    Full Text Available Christian Fynbo Christiansen,1 Morten Hylander Møller,2 Henrik Nielsen,1 Steffen Christensen3 1Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, 2Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, 3Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark Aim of database: The aim of this database is to improve the quality of care in Danish intensive care units (ICUs by monitoring key domains of intensive care and to compare these with predefined standards. Study population: The Danish Intensive Care Database (DID was established in 2007 and includes virtually all ICU admissions in Denmark since 2005. The DID obtains data from the Danish National Registry of Patients, with complete follow-up through the Danish Civil Registration System. Main variables: For each ICU admission, the DID includes data on the date and time of ICU admission, type of admission, organ supportive treatments, date and time of discharge, status at discharge, and mortality up to 90 days after admission. Descriptive variables include age, sex, Charlson comorbidity index score, and, since 2010, the Simplified Acute Physiology Score (SAPS II. The variables are recorded with 90%–100% completeness in the recent years, except for SAPS II score, which is 73%–76% complete. The DID currently includes five quality indicators. Process indicators include out-of-hour discharge and transfer to other ICUs for capacity reasons. Outcome indicators include ICU readmission within 48 hours and standardized mortality ratios for death within 30 days after admission using case-mix adjustment (initially using age, sex, and comorbidity level, and, since 2013, using SAPS II for all patients and for patients with septic shock. Descriptive data: The DID currently includes 335,564 ICU admissions during 2005–2015 (average 31,958 ICU admissions per year. Conclusion: The DID provides a

  9. Organic photovoltaics

    DEFF Research Database (Denmark)

    Demming, Anna; Krebs, Frederik C; Chen, Hongzheng

    2013-01-01

    's supply, even at our increasingly ravenous rate of global energy consumption [1]. But it's not what you have got it's what you do with it. Hence the intense focus on photovoltaic research to find more efficient ways to harness energy from the Sun. Recently much of this research has centred on organic...... solar cells since they offer simple, low-cost, light-weight and large-area flexible photovoltaic structures. This issue with guest editors Frederik C Krebs and Hongzheng Chen focuses on some of the developments at the frontier of organic photovoltaic technology. Improving the power conversion efficiency...... of organic photovoltaic systems, while maintaining the inherent material, economic and fabrication benefits, has absorbed a great deal of research attention in recent years. Here significant progress has been made with reports now of organic photovoltaic devices with efficiencies of around 10%. Yet operating...

  10. The Lifestyle Engagement Activity Program (LEAP): Implementing Social and Recreational Activity into Case-Managed Home Care.

    Science.gov (United States)

    Low, Lee-Fay; Baker, Jessica Rose; Harrison, Fleur; Jeon, Yun-Hee; Haertsch, Maggie; Camp, Cameron; Skropeta, Margaret

    2015-12-01

    The Lifestyle Engagement Activity Program (LEAP) incorporates social support and recreational activities into case-managed home care. This study's aim was to evaluate the effect of LEAP on engagement, mood, and behavior of home care clients, and on case managers and care workers. Quasi-experimental. Five Australian aged home care providers, including 2 specializing in care for ethnic minorities. Clients (n = 189) from 5 home care providers participated. The 12-month program had 3 components: (1) engaging support of management and staff; (2) a champion to drive practice change; (3) staff training. Case managers were trained to set meaningful social and/or recreational goals during care planning. Care workers were trained in good communication, to promote client independence and choice, and in techniques such as Montessori activities, reminiscence, music, physical activity, and humor. Data were collected 6 months before program commencement, at baseline, and 6 and 12 months. The Homecare Measure of Engagement Staff report and Client-Family interview were primary outcomes. Secondary outcomes were the Cohen-Mansfield Agitation Inventory; apathy, dysphoria, and agitation subscales of the Neuropsychiatric Inventory-Clinician Rating; the geriatric depression scale; UCLA loneliness scale; and home care satisfaction scale. Staff provided information on confidence in engaging clients and the Utrecht Work Engagement Scale. Twelve months after program commencement, clients showed a significant increase in self- or family-reported client engagement (b = 5.39, t[113.09] = 3.93, P recreationally engage clients (b = 0.52, t(21.33) = 2.80, P = .011, b = 0.29, t(198.69) = 2.58, P = .011, respectively). There were no significant changes in care worker-rated client engagement or client or family self-complete measures of depression or loneliness (P > .05). Client and family self-rated apathy increased over 12 months (b = 0.04, t(43.36) = 3.06, P = .004; b = 3.63, t(34.70) = 2.20, P

  11. Linkage to care among adults being investigated for tuberculosis in South Africa: pilot study of a case manager intervention.

    Science.gov (United States)

    Maraba, Noriah; Chihota, Violet; McCarthy, Kerrigan; Churchyard, Gavin J; Grant, Alison D

    2018-05-24

    We piloted an intervention to determine if support from a case manager would assist adults being investigated for tuberculosis (TB) to link into TB and HIV care. Pilot interventional cohort study. Patients identified by primary healthcare clinic staff in South Africa as needing TB investigations were enrolled. Participants were supported for 3 months by case managers who facilitated the care pathway by promoting HIV testing, getting laboratory results, calling patients to return for results and facilitating treatment initiation. Linkage to TB care was defined as starting TB treatment within 28 days in those with a positive test result; linkage to HIV care, for HIV-positive people, was defined as having blood taken for CD4 count and, for those eligible, starting antiretroviral therapy within 3 months. Intervention implementation was measured by number of attempts to contact participants. Among 562 participants (307 (54.6%) female, median age: 36 years (IQR 29-44)), most 477 (84.8%) had previously tested for HIV; of these, 328/475 (69.1%) self-reported being HIV-positive. Overall, 189/562 (33.6%) participants needed linkage to care (132 HIV care linkage only; 35 TB treatment linkage only; 22 both). Of 555 attempts to contact these 189 participants, 407 were to facilitate HIV care linkage, 78 for TB treatment linkage and 70 for both. At the end of 3-month follow-up, 40 participants had not linked to care (29 of the 132 (22.0%) participants needing linkage to HIV care only, 4 of the 35 (11.4%) needing to start on TB treatment only and 7 of the 22 (31.8%) needing both). Many people testing for TB need linkage to care. Despite case manager support, non-linkage into HIV care remained higher than desirable, suggesting a need to modify this intervention before implementation. Innovative strategies to enable linkage to care are needed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial

  12. Design of a Randomised Controlled Trial (RCT on the effectiveness of a Dutch patient advocacy case management intervention among severely disabled Multiple Sclerosis patients

    Directory of Open Access Journals (Sweden)

