Questioning the claims from Kaiser.

Science.gov (United States)

Talbot-Smith, Alison; Gnani, Shamini; Pollock, Allyson M; Gray, Denis Pereira

2004-06-01

The article by Feachem et al, published in the BMJ in 2002, claimed to show that, compared with the United Kingdom (UK) National Health Service (NHS), the Kaiser Permanente healthcare system in the United States (US) has similar healthcare costs per capita, and performance that is considerably better in certain respects. To assess the accuracy of Feachem et al's comparison and conclusions. Detailed re-examination of the data and methods used and consideration of the 82 letters responding to the article. Analyses revealed four main areas in which Feachem et al's methodology was flawed. Firstly, the populations of patients served by Kaiser Permanente and by the NHS are fundamentally different. Kaiser's patients are mainly employed, significantly younger, and significantly less socially deprived and so are healthier. Feachem et al fail to adjust adequately for these factors. Secondly, Feachem et al have wrongly inflated NHS costs by omitting substantial user charges payable by Kaiser members for care, excluding the costs of marketing and administration, and deducting the surplus from Kaiser's costs while underestimating the capital charge element of the NHS budget and other costs. They also used two methods of converting currency, the currency rate and a health purchasing power parity conversion. This is double counting. Feachem et al reported that NHS costs were 10% less per head than Kaiser. Correcting for the double currency conversion gives the NHS a 40% cost advantage such that per capita costs are 1161 dollars and 1951 dollars for the NHS and Kaiser, respectively. Thirdly, Feachem et al use non-standardised data for NHS bed days from the Organisation for Economic Cooperation and Development, rather than official Department of Health bed availability and activity statistics for England. Leaving aside the non-comparability of the population and lack of standardisation of the data, the result is to inflate NHS acute bed use and underestimate the efficiency of

Innovative partnerships to advance public health training in community-based academic residency programs

Directory of Open Access Journals (Sweden)

Lo JC

2017-10-01

Full Text Available Joan C Lo,1–3 Thomas E Baudendistel,2,3 Abhay Dandekar,3,4 Phuoc V Le,5 Stanton Siu,2,3 Bruce Blumberg6 1Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA; 2Department of Medicine, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 3Graduate Medical Education, Kaiser Permanente East Bay, Oakland, CA, USA; 4Department of Pediatrics, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 5School of Public Health, University of California Berkeley, Berkeley, CA, USA; 6Graduate Medical Education, Kaiser Permanente Northern California, Oakland, CA, USA Abstract: Collaborative partnerships between community-based academic residency ­training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH tracks in the Internal Medicine Residency and the Pediatrics Residency programs, with MPH graduate studies completed at the University of California Berkeley School of Public Health, enables physicians to integrate clinical training with formal education in epidemiology, biostatistics, health policy, and disease prevention. These residency-MPH programs draw on more than 50 years of clinical education, public health training, and health services research – creating an environment that sparks inquiry and added value by developing skills in patient-centered care through the lens of population-based outcomes. Keywords: graduate medical education, public health, master’s degree, internal medicine, pediatrics, residency training

Psychiatric and Medical Conditions in Transition-Aged Individuals With ASD.

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Davignon, Meghan N; Qian, Yinge; Massolo, Maria; Croen, Lisa A

2018-04-01

Children with autism spectrum disorder (ASD) have a variety of medical and psychiatric conditions and an increased use of health care services. There is limited information about the prevalence of psychiatric and medical conditions in adolescents and young adults with ASD. Our objective was to describe the frequency of medical and psychiatric conditions in a large population of diverse, insured transition-aged individuals with ASD. Participants included Kaiser Permanente Northern California members who were enrolled from 2013 to 2015 and who were 14 to 25 years old. Individuals with ASD ( n = 4123) were compared with peers with attention-deficit/hyperactivity disorder ( n = 20 615), diabetes mellitus ( n = 2156), and typical controls with neither condition ( n = 20 615). Over one-third (34%) of individuals with ASD had a co-occurring psychiatric condition; the most commonly reported medical conditions included infections (42%), obesity (25%), neurologic conditions (18%), allergy and/or immunologic conditions (16%), musculoskeletal conditions (15%), and gastrointestinal (11%) conditions. After controlling for sex, age, race, and duration of Kaiser Permanente Northern California membership, most psychiatric conditions were significantly more common in the ASD group than in each comparison group, and most medical conditions were significantly more common in the ASD group than in the attention-deficit/hyperactivity disorder and typical control groups but were similar to or significantly less common than the diabetes mellitus group. Although more research is needed to identify factors contributing to this excess burden of disease, there is a pressing need for all clinicians to approach ASD as a chronic health condition requiring regular follow-up and routine screening and treatment of medical and psychiatric issues. Copyright © 2018 by the American Academy of Pediatrics.

End-Stage Renal Disease Outcomes among the Kaiser Permanente Southern California Creatinine Safety Program (Creatinine SureNet): Opportunities to Reflect and Improve.

Science.gov (United States)

Sim, John J; Batech, Michael; Danforth, Kim N; Rutkowski, Mark P; Jacobsen, Steven J; Kanter, Michael H

2017-01-01

The Kaiser Permanente Southern California (KPSC) creatinine safety program (Creatinine SureNet) identifies and outreaches to thousands of people annually who may have had a missed diagnosis for chronic kidney disease (CKD). We sought to determine the value of this outpatient program and evaluate opportunities for improvement. Longitudinal cohort study (February 2010 through December 2015) of KPSC members captured into the creatinine safety program who were characterized using demographics, laboratory results, and different estimations of glomerular filtration rate. Age- and sex-adjusted rates of end-stage renal disease (ESRD) were compared with those in the overall KPSC population. Among 12,394 individuals, 83 (0.7%) reached ESRD. The age- and sex-adjusted relative risk of ESRD was 2.7 times higher compared with the KPSC general population during the same period (94.7 vs 35.4 per 100,000 person-years; p creatinine measurements, only 13% had a urine study performed (32% among patients with confirmed CKD). Our study found a higher incidence of ESRD among individuals captured into the KPSC creatinine safety program. If the Chronic Kidney Disease Epidemiology Collaboration equation were used, fewer people would have been captured while improving the accuracy for diagnosing CKD. Urine testing was low even among patients with confirmed CKD. Our findings demonstrate the importance of a creatinine safety net program in an integrated health system but also suggest opportunities to improve CKD care and screening.

Transforming and Sustaining the Care Environment

OpenAIRE

Goldfisher, Anne M.; Hounslow, Barbara; Blank, Judi

2014-01-01

Background: Caring Science Theory and Practices have been part of the Kaiser Permanente's Strategic Priority for Kaiser Permanente Northern Region since 2010. Their goal is to ensure the continued spread across the medical center of practices guided by the Caring Sciences framework that fosters caring-healing environments and that reinforce helping-trusting relationships between caregivers and between caregivers and patients. Methods: Gaining senior-level leader sponsorship is an essential el...

75 FR 70689 - Kaiser Aluminum Fabricated Products, LLC; Kaiser Aluminum-Greenwood Forge Division; Currently...

Science.gov (United States)

2010-11-18

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-70,376] Kaiser Aluminum Fabricated Products, LLC; Kaiser Aluminum- Greenwood Forge Division; Currently Known As Contech Forgings, LLC..., applicable to workers of Kaiser Aluminum Fabricated Products, LLC, Kaiser Aluminum-Greenwood Forge Division...

Genetic Ancestry Is not Associated with Breast Cancer Recurrence or Survival in U.S. Latina Women Enrolled in the Kaiser Permanente Pathways Study.

Science.gov (United States)

Engmann, Natalie J; Ergas, Isaac J; Yao, Song; Kwan, Marilyn L; Roh, Janise M; Ambrosone, Christine B; Kushi, Lawrence H; Fejerman, Laura

2017-09-01

Background: The U.S. Hispanic/Latino population is heterogeneous both socioculturally and by the proportion of European, Indigenous American, and African ancestry of the regions from which individuals originate. A previous study reported that genetic ancestry was associated with breast cancer survival among Latinas, independent of sociodemographic and tumor characteristics, suggesting that a genetic factor associated with ancestry may affect breast cancer survival. Methods: We evaluated the association of genetic ancestry with breast cancer outcomes among 506 Latina women with invasive breast cancer in the Pathways Study, a cohort study within Kaiser Permanente, an integrated health care delivery system. Proportional hazards models were used to assess the effect of ancestry on breast cancer recurrence (53 events), breast cancer-specific mortality (31 events) and all-cause mortality (54 events), with a mean follow-up time of 6 years. Results: Indigenous American ancestry was not associated with breast cancer recurrence [HR = 1.00 per 10% increase; 95% confidence interval (CI), 0.86-1.16], breast cancer mortality (HR = 0.95; 95% CI, 0.77-1.17), or all-cause mortality (HR = 0.93; 95% CI, 0.80-1.08). Adjustment for sociodemographic variables, tumor characteristics, and treatment did not alter the associations. Conclusions: Our results suggest that previously reported differences in breast cancer survival by genetic ancestry may be overcome by improving health care access and/or quality. Impact: Improving health care access and quality may reduce breast cancer disparities among U.S. Latinas. Cancer Epidemiol Biomarkers Prev; 26(9); 1466-9. ©2017 AACR . ©2017 American Association for Cancer Research.

Medical Device Plug-and-Play Interoperability Standards and Technology Leadership

Science.gov (United States)

2014-10-01

Kaiser Permanente, Johns Hopkins Medicine, the VA, FDA, NIST, TATRC, computer and information science groups at University of Pennsylvania...for sharing the findings from our TATRC work and from our NIH Quantum work relative to the gaps in existing standards and recommendations on how they...challenges facing the industry in areas such as interoperability, cybersecurity , data stewardship, and system reliability, and policies needed to accelerate

75 FR 61246 - Kaiser Federal Financial Group, Inc., Covina, CA; Approval of Conversion Application

Science.gov (United States)

2010-10-04

... DEPARTMENT OF THE TREASURY Office of Thrift Supervision [AC-51: OTS No. H-4729] Kaiser Federal... September 28, 2010, the Office of Thrift Supervision approved the application of K-Fed Mutual Holding Company and Kaiser Federal Bank, Covina, California, to convert to the stock form of organization. Copies...

Exposure to Mobile Source Air Pollution in Early-life and Childhood Asthma Incidence: The Kaiser Air Pollution and Pediatric Asthma Study.

Science.gov (United States)

Pennington, Audrey Flak; Strickland, Matthew J; Klein, Mitchel; Zhai, Xinxin; Bates, Josephine T; Drews-Botsch, Carolyn; Hansen, Craig; Russell, Armistead G; Tolbert, Paige E; Darrow, Lyndsey A

2018-01-01

Early-life exposure to traffic-related air pollution exacerbates childhood asthma, but it is unclear what role it plays in asthma development. The association between exposure to primary mobile source pollutants during pregnancy and during infancy and asthma incidence by ages 2 through 6 was examined in the Kaiser Air Pollution and Pediatric Asthma Study, a racially diverse birth cohort of 24,608 children born between 2000 and 2010 and insured by Kaiser Permanente Georgia. We estimated concentrations of mobile source fine particulate matter (PM2.5, µg/m), nitrogen oxides (NOX, ppb), and carbon monoxide (CO, ppm) at the maternal and child residence using a Research LINE source dispersion model for near-surface releases. Asthma was defined using diagnoses and medication dispensings from medical records. We used binomial generalized linear regression to model the impact of exposure continuously and by quintiles on asthma risk. Controlling for covariates and modeling log-transformed exposure, a 2.7-fold increase in first year of life PM2.5 was associated with an absolute 4.1% (95% confidence interval, 1.6%, 6.6%) increase in risk of asthma by age 5. Quintile analysis showed an increase in risk from the first to second quintile, but similar risk across quintiles 2-5. Risk differences increased with follow-up age. Results were similar for NOX and CO and for exposure during pregnancy and the first year of life owing to high correlation. Results provide limited evidence for an association of early-life mobile source air pollution with childhood asthma incidence with a steeper concentration-response relationship observed at lower levels of exposure.

TPMG Northern California appointments and advice call center.

Science.gov (United States)

Conolly, Patricia; Levine, Leslie; Amaral, Debra J; Fireman, Bruce H; Driscoll, Tom

2005-08-01

Kaiser Permanente (KP) has been developing its use of call centers as a way to provide an expansive set of healthcare services to KP members efficiently and cost effectively. Since 1995, when The Permanente Medical Group (TPMG) began to consolidate primary care phone services into three physical call centers, the TPMG Appointments and Advice Call Center (AACC) has become the "front office" for primary care services across approximately 89% of Northern California. The AACC provides primary care phone service for approximately 3 million Kaiser Foundation Health Plan members in Northern California and responds to approximately 1 million calls per month across the three AACC sites. A database records each caller's identity as well as the day, time, and duration of each call; reason for calling; services provided to callers as a result of calls; and clinical outcomes of calls. We here summarize this information for the period 2000 through 2003.

Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012-2013.

Science.gov (United States)

Grytdal, Scott P; DeBess, Emilio; Lee, Lore E; Blythe, David; Ryan, Patricia; Biggs, Christianne; Cameron, Miriam; Schmidt, Mark; Parashar, Umesh D; Hall, Aron J

2016-01-01

Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0-98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children age (outpatient incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person

Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE among Kaiser Permanente Member Populations in the United States, 2012-2013.

Directory of Open Access Journals (Sweden)

Scott P Grytdal

Full Text Available Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE. However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0-98 years. Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested. In addition, 22 (2% of specimens were positive for rotavirus; 19 (2% were positive for sapovirus; and 7 (1% were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children 65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person-years. Outpatient incidence rates of rotavirus, sapovirus, and astrovirus were 2.0, 1.6, 0.6 per 1,000 person

Incidence of Norovirus and Other Viral Pathogens That Cause Acute Gastroenteritis (AGE) among Kaiser Permanente Member Populations in the United States, 2012–2013

Science.gov (United States)

Grytdal, Scott P.; Biggs, Christianne; Cameron, Miriam; Schmidt, Mark; Parashar, Umesh D.; Hall, Aron J.