    Annema Coby

    2010-05-01

    Full Text Available Abstract Background Case management has been suggested as an innovative strategy that facilitates the improvement of a patient's quality of life, reduction of hospital length of stay, optimization of self-care and improvement of satisfaction of patients and professionals involved. However, there is little evidence about the effectiveness of the patient advocacy case management model in clinical practice. Therefore, the objective of our study was to examine the effects of the Dutch patient advocacy case management model for severely disabled Multiple Sclerosis (MS patients and their caregivers compared to usual care. Methods/design In this randomized controlled trial the effectiveness of casemanagement on quality of life of patients and their caregivers, quality of care, service use and economic aspects were evaluated. The primary outcomes of this study were quality of life of MS-patients and caregiver burden of caregivers. Furthermore, we examined quality of life of caregivers, quality of care, service use and costs. Discussion This is a unique trial in which we examined the effectiveness of case management from a broad perspective. We meticulously prepared this study and applied important features and created important conditions for both intervention and research protocol to increase the likelihood of finding evidence for the effectiveness of patient advocacy case management. Concerning the intervention we anticipated to five important conditions: 1 the contrast between the case management intervention compared to the usual care seems to be large enough to detect intervention effects; 2 we included patients with complex care situations and/or were at risk for critical situations; 3 the case managers were familiar with disease specific health-problems and a broad spectrum of solutions; 4 case managers were competent and authorized to perform a medical neurological examination and worked closely with neurologists specialized in MS; and 5 the

  13. E-Filing Case Management Services in the US Federal Courts: The Next Generation: A Case Study

    Directory of Open Access Journals (Sweden)

    J.Michael Greenwood

    2015-07-01

    Full Text Available The U.S. Federal Courts Administrative Office of the U.S. Courts (AOUSC was responsible for developing the Case Management/Electronic Case File system (legacy CM/ECF originally implemented in 1996 to service the federal courts. The AOUSC is presently developing its 2nd generation service (NextGen. The IJCA carried an earlier narrative of CM/ECF’s evolution.  This second IJCA article describes the approach taken to define and develop that 2nd generation CM/ECF system. This article reviews the methodology used for determining requirements; the new software tools and hardware technologies used; and the expanded functions and enhanced services being incorporated into the new product. Also included is an exploration of the various obstacles, problems, and organizational issues which occur when transitioning from a legacy system to one that is more modern and complex.

  14. Evaluation of a policy to strengthen case management and quality of diabetes care in general practice in Denmark

    DEFF Research Database (Denmark)

    Rudkjøbing, Andreas; Vrangbaek, Karsten; Birk, Hans Okkels

    2015-01-01

    OBJECTIVES: To evaluate the utilization of a policy for strengthening general practitioner's case management and quality of care of diabetes patients in Denmark incentivized by a novel payment mode. We also want to elucidate any geographical variation or variation on the basis of practice features...... of the GP were are able to determine differences in use of the policy in relation to the practice-specific information. RESULTS: At the end of the study period (2007-2012) approximately 30% of practices have enrolled extending services to approximately 10% of the diabetes population. There is regional...... structure defined in the policy not strong enough to move the majority of GPs to change their way of delivering and financing care for patients with diabetes within a period of more than 5 years....

  15. Adapting cognitive behavioral therapy for psychosis for case managers: increasing access to services in a community mental health agency.

    Science.gov (United States)

    Montesano, Vicki L; Sivec, Harry J; Munetz, Mark R; Pelton, Jeremy R; Turkington, Douglas

    2014-03-01

    The purpose of this article is twofold: (a) to describe the adaptation of an evidence-based practice and, (b) using a dissemination framework, to describe the process of implementing the practice at a community mental health agency. The authors describe the training concept and dissemination framework of implementing an emerging practice: high-yield cognitive behavioral techniques for psychosis, which is rooted in cognitive behavioral therapy. Thirteen case managers who represented teams from across the agency delivered the adapted practice at a community mental health agency. Implementation required buy in from all stakeholders, communication across disciplines, persistence, and flexibility. It appears that the use of a dissemination framework that is grounded in the literature, yet flexible, eases the process of implementing an adapted practice. Further research focusing on the effectiveness of this approach, along with the impact of implementing a full spectrum of cognitive behavioral therapy services for individuals with persistent psychotic symptoms, based on cognitive behavioral therapy principles, is indicated.

  16. Exploring representations and experiences of case-management users: towards difficulties and solutions to leading qualitative interviews with older people with complex living conditions.

    Science.gov (United States)

    Balard, Frédéric; Corre, Stéphanie Pin Le; Trouvé, Hélène; Saint-Jean, Olivier; Somme, Dominique

    2013-01-01

    By matching needs to resource services, case management could be a useful tool for improving the care of older people with complex living conditions. Collecting and analysing the users' experiences represents a good way to evaluate the effectiveness and efficiency of a case-management service. However, in the literature, fieldwork is very rarely considered and the users included in qualitative research seem to be the most accessible. This study was undertaken to describe the challenges of conducting qualitative research with older people with complex living conditions in order to understand their experiences with case-management services. Reflective analysis was applied to describe the process of recruiting and interviewing older people with complex living conditions in private homes, describing the protocol with respect to fieldwork chronology. The practical difficulties inherent in this type of study are addressed, particularly in terms of defining a sample, the procedure for contacting the users and conducting the interview. The users are people who suffer from a loss of autonomy because of cognitive impairment, severe disease and/or psychiatric or social problems. Notably, most of them refuse care and assistance. Reflective analysis of our protocol showed that the methodology and difficulties encountered constituted the first phase of data analysis. Understanding the experience of users of case management to analyse the outcomes of case-management services requires a clear methodology for the fieldwork.

  17. Effects of Problem-Solving Therapy and Clinical Case Management on Disability in Low-Income Older Adults.

    Science.gov (United States)

    Areán, Patricia A; Raue, Patrick J; McCulloch, Charles; Kanellopoulos, Dora; Seirup, Joanna K; Banerjee, Samprit; Kiosses, Dimitris N; Dwyer, Eleanor; Alexopoulos, George S

    2015-12-01

    To test the following hypotheses: (1) Clinical case management integrated with problem-solving therapy (CM-PST) is more effective than clinical case management alone (CM) in improving functional outcomes in disabled, impoverished patients and (2) improvement in depression, self-efficacy, and problem-solving skills mediates improvement of disability. Using a randomized controlled trial with a parallel design, 271 individuals were screened and 171 were randomized to 12 weekly sessions of either CM or CM-PST at 1:1 ratio. Raters were blind to patients' assignments. Participants were at least age 60 years with major depression, had at least one disability, were eligible for home-based meals services, and had income no more than 30% of their counties' median. The WHO Disability Assessment Scale was used. Both interventions resulted in improved functioning by 12 weeks (t = 4.28, df = 554, p = 0.001), which was maintained until 24 weeks. Contrary to hypothesis, CM was noninferior to CM-PST (one-sided p = 0.0003, t = -3.5, df = 558). Change in disability was not affected by baseline depression severity, cognitive function, or number of unmet social service needs. Improvements in self efficacy (t = -2.45, df = 672, p = 0.021), problem-solving skill (t = -2.44, df = 546, p = 0.015), and depression symptoms (t = 2.25, df = 672, p = .025) by week 9 predicted improvement in function across groups by week 12. CM is noninferior to CM-PST for late-life depression in low-income populations. The effect of these interventions occur early, with benefits in functional status maintained as long as 24 weeks after treatment initiation (clinicaltrials.gov; NCT00540865). Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  18. Measuring Physical Activity Intensity

    Medline Plus

    Full Text Available ... Healthy Weight Breastfeeding Micronutrient Malnutrition State and Local Programs Measuring Physical Activity Intensity Recommend on Facebook Tweet Share Compartir For more help with what ...