2016-01-01

Noroviruses and other viral pathogens are increasingly recognized as frequent causes of acute gastroenteritis (AGE). However, few laboratory-based data are available on the incidence of AGE caused by viral pathogens in the U.S. This study examined stool specimens submitted for routine clinical diagnostics from patients enrolled in Kaiser Permanente (KP) health plans in metro Portland, OR, and the Maryland, District of Columbia, and northern Virginia geographic areas to estimate the incidence of viral enteropathogens in these populations. Over a one-year study period, participating laboratories randomly selected stools submitted for routine clinical diagnostics for inclusion in the study along with accompanying demographic and clinical data. Selected stools were tested for norovirus, rotavirus, sapovirus, and astrovirus using standardized real-time RT-PCR protocols. Each KP site provided administrative data which were used in conjunction with previously published data on healthcare utilization to extrapolate pathogen detection rates into population-based incidence rates. A total of 1,099 specimens collected during August 2012 to September 2013 were included. Mean age of patients providing stool specimens was 46 years (range: 0–98 years). Noroviruses were the most common viral pathogen identified among patients with AGE (n = 63 specimens, 6% of specimens tested). In addition, 22 (2%) of specimens were positive for rotavirus; 19 (2%) were positive for sapovirus; and 7 (1%) were positive for astrovirus. Incidence of norovirus-associated outpatient visits was 5.6 per 1,000 person-years; incidence of norovirus disease in the community was estimated to be 69.5 per 1,000 person-years. Norovirus incidence was highest among children incidence = 25.6 per 1,000 person-years; community incidence = 152.2 per 1,000 person-years), followed by older adults aged >65 years (outpatient incidence = 7.8 per 1,000 person-years; community incidence = 75.8 per 1,000 person

Evaluation of a surveillance case definition for anogenital warts, Kaiser Permanente northwest.

Science.gov (United States)

Naleway, Allison L; Weinmann, Sheila; Crane, Brad; Gee, Julianne; Markowitz, Lauri E; Dunne, Eileen F

2014-08-01

Most studies of anogenital wart (AGW) epidemiology have used large clinical or administrative databases and unconfirmed case definitions based on combinations of diagnosis and procedure codes. We developed and validated an AGW case definition using a combination of diagnosis codes and other information available in the electronic medical record (provider type, laboratory testing). We calculated the positive predictive value (PPV) of this case definition compared with manual medical record review in a random sample of 250 cases. Using this case definition, we calculated the annual age- and sex-stratified prevalence of AGW among individuals 11 through 30 years of age from 2000 through 2005. We identified 2730 individuals who met the case definition. The PPV of the case definition was 82%, and the average annual prevalence was 4.16 per 1000. Prevalence of AGW was higher in females compared with males in every age group, with the exception of the 27- to 30-year-olds. Among females, prevalence peaked in the 19- to 22-year-olds, and among males, the peak was observed in 23- to 26-year-olds. The case definition developed in this study is the first to be validated with medical record review and has a good PPV for the detection of AGW. The prevalence rates observed in this study were higher than other published rates, but the age- and sex-specific patterns observed were consistent with previous reports.

The effect of patient satisfaction with pharmacist consultation on medication adherence: an instrumental variable approach

Directory of Open Access Journals (Sweden)

Gu NY

2008-12-01

Full Text Available There are limited studies on quantifying the impact of patient satisfaction with pharmacist consultation on patient medication adherence. Objectives: The objective of this study is to evaluate the effect of patient satisfaction with pharmacist consultation services on medication adherence in a large managed care organization. Methods: We analyzed data from a patient satisfaction survey of 6,916 patients who had used pharmacist consultation services in Kaiser Permanente Southern California from 1993 to 1996. We compared treating patient satisfaction as exogenous, in a single-equation probit model, with a bivariate probit model where patient satisfaction was treated as endogenous. Different sets of instrumental variables were employed, including measures of patients' emotional well-being and patients' propensity to fill their prescriptions at a non-Kaiser Permanente (KP pharmacy. The Smith-Blundell test was used to test whether patient satisfaction was endogenous. Over-identification tests were used to test the validity of the instrumental variables. The Staiger-Stock weak instrument test was used to evaluate the explanatory power of the instrumental variables. Results: All tests indicated that the instrumental variables method was valid and the instrumental variables used have significant explanatory power. The single equation probit model indicated that the effect of patient satisfaction with pharmacist consultation was significant (p<0.010. However, the bivariate probit models revealed that the marginal effect of pharmacist consultation on medication adherence was significantly greater than the single equation probit. The effect increased from 7% to 30% (p<0.010 after controlling for endogeneity bias. Conclusion: After appropriate adjustment for endogeneity bias, patients satisfied with their pharmacy services are substantially more likely to adhere to their medication. The results have important policy implications given the increasing focus

Treatment changes in patients with psoriasis on etanercept or adalimumab

DEFF Research Database (Denmark)

Lee, Erica B; Amin, Mina; Egeberg, Alexander

2018-01-01

PURPOSE: To determine the frequency of and reasons for treatment changes in patients with psoriasis. MATERIALS AND METHODS: A retrospective chart review of 140 patients with psoriasis treated with adalimumab or etanercept seen at Kaiser Permanente Los Angeles Medical Center between September 20, ...

Pathways: improving outcomes, not just 'cookbook medicine'.

Science.gov (United States)

O'Malley, S

1997-04-01

A Kaiser Permanente medical director cites four benefits to be derived from using clinical guidelines: better outcomes, faster patient recovery, reduced costs, and increased physician accountability. And, he notes, physicians are free to deviate from the guidelines--so long as they can justify their actions.

Measuring integrated care

DEFF Research Database (Denmark)

Strandberg-Larsen, Martin

2011-01-01

respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser...... differences were found in the perception of clinical integration in the two settings. More primary care clinicians in the Northern California region of Kaiser Permanente reported being part of a clinical integrated environment than did Danish general practitioners. By measuring the level of clinical...... and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine...

An update on the use of Atripla® in the treatment of HIV in the United States

Directory of Open Access Journals (Sweden)

Michael A Horberg

2010-06-01

Full Text Available Michael A Horberg1, Daniel B Klein21HIV Interregional Initiative, Kaiser Permanente, Oakland, California, USA; 2Department of Infectious Diseases, Kaiser Permanente Hayward Medical Center, Hayward, California, USAAbstract: Atripla® (Gilead Sciences Inc, Foster City, CA, USA and Bristol-Myers Squibb, New York City, NY, USA is a coformulated single pill composed of efavirenz, emtricitabine, and tenofovir disoproxil, intended as a once-daily potent combination antiretroviral therapeutic agent. Its efficacy is equivalent to the 3 component drugs taken in a combination as single medications. The coformulated antiretroviral regimen can be quite effective in patients whose human immunodeficiency virus is sensitive to all 3 components of Atripla. However, women at risk of pregnancy, already pregnant, or nursing mothers should not take Atripla, due to the teratogenic potential of the efavirenz moiety. Adverse effects are similar to those seen with the constituent medications, including potential central nervous system effects and renal toxicity. Since its US Food and Drug administration approval, prescriptions for Atripla have increased steadily.Keywords: tenofovir, efavirenz, emtricitabine, antiretroviral therapy

The permanental process

DEFF Research Database (Denmark)

McCullagh, Peter; Møller, Jesper

2006-01-01

We extend the boson process first to a large class of Cox processes and second to an even larger class of infinitely divisible point processes. Density and moment results are studied in detail. These results are obtained in closed form as weighted permanents, so the extension i called a permanental...... process. Temporal extensions and a particularly tractable case of the permanental process are also studied. Extensions of the fermion process along similar lines, leading to so-called determinantal processes, are discussed....

Frederik Kaiser (1808-1872) and the Modernisation of Dutch Astronomy

Science.gov (United States)

van der Heijden, Petra

Frederik Kaiser was the director of Leiden Observatory from 1837 until his death in 1872. Educated by his German-born uncle Johan Frederik Keyser (1766-1823), who was a proficient amateur astronomer, Kaiser proved to be a real observational talent. Despite the poor conditions in which he worked, his observations soon rivalled with the best in the world. Kaiser's contributions to astronomical practice include the foundation of a new, completely up-to-date observatory building in Leiden, and the introduction of statistics and precision measurements in daily practice at the observatory. Moreover he was the author of several bestselling books on popular astronomy. Kaiser had an extensive correspondence with colleagues all over Europe, mostly in Germany. Correpondents include Airy, Argelander, Von Auwers, Bessel, Encke, John Herschel, LeVerrier, Von Littrow, Schumacher, Otto W. Struve, as well as several geodesists and instrument makers. Preliminary research indicates that Frederik Kaiser played a crucial role in the revival of Dutch astronomy in the second half of the 19th century. This project aims at analysing and explaining Kaiser's activities in science, institutionalisation and popularisation, in the context of national and international developments in 19th-century astronomy and scientific culture.

Diagnosing the Kaiser: Psychiatry, Wilhelm II and the Question of German War Guilt The William Bynum Prize Essay 2016.

Science.gov (United States)

Freis, David

2018-07-01

After his abdication in November 1918, the German emperor Wilhelm II continued to haunt the minds of his people. With the abolition of the lese-majesty laws in the new republic, many topics that were only discussed privately or obliquely before could now be broached openly. One of these topics was the mental state of the exiled Kaiser. Numerous psychiatrists, physicians and laypeople published their diagnoses of Wilhelm in high-circulation newspaper articles, pamphlets, and books shortly after the end of the war. Whether these diagnoses were accurate and whether the Kaiser really was mentally ill became the issue of a heated debate.This article situates these diagnoses of Wilhelm II in their political context. The authors of these diagnoses - none of whom had met or examined Wilhelm II in person - came from all political camps and they wrote with very different motives in mind. Diagnosing the exiled Kaiser as mentally ill was a kind of exorcism of the Hohenzollern rule, opening the way for either a socialist republic or the hoped-for rule of a new leader. But more importantly, it was a way to discuss and allocate political responsibility and culpability. Psychiatric diagnoses were used to exonerate both the Emperor (for whom the treaty of Versailles provided a tribunal as war criminal) and the German nation. They were also used to blame the Kaiser's entourage and groups that had allegedly manipulated the weak-willed monarch. Medical concepts became a vehicle for a debate on the key political questions in interwar Germany.

Kaiser Family Foundation - Content Search

Data.gov (United States)

U.S. Department of Health & Human Services — Chartpacks, chartbooks, factsheets, reports, and slide presentations bring Kaiser Family Foundation information to life, and can be easily incorporated into your...

Frederik Kaiser (1808-1872, een gekweld man met een missie

Directory of Open Access Journals (Sweden)

Huib Zuidervaart

2011-06-01

Full Text Available Frederik Kaiser (1808-1872, a tormented man with a missionThe Leiden astronomer Kaiser has been instrumental for the rise of Dutch astronomy in the late nineteenth-century. His career was impressive. In 1826, without any formal university education, he began at the Leiden Astronomical Observatory as an ordinary observer. Through his work in astronomy he obtained an honorary doctorate, which enabled him in 1838 to become director of the observatory. In 1844 he was appointed full professor and in the academic year 1857/1858 he even became Rector Magnificus of Leiden University. In 1860 he even saw the fulfillmentof his life-long dream: the opening of a brand new astronomical observatory. However, in spite of these obvious professional successes, Kaiser's personal life was full of melancholy. This paper investigates Kaiser's personality, using correspondence with his family, as well as testimonies written down by his students and other contemporaries. Among others, we demonstrate the way in which Kaiser used his personal network, as well as his fierce continuous – and often publicly expressed – complaining, as a successful strategy in establishing his new astronomical observatory.

Understanding Faculty and Trainee Needs Related to Scholarly Activity in a Large, Nonuniversity Graduate Medical Education Program.

Science.gov (United States)

Becker, Davida; Garth, Hanna; Hollander, Rachel; Klein, Felice; Klau, Marc

2017-01-01

Graduate medical education (GME) programs must develop curriculum to ensure scholarly activity among trainees and faculty to meet accreditation requirements and to support evidence-based medicine. Test whether research-related needs and interests varied across four groups: primary care trainees, specialty trainees, primary care faculty, and specialty faculty. We surveyed a random sample of trainees and faculty in Kaiser Permanente Southern California's GME programs. We investigated group differences in outcomes using Fisher exact and Kruskal-Wallis tests. Research experiences, skills, barriers, motivators, and interests in specific research skills development. Participants included 47 trainees and 26 faculty (response rate = 30%). Among primary care faculty, 12 (71%) reported little or no research experience vs 1 (11%) for specialty faculty, 14 (41%) for primary care trainees, and 1 (8%) for specialty trainees (p work roles taking priority; desire for work-life balance; and lack of managerial support, research equipment, administrative support, and funding. Faculty and trainees in primary care and specialties have differing research-related needs that GME programs should consider when designing curricula to support scholarly activity. Developing research skills of primary care faculty is a priority to support trainees' scholarly activity.

One-Year Outcomes of an Integrated Multiple Sclerosis Disease Management Program.