  19. AGS intensity upgrades

    International Nuclear Information System (INIS)

    Roser, T.

    1995-01-01

    After the successful completion of the AGS Booster and several upgrades of the AGS, a new intensity record of 6.3 x 10 13 protons per pulse accelerated to 24 GeV was achieved. The high intensity slow-extracted beam program at the AGS typically serves about five production targets and about eight experiments including three rare Kaon decay experiments. Further intensity upgrades are being discussed that could increase the average delivered beam intensity by up to a factor of four

  20. Effect of a Dengue Clinical Case Management Course on Physician Practices in Puerto Rico.

    Science.gov (United States)

    Han, George S; Gregory, Christopher J; Biggerstaff, Brad J; Horiuchi, Kalanthe; Perez-Guerra, Carmen; Soto-Gomez, Eunice; Matos, Desiree; Margolis, Harold S; Tomashek, Kay M

    2016-11-15

     Prior to 2010, the clinical management of dengue in Puerto Rico was inconsistent with World Health Organization guidelines. A 4-hour classroom-style course on dengue clinical management was developed in 2009 and mandated for Puerto Rico medical licensure in 2010. Fifty physicians were trained as "master trainers" and gave this course to 7638 physicians. This study evaluated the effect of the course on the clinical management of hospitalized dengue patients.  Pre- and post-course test responses were compared. Changes in physician practices were assessed by reviewing medical records of 430 adult and 1075 pediatric dengue patients at the 12 hospitals in Puerto Rico that reported the most cases during 2008-2009 (pre-intervention) and 2011 (post-intervention). Mixed-effects logistic regression was used to compare key indicators of dengue management.  Physician test scores increased from 48% to 72% correct. Chart reviews showed that the percentage of adult patients who did not receive corticosteroids increased from 30% to 68% (odds ratio [OR], 5.9; 95% confidence interval [CI], 3.7-9.5) and from 91% to 96% in pediatric patients (OR, 2.7; 95% CI, 1.5-4.9). Usage of isotonic intravenous saline during the critical period increased from 57% to 90% in adult patients (OR, 6.2; 95% CI, 1.9-20.4) and from 25% to 44% in pediatric patients (OR, 3.4; 95% CI, 2.2-5.3).  Management of dengue inpatients significantly improved following implementation of a classroom-style course taught by master trainers. An online version of the course was launched in 2014 to expand its reach and sustainability. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  1. 20 CFR 669.400 - What are the elements of the Individual Employment Plan that is authorized as an intensive service?

    Science.gov (United States)

    2010-04-01

    ... customer-centered case management tool, an IEP is a personal record and must receive confidential treatment. ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What are the elements of the Individual Employment Plan that is authorized as an intensive service? 669.400 Section 669.400 Employees' Benefits...

  2. Use of integrated dual disorder treatment via assertive community treatment versus clinical case management for persons with co-occurring disorders and antisocial personality disorder.

    Science.gov (United States)

    Frisman, Linda K; Mueser, Kim T; Covell, Nancy H; Lin, Hsiu-Ju; Crocker, Anne; Drake, Robert E; Essock, Susan M

    2009-11-01

    We conducted secondary analyses of data from a randomized trial testing the effectiveness of Assertive Community Treatment (ACT) in delivery of integrated dual disorder treatment (IDDT) to explore the impact of IDDT delivered through ACT teams compared with standard clinical case management for dually-disordered persons with and without antisocial personality disorder (ASPD). This analysis included 36 individuals with ASPD and 88 individuals without ASPD. Participants with ASPD assigned to ACT showed a significantly greater reduction in alcohol use and were less likely to go to jail than those in standard clinical case management, whereas participants without ASPD did not differ between the 2 case management approaches. There were no significant differences for other substance use or criminal justice outcomes. This study provides preliminary evidence that persons with co-occurring serious mental illness, substance use disorders, and ASPD may benefit from delivery of IDDT through ACT teams.

  3. Design, and participant enrollment, of a randomized controlled trial evaluating effectiveness and cost-effectiveness of a community-based case management intervention, for patients suffering from COPD

    DEFF Research Database (Denmark)

    Sørensen, Sabrina Storgaard; Pedersen, Kjeld Møller; Weinreich, Ulla Møller

    2015-01-01

    Background: Case management interventions are recommended to improve quality of care and reduce costs in chronic care, but further evidence on effectiveness and cost-effectiveness is needed. The objective of this study is the reporting of the design and participant enrollment of a randomized...... controlled trial, conducted to evaluate the effectiveness and cost-effectiveness of a community-based case management model for patients suffering from chronic obstructive pulmonary disease (COPD). With a focus on support for self-care and care coordination, the intervention was hypothesized to result...... patients were randomized into two groups: the case-managed group and the usual-care group. Participant characteristics were obtained at baseline, and measures on effectiveness and costs were obtained through questionnaires and registries within a 12-month follow-up period. In the forthcoming analysis...

  4. Metabonomics and Intensive Care

    OpenAIRE

    Antcliffe, D; Gordon, AC

    2016-01-01

    This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency medicine 2016. Other selected articles can be found online at http://www.biomedcentral.com/collections/annualupdate2016. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.

  5. Current advance care planning practice in the Australian community: an online survey of home care package case managers and service managers.

    Science.gov (United States)

    Sellars, Marcus; Detering, Karen M; Silvester, William

    2015-04-23

    Advance care planning (ACP) is the process of planning for future healthcare that is facilitated by a trained healthcare professional, whereby a person's values, beliefs and treatment preferences are made known to guide clinical decision-making at a future time when they cannot communicate their decisions. Despite the potential benefits of ACP for community aged care clients the availability of ACP is unknown, but likely to be low. In Australia many of these clients receive services through Home Care Package (HCP) programs. This study aimed to explore current attitudes, knowledge and practice of advance care planning among HCP service managers and case managers. An invitation to take part in a cross-sectional online survey was distributed by email to all HCP services across Australia in November 2012. Descriptive analyses were used to examine overall patterns of responses to each survey item in the full sample. 120 (response rate 25%) service managers and 178 (response rate 18%) case managers completed the survey. Only 34% of services had written ACP policies and procedures in place and 48% of case managers had previously completed any ACP training. In addition, although most case managers (70%) had initiated an ACP discussion in the past 12 months and viewed ACP as part of their role, the majority of the conversations (80%) did not result in documentation of the client's wishes and most (85%) of the case managers who responded did not believe ACP was done well within their service. This survey shows low organisational ACP systems and support for case managers and a lack of a normative approach to ACP across Australian HCP services. As HCPs become more prevalent it is essential that a model of ACP is developed and evaluated in this setting, so that clients have the opportunity to discuss and document their future healthcare wishes if they choose to.