Science.gov (United States)

Groeneweg, Marti; Forrester, Sara H; Arnold, Beth; Palazzo, Lorella; Zhu, Weiwei; Yoon, Paul; Scearce, Tim

2018-05-01

Multiple sclerosis (MS) is associated with high total health care cost, the majority of which is attributable to medications. Patients with MS are less likely to experience relapses, emergency department (ED) visits, and hospitalizations when they are adherent to disease-modifying treatments. Disease management programs are hypothesized to improve medication adherence thereby improving clinical and economic outcomes. To evaluate the clinical and economic effects of a specialty pharmacy and chronic disease management program for patients with MS from a health plan perspective. This study was a retrospective analysis using prescription drug claims, medical claims, and electronic medical record information (2013-2015) 1 year before and after enrollment in the disease management program for members with 24 months of continuous health plan coverage. Medication adherence was calculated using proportion of days covered (PDC). Relapse rate was defined as an MS outpatient visit associated with a corticosteroid dispense within 7 days of the visit or an MS hospitalization. Disease progression was assessed using the Modified Expanded Disability Status Scale (mEDSS). Resource use included outpatient visits, ED visits, and hospitalizations. Cost information was collected as health plan-paid amount and was reported in 2013 U.S. dollars. The analysis included 377 patients (mean age 55 years, 76.4% female). After enrollment in the program, 78.7% of the study group had a PDC of ≥ 0.80 compared with 70.0% before enrollment (P management for patients with MS can increase the proportion of patients adherent to medication. The increase in health plan spend on MS medications is not offset by savings in health care resource utilization. This study was funded by Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington Pharmacy Administration. The authors have no disclosures to report.

Comparison of paper and electronic surveys for measuring patient-reported outcomes after anterior cruciate ligament reconstruction.

Science.gov (United States)

Bojcic, Jamie L; Sue, Valerie M; Huon, Tomy S; Maletis, Gregory B; Inacio, Maria C S

2014-01-01

This study compared response rates of paper and electronic versions of the Knee injury Osteoarthritis and Outcome Score questionnaire and examined the characteristics of patients who responded to each survey method. A total of 1486 patients registered by the Kaiser Permanente Anterior Cruciate Ligament Reconstruction Registry between 2005 and 2010 were included in this study. Response rates by survey modality for the overall cohort, by the specific time periods, and by age and sex at time of anterior cruciate ligament reconstruction were compared using χ(2) tests or the Fisher exact test when appropriate. Independent Student t tests were used to compare the Knee injury Osteoarthritis and Outcome Scores of survey respondents. The overall survey response rate was 42%. The 36% response rate in the electronic-survey group was significantly higher than the 22% response rate in the paper-survey group (p survey produced higher response rates, it is not sufficient alone to replace the traditional paper version among this Kaiser Permanente population.

Site support program plan for ICF Kaiser Hanford Company, Revision 1

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-10-01

This document is the general administrative plan implemented by the Hanford Site contractor, ICF Kaiser Hanford Company. It describes the mission, administrative structure, projected staffing, to be provided by the contractor. The report breaks out the work responsibilities within the different units of the company, a baseline schedule for the different groups, and a cost summary for the different operating units.

Site support program plan for ICF Kaiser Hanford Company, Revision 1

International Nuclear Information System (INIS)

1995-10-01

This document is the general administrative plan implemented by the Hanford Site contractor, ICF Kaiser Hanford Company. It describes the mission, administrative structure, projected staffing, to be provided by the contractor. The report breaks out the work responsibilities within the different units of the company, a baseline schedule for the different groups, and a cost summary for the different operating units

Educação Permanente em Saúde no Brasil: educação ou gerenciamento permanente?

Directory of Open Access Journals (Sweden)

Cristiane Lopes Simão Lemos

2016-03-01

Full Text Available Resumo O objetivo do estudo foi analisar a concepção e os fundamentos da Educação Permanente em Saúde (EPS constante da Política Nacional de Educação Permanente em Saúde (PNEPS no Brasil. A metodologia baseou-se na análise de documentos do Ministério da Saúde e de artigos científicos relacionados. Constatou-se que a concepção da EPS na PNEPS transcende um significado pedagógico, respondendo a um processo de reestruturação dos serviços diante das novas demandas do modelo. Justamente no momento em que o trabalho se encontra cada vez mais instável e precarizado, o Ministério da Saúde apresenta um discurso sobre uma gestão inovadora, dando centralidade à questão da EPS. A ideia não é de educação permanente, mas de gerenciamento permanente. Ao contrário de um instrumento de transformação radical, a EPS converte-se em uma ideologia que seduz pela sua aparência de novidade pedagógica.

[The Internet and shared decision-making between patients and healthcare providers].

Science.gov (United States)

Silber, Denise

2009-10-01

Insurance companies like Kaiser Permanente in the United States remunerate physicians for their email correspondence with patients, increasing the efficiency of office visits. A survey by the French National Board of Physicians regarding the computerization of medical practices in April 2009, confirms that both physicians and patients in France are very favorable to the development of these tools. When patients can manage and/or access their medical files and determine which providers can access them, they become a true partner.

A new class of weight and WA systems of the Kravchenko-Kaiser functions

Science.gov (United States)

Kravchenko, V. F.; Pustovoit, V. I.; Churikov, D. V.

2014-05-01

A new class of weight and WA-systems of the Kravchenko-Kaiser functions which showed its efficiency in various physical applications is proposed and substantiated. This publication consists of three parts. In the first the Kravchenko-Kaiser weight functions are constructed on basis of the theory of atomic functions (AFs) and the Kaiser windows for the first time. In the second part new constructions of analytic WA-systems of the Kravchenko-Kaiser functions are costructed. In the third part their applications to problems of weight averaging of the difference frequency signals are considered. The numerical experiment and the physical analysis of the results for concrete physical models confirmed their efficiency. This class of functions can find wide physical applications in problems of digital signal processing, restoration of images, radar, radiometry, radio astronomy, remote sensing, etc.

Economic burden related to chemotherapy-related adverse events in patients with metastatic breast cancer in an integrated health care system

Directory of Open Access Journals (Sweden)

Rashid N

2016-10-01

Full Text Available Nazia Rashid,1 Han A Koh,2 Hilda C Baca,3 Kathy J Lin,1 Susan E Malecha,4 Anthony Masaquel5 1Drug Information Services, Kaiser Permanente, Downey, 2Southern California Permanente Medical Group, Kaiser Permanente, Bellflower, 3Pharmacy Analytical Services, Kaiser Permanente, Downey, 4US Medical Affairs, Genetech Inc., San Francisco, 5Health Economics and Outcomes, Genentech Inc., San Francisco, CA, USA Background: Breast cancer is treated with many different modalities, including chemotherapy that can be given as a single agent or in combination. Patients often experience adverse events from chemotherapy during the cycles of treatment which can lead to economic burden.Objective: The objective of this study was to evaluate costs related to chemotherapy-related adverse events in patients with metastatic breast cancer (mBC in an integrated health care delivery system.Methods: Patients with mBC newly initiated on chemotherapy were identified and the first infusion was defined as the index date. Patients were ≥18 years old at time of index date, had at least 6 months of health plan membership and drug eligibility prior to their index date. The chemotherapy adverse events were identified after the index date and during first line of chemotherapy. Episodes of care (EOC were created using healthcare visits. Chart review was conducted to establish whether the adverse events were related to chemotherapy. Costs were calculated for each visit, including medications related to the adverse events, and aggregated to calculate the total EOC cost.Results: A total of 1,682 patients with mBC were identified after applying study criteria; 54% of these patients had one or more adverse events related to chemotherapy. After applying the EOC method, there were a total of 5,475 episodes (4,185 single episodes [76.4%] and 1,290 multiple episodes [23.6%] related to chemotherapy-related adverse events. Within single episodes, hematological (1,387 EOC, 33

Optimized Kaiser-Bessel Window Functions for Computed Tomography.

Science.gov (United States)

Nilchian, Masih; Ward, John Paul; Vonesch, Cedric; Unser, Michael

2015-11-01

Kaiser-Bessel window functions are frequently used to discretize tomographic problems because they have two desirable properties: 1) their short support leads to a low computational cost and 2) their rotational symmetry makes their imaging transform independent of the direction. In this paper, we aim at optimizing the parameters of these basis functions. We present a formalism based on the theory of approximation and point out the importance of the partition-of-unity condition. While we prove that, for compact-support functions, this condition is incompatible with isotropy, we show that minimizing the deviation from the partition of unity condition is highly beneficial. The numerical results confirm that the proposed tuning of the Kaiser-Bessel window functions yields the best performance.

The Kaiser Wilhelm Society under National Socialism

CERN Document Server

Sachse, Carola; Walker, Mark

2009-01-01

During the first part of the twentieth century, German science led the world. The most important scientific institution in Germany was the Kaiser Wilhelm Society, including institutes devoted to different fields of scientific research. These researchers were not burdened by teaching obligations and enjoyed excellent financial and material support. When the National Socialists came to power in Germany, all of German society, including science, was affected. The picture that previously dominated our understanding of science under National Socialism from the end of the Second World War to the recent past - a picture of leading Nazis ignorant and unappreciative of modern science and of scientists struggling to resist the Nazis - needs to be revised. This book surveys the history of Kaiser Wilhelm Institutes under Hitler, illustrating definitively the cooperation, if not collaboration, between scientists and National Socialists in order to further the goals of autarky, racial hygiene, war, and genocide.

12-Step participation reduces medical use costs among adolescents with a history of alcohol and other drug treatment.

Science.gov (United States)

Mundt, Marlon P; Parthasarathy, Sujaya; Chi, Felicia W; Sterling, Stacy; Campbell, Cynthia I

2012-11-01

Adolescents who attend 12-step groups following alcohol and other drug (AOD) treatment are more likely to remain abstinent and to avoid relapse post-treatment. We examined whether 12-step attendance is also associated with a corresponding reduction in health care use and costs. We used difference-in-difference analysis to compare changes in seven-year follow-up health care use and costs by changes in 12-step participation. Four Kaiser Permanente Northern California AOD treatment programs enrolled 403 adolescents, 13-18-years old, into a longitudinal cohort study upon AOD treatment entry. Participants self-reported 12-step meeting attendance at six-month, one-year, three-year, and five-year follow-up. Outcomes included counts of hospital inpatient days, emergency room (ER) visits, primary care visits, psychiatric visits, AOD treatment costs and total medical care costs. Each additional 12-step meeting attended was associated with an incremental medical cost reduction of 4.7% during seven-year follow-up. The medical cost offset was largely due to reductions in hospital inpatient days, psychiatric visits, and AOD treatment costs. We estimate total medical use cost savings at $145 per year (in 2010 U.S. dollars) per additional 12-step meeting attended. The findings suggest that 12-step participation conveys medical cost offsets for youth who undergo AOD treatment. Reduced costs may be related to improved AOD outcomes due to 12-step participation, improved general health due to changes in social network following 12-step participation, or better compliance to both AOD treatment and 12-step meetings. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

The Impact of Telephonic Wellness Coaching on Weight Loss: A “Natural Experiments for Translation in Diabetes (NEXT-D)” Study

Science.gov (United States)

Schmittdiel, Julie A.; Adams, Sara R.; Goler, Nancy; Sanna, Rashel S.; Boccio, Mindy; Bellamy, David J.; Brown, Susan D.; Neugebauer, Romain S.; Ferrara, Assiamira

2016-01-01

Objective To evaluate the impact of a population-based telephonic wellness coaching program on weight loss. Methods Individual-level segmented regression analysis of interrupted time series data comparing the BMI trajectories in the 12 months before vs. the 12 months after initiating coaching among a cohort of Kaiser Permanente Northern California (KPNC) members (n=954) participating in The Permanente Medical Group (TPMG) Wellness Coaching program in 2011. The control group was a 20:1 propensity-score matched control group (n=19,080) matched with coaching participants based on baseline demographic and clinical characteristics. Results Wellness coaching participants had a significant upward trend in BMI in the 12 months before their first Wellness coaching session, and a significant downward trend in BMI in the 12 months after their first session equivalent to a clinically significant reduction of greater than one unit of baseline BMI (pcoaching has a positive impact on BMI reduction that is both statistically and clinically significant. Future research and quality improvement efforts should focus on disseminating Wellness coaching for weight loss in diabetes patients and those at risk for developing the disease. PMID:28124501

Postcataract endophthalmitis prophylaxis using irrigation, incision hydration, and eye pressurization with vancomycin

Directory of Open Access Journals (Sweden)

Schelonka LP

2015-07-01

Full Text Available Lee P Schelonka,1 Margaret A SaBell2 1Department of Opthalmology, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, 2Department of Infection Control, Kaiser Permanente Lone Tree Medical Offices, Lone Tree, Denver, CO, USA Purpose: This study aimed to determine whether switching from balanced salt solution (BSS to vancomycin 20 g/mL BSS for incision hydration and eye pressurization reduces the rate of postcataract endophthalmitis.Methods: This was a patient safety/quality improvement project, including all patients undergoing cataract surgery at the Kaiser Permanente Colorado Ophthalmology Department from January 2002 to December 2014. Throughout the study, patients received vancomycin 20 µg/mL in the irrigating solution. During the baseline period from 2002 to 2005, surgeons pressurized eyes and hydrated incisions with plain BSS. During the intervention period from 2006 through 2014, surgeons switched from BSS to the vancomycin/BSS irrigating solution for eye pressurization and incision hydration.Results: A total of 57,263 cataract operations were performed by 24 surgeons at seven surgical centers: 12,400 in the baseline period and 44,863 in the intervention period. The rate of postcataract endophthalmitis declined significantly from 5/12,400 (rate: 0.4/1,000 in the baseline period to 1/44,863 (rate: 0.022/1,000 during the intervention period (odds ratio [OR]: 18.1, 95% confidence interval [CI]: 2.11–154.9; χ2=13.5, P=0.00024. Accounting for an estimated 2.05-fold risk reduction due to confounding variables, the risk reduction attributed to the intervention remained significant: (adjusted OR: 8.78, 95% CI: 1.73–44.5; χ2=10.06, P=0.0015. Since 2009, we have not experienced any cases of postcataract endophthalmitis after 32,753 operations.Conclusion: We experienced a significant reduction in postcataract endophthalmitis when we switched from BSS to the vancomycin/BSS irrigating solution for incision hydration and eye pressurization

Measuring integrated care.