  6. Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care.

    Science.gov (United States)

    van der Plas, Annicka G M; Vissers, Kris C; Francke, Anneke L; Donker, Gé A; Jansen, Wim J J; Deliens, Luc; Onwuteaka-Philipsen, Bregje D

    2015-01-01

    Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. To compare cancer patients with and without additional support from a case manager on: 1) the patients' general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is 'only' advisory and he or she does not provide hands-on care or prescribe medication.

  7. A study on magnetic relaxation times of various organs and body fluids using superconducting magnetic resonance imaging system part I: measurement of relative signal intensity and T2 relaxation time in various portions of brain and cerebrospinal fluid

    International Nuclear Information System (INIS)

    Chang, Kee Hyun; Lee, Ghi Jai; Han, Moon Hee; Kim, Jae Ho; Han, Man Chang; Kim, Chu Wan

    1988-01-01

    This study was undertake to determine if routine clinical magnetic resonance imaging sequences using only two different repetition times (TRs) and with only two sequential echo times (TEs) can be used to measure reproducible relative signal intensity and T2 relaxation time for normal brain tissues and cerebrospinal fluid using a 2.0T superconducting system. In 47 patients 6 different anatomic sites were measured. For each anatomic location, the mean and standard deviation of these values were determined. On T1-weighted (SE 500msec/30msec) images, in globus pallidus and thalamus, of the CSF, cortical gray matter and retrobulbar fat tissue varied more, with a standard deviation of 11-14% on T1-weighted images. On T2-weighted (SE 3000msec/30msec and 3000msec/80msec) images, the relative signal intensity of all anatomic regions varied more than on T1-weighted images. The standard deviation of T2 relaxation times also varied from 10% (fat tissue) to 18% (CSF). These variations might be due to partial volume averaging, signal alteration of CSF secondary to CSF pulsatile motion, etc. Knowing that relative signal intensity and T2 relaxation times calculated from routine imaging sequences are reproducible in only limited area, these normal ranges can be used to investigate changes occurring in disease states of the limited regions.

  8. 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

  9. Introduction of mobile phones for use by volunteer community health workers in support of integrated community case management in Bushenyi District, Uganda: development and implementation process.

    Science.gov (United States)

    Tumusiime, David Katuruba; Agaba, Gad; Kyomuhangi, Teddy; Finch, Jan; Kabakyenga, Jerome; MacLeod, Stuart

    2014-01-01

    A substantial literature suggests that mobile phones have great potential to improve management and survival of acutely ill children in rural Africa. The national strategy of the Ugandan Ministry of Health calls for employment of volunteer community health workers (CHWs) in implementation of Integrated Community Case Management (iCCM) of common illnesses (diarrhea, acute respiratory infection, pneumonia, fever/malaria) affecting children under five years of age. A mobile phone enabled system was developed within iCCM aiming to improve access by CHWs to medical advice and to strengthen reporting of data on danger signs and symptoms for acutely ill children under five years of age. Herein critical steps in development, implementation, and integration of mobile phone technology within iCCM are described. Mechanisms to improve diagnosis, treatment and referral of sick children under five were defined. Treatment algorithms were developed by the project technical team and mounted and piloted on the mobile phones, using an iterative process involving technical support personnel, health care providers, and academic support. Using a purposefully developed mobile phone training manual, CHWs were trained over an intensive five-day course to make timely diagnoses, recognize clinical danger signs, communicate about referrals and initiate treatment with appropriate essential drugs. Performance by CHWs and the accuracy and completeness of their submitted data was closely monitored post training test period and during the subsequent nine month community trial. In the full trial, the number of referrals and correctly treated children, based on the agreed treatment algorithms, was recorded. Births, deaths, and medication stocks were also tracked. Seven distinct phases were required to develop a robust mobile phone enabled system in support of the iCCM program. Over a nine month period, 96 CHWs were trained to use mobile phones and their competence to initiate a community trial was

  10. 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

    2014-01-01

    Aim 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. Methods Scoping review of reports from 29 selected iCCM programmes purposively provided by stakeholders containing any information relevant to understand quality of care issues. Results 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. Conclusion Large, multi–faceted, iCCM programmes, with strong

  11. Improved malaria case management in formal private sector through public private partnership in Ethiopia: retrospective descriptive study.

    Science.gov (United States)

    Argaw, Mesele D; Woldegiorgis, Asfawesen Gy; Abate, Derebe T; Abebe, Mesfin E

    2016-07-11

    Malaria is a major public health problem and still reported among the 10 top causes of morbidity and mortality in Ethiopia. More than one-third of the people sought treatment from the private health sector. Evaluating adherences of health care providers to standards are paramount importance to determine the quality and the effectiveness of service delivery. Therefore, the aim of this study was to evaluate the contribution of public private mix (PPM) approach in improving quality of malaria case management among formal private providers. A retrospective data analysis was conducted using 2959 facility-months data collected from 110 PPM for malaria care facilities located in Amhara, Dire Dawa, Hareri, Oromia, Southern Nation Nationalities and Peoples and Tigray regions. Data abstraction formats were used to collect and collate the data on quarterly bases. The data were manually cleaned and analysed using Microsoft Office Excel 2010. To claim statistical significance non-parametric McNemar test was done and decision accepted at P < 0.05. From April 2012-September 2015, a total of 873,707 malaria suspected patients were identified, of which one-fourth (25.6 %) were treated as malaria cases. Among malaria suspected cases the proportion of malaria investigation improved from recorded in first quarter 87.7-100.0 % in last quarter (X(2) = 66.84, P < 0.001). The majority (96.0 %) were parasitologically-confirmed cases either by using microscopy or rapid diagnostic tests. The overall slid positivity rate was 25.1 % of which half (50.7 %) were positive for Plasmodium falciparum and slightly lower than half (45.2 %) for Plasmodium vivax; the remaining 8790 (4.1 %) showed mixed infections of P. falciparum and P. vivax. Adherence to appropriate treatment using artemether-lumefantrine (AL) was improved from 47.8 % in the first quarter to 95.7 % in the last quarter (X(2) = 12.89, P < 0.001). Similarly, proper patient management using chloroquine (CQ) was improved

  12. Quality assurance of malaria case management in an urban and in sub-rural health centres in Goma, Congo

    Science.gov (United States)

    Kasereka, Claude M.; Kasagila, Eric K.; Inipavudu, John B.; Toranke, Suleiman I.