Science.gov (United States)

Strandberg-Larsen, Martin

2011-02-01

The positive outcomes of coordination of healthcare services are to an increasing extent becoming clear. However the complexity of the field is an inhibiting factor for vigorously designed trial studies. Conceptual clarity and a consistent theoretical frame-work are thus needed. While researchers respond to these needs, patients and providers face the multiple challenges of today's healthcare environment. Decision makers, planners and managers need evidence based policy options and information on the scope of the integrated care challenges they are facing. The US managed care organization Kaiser Permanente has been put forward as an example for European healthcare systems to follow, although the evidence base is far from conclusive. The thesis has five objectives: 1) To contribute to the understanding of the concept of integration in healthcare systems and to identify measurement methods to capture the multi-dimensional aspects of integrated healthcare delivery. 2) To assess the level of integration of the Danish healthcare system. 3) To assess the use of joint health plans as a tool for coordination between the regional and local level in the Danish healthcare system. 4) To compare the inputs and performance of the Danish healthcare system and the managed care organization Kaiser Permanente, California, US. 5) To compare primary care clinicians' perception of clinical integration in two healthcare systems: Kaiser Permanente, Northern California and the Danish healthcare system. Further to examine the associations between specific organizational factors and clinical integration within each system. The literature was systematically searched to identify methods for measurement of integrated healthcare delivery. A national cross-sectional survey was conducted among major professional stake-holders at five different levels of the Danish healthcare system. The survey data were used to allow for analysis of the level of integration achieved. Data from the survey were

Properties and simulation of α-permanental random fields

DEFF Research Database (Denmark)

Møller, Jesper; Rubak, Ege Holger

An α-permanental random field is briefly speaking a model for a collection of random variables with positive associations, where α is a positive number and the probability generating function is given in terms of a covariance or more general function so that density and moment expressions are given...... by certain α-permanents. Though such models possess many appealing probabilistic properties, many statisticians seem unaware of  α-permanental random fields and their potential applications. The purpose of this paper is first to summarize useful probabilistic results using the simplest possible setting......, and second to study stochastic constructions and simulation techniques, which should provide a useful basis for discussing the statistical aspects in future work. The paper also discusses some examples of  α-permanental random fields....

Linked analysis for definition of nurse advice line syndrome groups, and comparison to encounters.

Science.gov (United States)

Magruder, Steven F; Henry, J; Snyde, M

2005-08-26

Nurse advice call centers are a potentially important source of data for syndromic surveillance purposes. For this reason, researchers at Johns Hopkins University Applied Physics Laboratory and Kaiser Permanente of the Mid-Atlantic States (KPMAS) have been collaborating to develop methods to use this data within the ESSENCE II Syndromic Surveillance System in the National Capital Region. The objective of this report is to present a general method for finding syndrome groups in data sources that can be linked to physician encounters and to determine effective advice call syndrome groups for use with KPMAS advice data. Advice calls are linked to physician encounters and stratified by patient age. They are placed in groups according to a maximum positive predictive value criterion. The groups are evaluated by correlating the resulting syndrome time series against physician encounter data. Potentially useful advice syndrome groups are found for respiratory, lower gastrointestinal (GI), and total GI syndromes for each age stratum. The time series of the advice data for respiratory, lower GI, and upper GI syndromes accurately predict the physician encounter time series for the corresponding syndromes for each age stratum.

Medline Plus

Full Text Available ... Merriam, KS, 05/04/2012) Colorectal Cancer Laparoscopic Right Colectomy ... Incontinence Advanced Procedures in Male Incontinence: The Male Sling (Kaiser Permanente San Diego ...

Replication of clinical innovations in multiple medical practices.

Science.gov (United States)

Henley, N S; Pearce, J; Phillips, L A; Weir, S

1998-11-01

Many clinical innovations had been successfully developed and piloted in individual medical practice units of Kaiser Permanente in North Carolina during 1995 and 1996. Difficulty in replicating these clinical innovations consistently throughout all 21 medical practice units led to development of the interdisciplinary Clinical Innovation Implementation Team, which was formed by using existing resources from various departments across the region. REPLICATION MODEL: Based on a model of transfer of best practices, the implementation team developed a process and tools (master schedule and activity matrix) to quickly replicate successful pilot projects throughout all medical practice units. The process involved the following steps: identifying a practice and delineating its characteristics and measures (source identification); identifying a team to receive the (new) practice; piloting the practice; and standardizing, including the incorporation of learnings. The model includes the following components for each innovation: sending and receiving teams, an innovation coordinator role, an innovation expert role, a location expert role, a master schedule, and a project activity matrix. Communication depended on a partnership among the location experts (local knowledge and credibility), the innovation coordinator (process expertise), and the innovation experts (content expertise). Results after 12 months of working with the 21 medical practice units include integration of diabetes care team services into the practices, training of more than 120 providers in the use of personal computers and an icon-based clinical information system, and integration of a planwide self-care program into the medical practices--all with measurable improved outcomes. The model for sequential replication and the implementation team structure and function should be successful in other organizational settings.

La formación permanente del profesorado en entornos virtuales de aprendizaje

OpenAIRE

Sonia Mª SANTOVEÑA CASAL

2012-01-01

La educación permanente nos permite adaptarnos a las exigencias sociales y a las demandas de la sociedad del conocimiento. En este contexto se hace imprescindible una formación permanente con apoyo de entornos virtuales de aprendizaje de calidad. El objetivo principal de esta investigación es el estudio de la calidad de los cursos virtuales destinados a la formación del profesorado desde diferentes instituciones públicas. La muestra está formada por cuatro cursos de formación permanente desti...

Moving from tacit knowledge to evidence-based practice: the Kaiser Permanente community partners study.

Science.gov (United States)

Enguídanos, Susan M; Jamison, Paula M

2006-01-01

For several decades both medical and social work practices have failed to consistently include measures to determine the effectiveness of their care and practices. This is especially true of care management practices. With the growth and aging of our population, this is of particular concern when many of our resources for older adults are channeled into services such as geriatric care management. This article describes a randomized controlled trial that tested the effectiveness of four levels of geriatric care management. Results from this study did not support the tacit knowledge of the clinicians in terms of the effectiveness of their practices. This article describes the study methods and results, and how evidence from this study impacted subsequent service provided by geriatric care managers.