    2011-01-01

    Abstract Background Every year, up to three million deaths throughout the world occur as a result of malaria, 90% of which occur in Africa. Despite training providers in malaria case management and the availability of appropriate medical suppliers, there are still weaknesses in the management chain of malaria. Objectives Our aim was to assess the quality of malaria case management in two primary health care centres in the Goma health district. Specific objectives were the assessment of quality accuracy in the dosage, the duration of treatment, the intervals between administrations, and the routes of administration of anti-malarial medication in two health centres, as well as the subsequent comparison of those two sites. Method A descriptive retrospective study was conducted using the malaria register's review to assess two health centres in the Goma health district. Socio-demographical and clinical data were recorded and the quality was assessed against the national guidelines. Descriptive statistics with percentages and Chi-square values were computed. Results Under-dosage was more common in CCLK (Centre Chrétien du Lac Kivu [Lake Kivu Christian Centre]) with 55 patients (62.5%; 95% CI, 52% – 71.8%) patients, whilst the over-dosage was present in 64 patients (80%; 95% CI, 69.9% – 87.2%) in CASOP (Caisse de Solidarité Ouvrière et Paysanne [Fund of Solidarity Workers and Peasants]). The duration of treatment was shorter in CCLK in 15 patients (93.7%; 95% CI, 71.6% – 98.8%); CASOP had a high rate of inappropriate intervals between the administration of drugs in 14 patients (82.3%; 95% CI, 58.9% – 93.8%). Intravenous administration rates were high in both sites with respectively 102 patients in CASOP (62.5%; 95% CI, 54.9% – 69.6%) and 61 patients in CCLK (37.4%; 95% CI, 30.3% – 45.0%). Significant differences were found between the two sites with regard to intervals of administration (χ2 = 7.11, p = 0.007), duration of treatment (χ2 = 8.51, p = 0

  13. Measuring Physical Activity Intensity

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    Full Text Available ... miles per hour Tennis (doubles) Ballroom dancing General gardening Vigorous Intensity Race walking, jogging, or running Swimming ... miles per hour or faster Jumping rope Heavy gardening (continuous digging or hoeing) Hiking uphill or with ...

  14. Measuring Physical Activity Intensity

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    Full Text Available ... The amount of energy used by the body per minute of activity. The table below lists examples ... of Page Moderate Intensity Walking briskly (3 miles per hour or faster, but not race-walking) Water ...

  15. Measuring Physical Activity Intensity

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    Full Text Available ... For this reason, some items on this page will be unavailable. For more information about this message, ... If you're doing vigorous-intensity activity, you will not be able to say more than a ...

  16. Measuring Physical Activity Intensity

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    Full Text Available ... level of effort required by a person to do an activity. When using relative intensity, people pay ... State and Local Programs File Formats Help: How do I view different file formats (PDF, DOC, PPT, ...

  17. Measuring Physical Activity Intensity

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    Full Text Available ... an activity. When using relative intensity, people pay attention to how physical activity affects their heart rate ... Physical Activity Overweight & Obesity Healthy Weight Breastfeeding Micronutrient Malnutrition State and Local Programs File Formats Help: How ...

  18. Measuring Physical Activity Intensity

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    Full Text Available ... Local Programs Measuring Physical Activity Intensity Recommend on Facebook Tweet Share Compartir For more help with what ... RSS ABOUT About CDC Jobs Funding LEGAL Policies Privacy FOIA No Fear Act OIG 1600 Clifton Road ...

  19. Measuring Physical Activity Intensity

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    Full Text Available ... Intensity The amount of energy used by the body per minute of activity. The table below lists ... upon the amount of energy used by the body while doing the activity. Top of Page Moderate ...

  20. Measuring Physical Activity Intensity

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    Full Text Available ... to Your Life Activities for Children Activities for Older Adults Overcoming Barriers ... required by a person to do an activity. When using relative intensity, people pay attention to how physical activity affects their ...

  1. Measuring Physical Activity Intensity

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    Full Text Available ... Adults Need More Physical Activity MMWR Data Highlights State Indicator Report on Physical Activity, 2014 Recommendations & Guidelines ... Activity Overweight & Obesity Healthy Weight Breastfeeding Micronutrient Malnutrition State and Local Programs Measuring Physical Activity Intensity Recommend ...

  2. Measuring Physical Activity Intensity

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    Full Text Available ... 10 miles per hour or faster Jumping rope Heavy gardening (continuous digging or hoeing) Hiking uphill or with a heavy backpack Other Methods of Measuring Intensity Target Heart ...

  3. Measuring Physical Activity Intensity

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    Full Text Available ... Adults Needs for Children What Counts Needs for Older Adults Needs for Pregnant or Postpartum Women Physical Activity & ... to Your Life Activities for Children Activities for Older Adults Overcoming Barriers Measuring Physical Activity Intensity Target Heart ...

  4. Measuring Physical Activity Intensity

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    Full Text Available ... Hiking uphill or with a heavy backpack Other Methods of Measuring Intensity Target Heart Rate and Estimated ... Help: How do I view different file formats (PDF, DOC, PPT, MPEG) on this site? Adobe PDF ...

  5. Measuring Physical Activity Intensity

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    Full Text Available ... Hiking uphill or with a heavy backpack Other Methods of Measuring Intensity Target Heart Rate and Estimated ... YouTube Instagram Listen Watch RSS ABOUT About CDC Jobs Funding LEGAL Policies Privacy FOIA No Fear Act ...

  6. Measuring Physical Activity Intensity

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    Full Text Available ... Measuring Intensity Target Heart Rate and Estimated Maximum Heart Rate Perceived Exertion (Borg Rating of Perceived Exertion Scale) Get Email Updates To receive email updates about this page, enter your email ... ...

  7. Measuring Physical Activity Intensity

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    Full Text Available ... be able to say more than a few words without pausing for a breath. Absolute Intensity The ... site? Adobe PDF file Microsoft PowerPoint file Microsoft Word file Microsoft Excel file Audio/Video file Apple ...

  8. Data-intensive science

    CERN Document Server

    Critchlow, Terence

    2013-01-01

    Data-intensive science has the potential to transform scientific research and quickly translate scientific progress into complete solutions, policies, and economic success. But this collaborative science is still lacking the effective access and exchange of knowledge among scientists, researchers, and policy makers across a range of disciplines. Bringing together leaders from multiple scientific disciplines, Data-Intensive Science shows how a comprehensive integration of various techniques and technological advances can effectively harness the vast amount of data being generated and significan

  9. Towards higher intensities

    CERN Multimedia

    CERN Bulletin

    2010-01-01

    Over the past 2 weeks, commissioning of the machine protection system has advanced significantly, opening up the possibility of higher intensity collisions at 3.5 TeV. The intensity has been increased from 2 bunches of 1010 protons to 6 bunches of 2x1010 protons. Luminosities of 6x1028 cm-2s-1 have been achieved at the start of fills, a factor of 60 higher than those provided for the first collisions on 30 March.   The recent increase in LHC luminosity as recorded by the experiments. (Graph courtesy of the experiments and M. Ferro-Luzzi) To increase the luminosity further, the commissioning crews are now trying to push up the intensity of the individual proton bunches. After the successful injection of nominal intensity bunches containing 1.1x1011 protons, collisions were subsequently achieved at 450 GeV with these intensities. However, half-way through the first ramping of these nominal intensity bunches to 3.5 TeV on 15 May, a beam instability was observed, leading to partial beam loss...

  10. Spouses’ involvement in older patients’ fast-track programmes during total hip replacement using case management intervention. A study protocol of the SICAM-trial

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher; Kristensson, Jimmie

    2015-01-01

    Aim To present the protocol of a two-group quasi-experimental study of spouses’ involvement through case management (The SICAM-trial) in older patients’ fast-track programmes during total hip replacement. Background Patients in fast-track programmes are required to take an active part in their tr......Aim To present the protocol of a two-group quasi-experimental study of spouses’ involvement through case management (The SICAM-trial) in older patients’ fast-track programmes during total hip replacement. Background Patients in fast-track programmes are required to take an active part...... in their treatment and rehabilitation. Spouses of older patients can often provide valued practical and emotional support, reducing stress, pain and length of stay – yet they are seldom invited to participate in a supporting role. Design A two-group quasi-experimental design with pre-test and repeated post...... and subsequently include the intervention group to avoid contamination of the control group. A case manager will be recruited to perform the case management intervention. Data will be collected from both groups at baseline, 2 weeks and 3 months after surgery. Outcome measures for patients include: functional...

  11. Real-world use of the risk-need-responsivity model and the level of service/case management inventory with community-supervised offenders.

    Science.gov (United States)

    Dyck, Heather L; Campbell, Mary Ann; Wershler, Julie L

    2018-06-01

    The risk-need-responsivity model (RNR; Bonta & Andrews, 2017) has become a leading approach for effective offender case management, but field tests of this model are still required. The present study first assessed the predictive validity of the RNR-informed Level of Service/Case Management Inventory (LS/CMI; Andrews, Bonta, & Wormith, 2004) with a sample of Atlantic Canadian male and female community-supervised provincial offenders (N = 136). Next, the case management plans prepared from these LS/CMI results were analyzed for adherence to the principles of risk, need, and responsivity. As expected, the LS/CMI was a strong predictor of general recidivism for both males (area under the curve = .75, 95% confidence interval [.66, .85]), and especially females (area under the curve = .94, 95% confidence interval [.84, 1.00]), over an average 3.42-year follow-up period. The LS/CMI was predictive of time to recidivism, with lower risk cases taking longer to reoffend than higher risk cases. Despite the robust predictive validity of the LS/CMI, case management plans developed by probation officers generally reflected poor adherence to the RNR principles. These findings highlight the need for better training on how to transfer risk appraisal information from valid risk tools to case plans to better meet the best-practice principles of risk, need, and responsivity for criminal behavior risk reduction. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

  12. The process of decision-making in home-care case management: implications for the introduction of universal assessment and information technology.

    Science.gov (United States)

    Egan, Mary; Wells, Jennie; Byrne, Kerry; Jaglal, Susan; Stolee, Paul; Chesworth, Bert M; Hillier, Loretta M

    2009-07-01

    Increasingly, jurisdictions are adopting universal assessment procedures and information technology to aid in healthcare data collection and care planning. Before their potential can be realised, a better understanding is needed of how these systems can best be used to support clinical practice. We investigated the decision-making process and information needs of home-care case managers in Ontario, Canada, prior to the widespread use of universal assessment, with a view of determining how universal assessment and information technology could best support this work. Three focus groups and two individual interviews were conducted; questioning focused on decision-making in the post-acute care of individuals recovering from a hip fracture. We found that case managers' decisional process was one of a clinician-broker, combining clinical expertise and information about local services to support patient goals within the context of limited resources. This process represented expert decision-making, and the case managers valued their ability to carry out non-standardised interviews and override system directives when they noted that data may be misleading. Clear information needs were found in four areas: services available outside of their regions, patient medical information, patient pre-morbid functional status and partner/spouse health and functional status. Implications for the use of universal assessment are discussed. Recommendations are made for further research to determine the impact of universal assessment and information technology on the process and outcome of home-care case manager decision-making.

  13. Effectiveness of Telebehavioral Health Program Nurse Case Managers (NCM): Data Collection Tools and the Process for NCM-Sensitive Outcome Measures.

    Science.gov (United States)

    Carlson, Judy; Cohen, Roslyn; Bice-Stephens, Wynona

    2014-01-01

    As a part of our nation's pursuit of improvements in patient care outcomes, continuity of care, and cost containment, the case manager has become a vital member on interdisciplinary teams and in health care agencies. Telebehavioral health programs, as a relatively new method of delivering behavioral health care, have recently begun to incorporate case management into their multidisciplinary teams. To determine the efficacy and efficiency of healthcare programs, program managers are charged with the determination of the outcomes of the care rendered to patient populations. However, programs that use telehealth methods to deliver care have unique structures in place that impact ability to collect outcome data. A military medical center that serves the Pacific region developed surveys and processes to distribute, administer, and collect information about a telehealth environment to obtain outcome data for the nurse case manager. This report describes the survey development and the processes created to capture nurse case manager outcomes. Additionally, the surveys and processes developed in this project for measuring outcomes may be useful in other settings and disciplines.

  14. Design of a Randomised Controlled Trial (RCT) on the effectiveness of a Dutch patient advocacy case management intervention among severely disabled Multiple Sclerosis patients

    NARCIS (Netherlands)

    Wynia, Klaske; Annema, Coby; Nissen, Hans; De Keyser, Jacques; Middel, Berry

    2010-01-01

    Background: Case management has been suggested as an innovative strategy that facilitates the improvement of a patient's quality of life, reduction of hospital length of stay, optimization of self-care and improvement of satisfaction of patients and professionals involved. However, there is little

  15. Provision of assistive technology devices among people with ALS in Germany: a platform-case management approach.

    Science.gov (United States)

    Funke, Andreas; Spittel, Susanne; Grehl, Torsten; Grosskreutz, Julian; Kettemann, Dagmar; Petri, Susanne; Weyen, Ute; Weydt, Patrick; Dorst, Johannes; Ludolph, Albert C; Baum, Petra; Oberstadt, Moritz; Jordan, Berit; Hermann, Andreas; Wolf, Joachim; Boentert, Matthias; Walter, Bertram; Gajewski, Nadine; Maier, André; Münch, Christoph; Meyer, Thomas

    2018-01-30

    The procurement of assistive technology devices (ATD) is an essential component of managed care in ALS. The objective was to analyze the standards of care for ATD and to identify challenges in the provision process. A cohort study design was used. We investigated the provision of 11,364 ATD in 1494 patients with ALS at 12 ALS centers in Germany over four years. Participants were patients that entered a case management program for ATD including systematic assessment of ATD on a digital management platform. Wheelchairs (requested in 65% of patients), orthoses (52%), bathroom adaptations (49%), and communication devices (46%) were the most needed ATD. There was a wide range in the number of indicated ATD per patient: 1 to 4 ATD per patient in 45% of patients, 5 to 20 ATD in 48%, and >20 ATD in 7% of patients. Seventy percent of all requested ATD were effectively delivered. However, an alarming failure rate during procurement was found in ATD that are crucial for ALS patients such as powered wheelchairs (52%), communication devices (39%), or orthoses (21%). Leading causes for not providing ATD were the refusal by health insurances, the decision by patients, and the death of the patient before delivery of the device. The need for ATD was highly prevalent among ALS patients. Failed or protracted provision posed substantial barriers to ATD procurement. Targeted national strategies and the incorporation of ATD indication criteria in international ALS treatment guidelines are urgently needed to overcome these barriers.

  16. Evaluating the utility of syndromic case management for three sexually transmitted infections in women visiting hospitals in Delhi, India.

    Science.gov (United States)

    Sonkar, Subash Chandra; Wasnik, Kirti; Kumar, Anita; Sharma, Vineeta; Mittal, Pratima; Mishra, Prashant Kumar; Bharadwaj, Mausumi; Saluja, Daman

    2017-05-03

    Utility of syndromic case management (SCM) in women visiting obstetrics & gynecology department needs to be evaluated as it is subjective and imperfect. Consequently, antibiotic resistance has accelerated along with increased risk of infection to the partners. To understand the effectiveness and/or inadequacies of SCM, 11000 women were recruited and examined by clinicians for infection by Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV), Bacterial vaginosis (BV) and others. Amongst these patients, 1797 (16.3%) reported vaginal discharge (VD). Other symptoms included: vaginitis (97%), cervicitis (75%), genital ulcers (60%), abnormal vaginal discharge (55%) and lower abdominal pain (48%). The patients were treated for single or co-infections using pre-packed National Aids Control Program III STI/RTI Kits. However, based on PCR diagnostics, 1453/1797 (81%) subjects were uninfected for NG/TV/CT. Amongst 344 (19%) infected patients, 257 (75%) carried infection with single pathogen (TV/NG/CT) while 87/344 (25%) were co-infected with multiple pathogens. Prevalence of TV, NG & CT was 4%, 7% and 8% respectively. Co-infection with CT + NG was highest, 51% (44/87), whereas, co-infection with CT + TV was 21% and NG + TV was 18% while co-infection with all three pathogens was 1.3%. We conclude that SCM is imprecise and successful intervention requires accurate and confirmatory diagnostic approach.

  17. Integrated case management for work-related upper-extremity disorders: impact of patient satisfaction on health and work status.

    Science.gov (United States)

    Feuerstein, Michael; Huang, Grant D; Ortiz, Jose M; Shaw, William S; Miller, Virginia I; Wood, Patricia M

    2003-08-01

    An integrated case management (ICM) approach (ergonomic and problem-solving intervention) to work-related upper-extremity disorders was examined in relation to patient satisfaction, future symptom severity, function, and return to work (RTW). Federal workers with work-related upper-extremity disorder workers' compensation claims (n = 205) were randomly assigned to usual care or ICM intervention. Patient satisfaction was assessed after the 4-month intervention period. Questionnaires on clinical outcomes and ergonomic exposure were administered at baseline and at 6- and 12-months postintervention. Time from intervention to RTW was obtained from an administrative database. ICM group assignment was significantly associated with greater patient satisfaction. Regression analyses found higher patient satisfaction levels predicted decreased symptom severity and functional limitations at 6 months and a shorter RTW. At 12 months, predictors of positive outcomes included male gender, lower distress, lower levels of reported ergonomic exposure, and receipt of ICM. Findings highlight the utility of targeting workplace ergonomic and problem solving skills.

  18. Independent Evaluation of the integrated Community Case Management of Childhood Illness Strategy in Malawi Using a National Evaluation Platform Design.

    Science.gov (United States)

    Amouzou, Agbessi; Kanyuka, Mercy; Hazel, Elizabeth; Heidkamp, Rebecca; Marsh, Andrew; Mleme, Tiope; Munthali, Spy; Park, Lois; Banda, Benjamin; Moulton, Lawrence H; Black, Robert E; Hill, Kenneth; Perin, Jamie; Victora, Cesar G; Bryce, Jennifer

    2016-03-01

    We evaluated the impact of integrated community case management of childhood illness (iCCM) on careseeking for childhood illness and child mortality in Malawi, using a National Evaluation Platform dose-response design with 27 districts as units of analysis. "Dose" variables included density of iCCM providers, drug availability, and supervision, measured through a cross-sectional cellular telephone survey of all iCCM-trained providers. "Response" variables were changes between 2010 and 2014 in careseeking and mortality in children aged 2-59 months, measured through household surveys. iCCM implementation strength was not associated with changes in careseeking or mortality. There were fewer than one iCCM-ready provider per 1,000 under-five children per district. About 70% of sick children were taken outside the home for care in both 2010 and 2014. Careseeking from iCCM providers increased over time from about 2% to 10%; careseeking from other providers fell by a similar amount. Likely contributors to the failure to find impact include low density of iCCM providers, geographic targeting of iCCM to "hard-to-reach" areas although women did not identify distance from a provider as a barrier to health care, and displacement of facility careseeking by iCCM careseeking. This suggests that targeting iCCM solely based on geographic barriers may need to be reconsidered. © The American Society of Tropical Medicine and Hygiene.

  19. Development of a prototype continuity of care record with context-specific links to meet the information needs of case managers for persons living with HIV.

    Science.gov (United States)

    Schnall, Rebecca; Cimino, James J; Bakken, Suzanne

    2012-08-01

    (1) To develop a prototype Continuity of Care Record (CCR) with context-specific links to electronic HIV information resources; and (2) to assess case managers' perceptions regarding the usability of the prototype. We integrated context-specific links to HIV case management information resources into a prototype CCR using the Infobutton Manager and Librarian Infobutton Tailoring Environment (LITE). Case managers (N=9) completed a think-aloud protocol and the Computer System Usability Questionnaire (CSUQ) to evaluate the usability of the prototype. Verbalizations from the think-aloud protocol were summarized using thematic analysis. CSUQ data were analyzed with descriptive statistics. Although participants expressed positive comments regarding the usability of the prototype, the think-aloud protocol also identified the need for improvement in resource labels and for additional resources. On a scale ranging from 1 (strongly agree) to 7 (strongly disagree), the average CSUQ overall satisfaction was 2.25 indicating that users (n=9) were generally satisfied with the system. Mean CSUQ factor scores were: System Usefulness (M=2.13), Information Quality (M=2.46), and Interface Quality (M=2.26). Our novel application of the Infobutton Manager and LITE in the context of case management for persons living with HIV in community-based settings resulted in a prototype CCR with infobuttons that met the majority of case managers' information needs and received relatively positive usability ratings. Findings from this study inform future integration of context-specific links into CCRs and electronic health records and support their use for meeting end-users information needs. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  20. HIV Case Management Support Service Is Associated with Improved CD4 Counts of Patients Receiving Care at the Antiretroviral Clinic of Pantang Hospital, Ghana

    Directory of Open Access Journals (Sweden)

    Bismark Sarfo

    2017-01-01

    Full Text Available Background. Factors associated with individual patient-level management of HIV have received minimal attention in sub-Saharan Africa. This study determined the association between support services and cluster of differentiation 4 (CD4 counts among HIV patients attending ART clinic in Ghana. Methodology. This was a cross-sectional study involving adults with HIV recruited between 1 August 2014 and 31 January 2015. Data on support services were obtained through a closed-ended personal interview while the CD4 counts data were collected from their medical records. Data were entered into EpiData and analyzed using Stata software. Results. Of the 201 patients who participated in the study, 67% (129/191 received case management support service. Counseling about how to prevent the spread of HIV (crude odds ratio (cOR (95% confidence interval (CI (2.79 (1.17–6.68, mental health services (0.2 (0.04–1.00, and case management support service (2.80 (1.34–5.82 was associated with improved CD4 counts of 350 cells/mm3 or more. After adjusting for counseling about how to prevent the spread of HIV and mental health services, case management support service was significantly associated with CD4 counts of 350 cells/mm3 or more (aOR = 2.36 (CI = 1.01–5.49. Conclusion. Case management support service for HIV patients receiving ART improves their CD4 counts above 350 cells/mm3. Incorporating HIV case management services in ART regimen should be a priority in sub-Saharan Africa.

  1. Evaluation of organ-specific peripheral doses after 2-dimensional, 3-dimensional and hybrid intensity modulated radiation therapy for breast cancer based on Monte Carlo and convolution/superposition algorithms: Implications for secondary cancer risk assessment

    International Nuclear Information System (INIS)

    Joosten, Andreas; Matzinger, Oscar; Jeanneret-Sozzi, Wendy; Bochud, François; Moeckli, Raphaël

    2013-01-01

    Background and purpose: To make a comprehensive evaluation of organ-specific out-of-field doses using Monte Carlo (MC) simulations for different breast cancer irradiation techniques and to compare results with a commercial treatment planning system (TPS). Materials and methods: Three breast radiotherapy techniques using 6MV tangential photon beams were compared: (a) 2DRT (open rectangular fields), (b) 3DCRT (conformal wedged fields), and (c) hybrid IMRT (open conformal + modulated fields). Over 35 organs were contoured in a whole-body CT scan and organ-specific dose distributions were determined with MC and the TPS. Results: Large differences in out-of-field doses were observed between MC and TPS calculations, even for organs close to the target volume such as the heart, the lungs and the contralateral breast (up to 70% difference). MC simulations showed that a large fraction of the out-of-field dose comes from the out-of-field head scatter fluence (>40%) which is not adequately modeled by the TPS. Based on MC simulations, the 3DCRT technique using external wedges yielded significantly higher doses (up to a factor 4–5 in the pelvis) than the 2DRT and the hybrid IMRT techniques which yielded similar out-of-field doses. Conclusions: In sharp contrast to popular belief, the IMRT technique investigated here does not increase the out-of-field dose compared to conventional techniques and may offer the most optimal plan. The 3DCRT technique with external wedges yields the largest out-of-field doses. For accurate out-of-field dose assessment, a commercial TPS should not be used, even for organs near the target volume (contralateral breast, lungs, heart)

  2. Intensity Conserving Spectral Fitting

    Science.gov (United States)

    Klimchuk, J. A.; Patsourakos, S.; Tripathi, D.

    2015-01-01

    The detailed shapes of spectral line profiles provide valuable information about the emitting plasma, especially when the plasma contains an unresolved mixture of velocities, temperatures, and densities. As a result of finite spectral resolution, the intensity measured by a spectrometer is the average intensity across a wavelength bin of non-zero size. It is assigned to the wavelength position at the center of the bin. However, the actual intensity at that discrete position will be different if the profile is curved, as it invariably is. Standard fitting routines (spline, Gaussian, etc.) do not account for this difference, and this can result in significant errors when making sensitive measurements. Detection of asymmetries in solar coronal emission lines is one example. Removal of line blends is another. We have developed an iterative procedure that corrects for this effect. It can be used with any fitting function, but we employ a cubic spline in a new analysis routine called Intensity Conserving Spline Interpolation (ICSI). As the name implies, it conserves the observed intensity within each wavelength bin, which ordinary fits do not. Given the rapid convergence, speed of computation, and ease of use, we suggest that ICSI be made a standard component of the processing pipeline for spectroscopic data.

  3. Knowledge Sharing in Knowledge-Intensive Firms

    DEFF Research Database (Denmark)

    Gupta, Akshey; Michailova, Snejina

    2004-01-01

    This paper is a study of the knowledge-sharing difficulties experienced by three departments in a knowledge-intensive firm. The case organization is a global consulting firm that has been on the forefront of knowledge management and has won several knowledge management related international accla...

  4. The intense neutron generator

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, W B

    1966-07-01

    The presentation discusses both the economic and research contexts that would be served by producing neutrons in gram quantities at high intensities by electrical means without uranium-235. The revenue from producing radioisotopes is attractive. The array of techniques introduced by the multipurpose 65 megawatt Intense Neutron Generator project includes liquid metal cooling, superconducting magnets for beam bending and focussing, super-conductors for low-loss high-power radiofrequency systems, efficient devices for producing radiofrequency power, plasma physics developments for producing and accelerating hydrogen, ions at high intensity that are still far out from established practice, a multimegawatt high voltage D.C. generating machine that could have several applications. The research fields served relate principally to materials science through neutron-phonon and other quantum interactions as well as through neutron diffraction. Nuclear physics is served through {mu}-, {pi}- and K-meson production. Isotope production enters many fields of applied research. (author)

  5. The intense neutron generator

    International Nuclear Information System (INIS)

    Lewis, W.B.

    1966-01-01

    The presentation discusses both the economic and research contexts that would be served by producing neutrons in gram quantities at high intensities by electrical means without uranium-235. The revenue from producing radioisotopes is attractive. The array of techniques introduced by the multipurpose 65 megawatt Intense Neutron Generator project includes liquid metal cooling, superconducting magnets for beam bending and focussing, super-conductors for low-loss high-power radiofrequency systems, efficient devices for producing radiofrequency power, plasma physics developments for producing and accelerating hydrogen, ions at high intensity that are still far out from established practice, a multimegawatt high voltage D.C.