Experimental study on the Kaiser effect of AE under multiaxial loading in granite

International Nuclear Information System (INIS)

Watanabe, Hidehiko; Hiroi, Takehiro

2012-01-01

Knowledge of the in-situ stresses is essential for underground excavation design, particularly in evaluating stability of excavation. Acoustic Emission method, which utilizes the Kaiser effect, is one of the simple methods for measuring in-situ stresses. Experiments on the Kaiser effect has been carried out under uniaxial compression and triaxial compression (σ 1 > σ 2 = σ 3 ), but has not been carried out under the three different principal stresses (σ 1 > σ 2 > σ 3 ). In this study, we performed two experiments on the Kaiser effect under multiaxial loading, using a hollow cylindrical granite specimen. The rapidly increasing point of cumulative AE event count was determined as the peak point of AE event count rate increment (AERI). The main results are summarized as follows. (1) In the case of the cyclic incremental σ 1 loading under σ 2 ≠σ 3 , the large peak point of AERI appeared just before the pre-stress level. And as more stresses prior to just before the peak point were estimated, the estimated error showed a tendency to increase. (2) In the case of re-loading under the lower σ 2 and σ 3 more than pre-loading, the estimated stresses using the three peak points of AERI corresponded to the pre-differential stresses (σ 1 -σ 2 ), (σ 1 -σ 3 ) and pre-axial stress σ 1 . The magnitudes of the three principal stresses were estimated under multiaxial loading from the Kaiser effect, using only one specimen. (author)

Intersection local times, loop soups and permanental Wick powers

CERN Document Server

Jan, Yves Le; Rosen, Jay

2017-01-01

Several stochastic processes related to transient Lévy processes with potential densities u(x,y)=u(y-x), that need not be symmetric nor bounded on the diagonal, are defined and studied. They are real valued processes on a space of measures \\mathcal{V} endowed with a metric d. Sufficient conditions are obtained for the continuity of these processes on (\\mathcal{V},d). The processes include n-fold self-intersection local times of transient Lévy processes and permanental chaoses, which are `loop soup n-fold self-intersection local times' constructed from the loop soup of the Lévy process. Loop soups are also used to define permanental Wick powers, which generalizes standard Wick powers, a class of n-th order Gaussian chaoses. Dynkin type isomorphism theorems are obtained that relate the various processes. Poisson chaos processes are defined and permanental Wick powers are shown to have a Poisson chaos decomposition. Additional properties of Poisson chaos processes are studied and a martingale extension is obt...

Synthesis of nanodiamond derivatives carrying amino functions and quantification by a modified Kaiser test

Directory of Open Access Journals (Sweden)

Gerald Jarre

2014-11-01

Full Text Available Nanodiamonds functionalized with different organic moieties carrying terminal amino groups have been synthesized. These include conjugates generated by Diels–Alder reactions of ortho-quinodimethanes formed in situ from pyrazine and 5,6-dihydrocyclobuta[d]pyrimidine derivatives. For the quantification of primary amino groups a modified photometric assay based on the Kaiser test has been developed and validated for different types of aminated nanodiamond. The results correspond well to values obtained by thermogravimetry. The method represents an alternative wet-chemical quantification method in cases where other techniques like elemental analysis fail due to unfavourable combustion behaviour of the analyte or other impediments.

Um teste direto da teoria de renda permanente: o caso brasileiro

Directory of Open Access Journals (Sweden)

Fábio Augusto Reis Gomes

2012-01-01

Full Text Available O presente artigo busca averiguar se a teoria da renda permanente (TRP é capaz de explicar a evolução do consumo no Brasil através de um teste direto com base em revisões de consumo induzidas por inovações na renda. De acordo com a TRP, o consumo reage às mudanças na renda na medida em que a renda corrente contem informação sobre a renda permanente. Para mensurar esta relação, foi estimado um modelo ARIMA (p,1,q para a renda corrente e, como resultado, foi possível verificar se as revisões de consumo e renda permanente se assemelham. Por fim, a TRP foi rejeitada.

Nurse Knowledge Exchange Plus: Human-Centered Implementation for Spread and Sustainability.

Science.gov (United States)

Lin, Mike; Heisler, Scott; Fahey, Linda; McGinnis, Juli; Whiffen, Teri L

2015-07-01

Kaiser Permanente implemented a new model of nursing communication at shift change-in the bedside nursing report known as the Nurse Knowledge Exchange (NKE) in 2004-but noted variations in its spread and sustainability across medical centers five years later. The six core elements of NKEplus were as follows: team rounding in the last hour before shift changes, pre-shift patient assignments that limit the number of departing nurses at shift change, unit support for uninterrupted bedside reporting, standardization for report and safety check formats, and collaboration with patients to update in-room care boards. In January 2011 Kaiser Permanente Southern California (KPSC; Pasadena) began implementing NKEplus in 125 nursing units across 14 hospitals, with the use of human-centered design principles: creating shared understanding of the need for change, minimum specifications, and customization by frontline staff. Champion teams on each nursing unit designed and pilot tested unit-specific versions of NKEplus for four to eight weeks. Implementation occurred in waves and proceeded from medical/surgical units to specialty units. Traditional performance improvement strategies of accountability, measurement, and management were also applied. By the end of 2012, 100% of the 64 medical/surgical units and 47 (77.0%) of the 61 specialty units in KPSC medical centers implemented NKEplus-as had all but 1 of the specialty units by May 2013. The mean KPSC score on the NKEplus nursing behavior bundle improved from 65.9% in 2010 to 71.3% in the first quarter of 2014. The mean KPSC Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score for nurse communication improved from 73.1% in 2010 to 76.4% in the first quarter of 2014 (p < . 001). Human-centered implementation appeared to help spread a new model of nursing handoffs and change the culture of professional nursing practice related to shift change.

La educación permanente y las plataformas web en España

Directory of Open Access Journals (Sweden)

Medina, Beatriz

2014-04-01

Full Text Available La Educación Permanente en España, actualmente disfrutando de una etapa de consolidación, está haciéndose eco de las novedades educativas relacionadas con las Tecnologías de la Información y la Comunicación. En este sentido, realizamos un estudio con el objetivo de conocer la presencia de la Educación Permanente en internet y su oferta formativa, para lograrlo utilizamos la metodología comparada. Las distintas administraciones competentes ofrecen una variada oferta de recursos en plataformas web para hacer más accesible la Educación Permanente. Entre los principales hallazgos tenemos que todas las comunidades y ciudades autónomas del país poseen páginas o portales web dirigidos a las personas adultas que se encuentran en esta etapa del sistema educativo español, excepto Baleares; solo la comunidad autónoma Andalucía tiene un portal exclusivo para la Educación Permanente.

EDUCACIÓN PERMANENTE EN SERVICIO DE FORMACIÓN DE PROFESIONALES DE ENFERMERÍA

Directory of Open Access Journals (Sweden)

Rosa Gomes Ferreira

2015-12-01

Full Text Available A formação é um processo contínuo e deve estar presente no cotidiano de trabalho e para tal, surge a educação permanente, como pactuação teoria-prática. Nossos objetivos são o de descrever as práticas educativas em saúde, enfatizando a educação permanente e analisar os contrapontos e intersecções à efetividade da assistência, mediante a prática de educação permanente. Estudo qualitativo, descritivo, exploratório. O estudo aponta que a educação permanente emerge como ferramenta capaz de despertar desejo, no trabalhador, em discutir e refletir acerca da prática. No entanto, todas as práticas educativas, tal como a educação continuada, tem valor e penetrância no campo do trabalho.  DOI: http://dx.doi.org/10.12957/sustinere.2015.18127

Specialty pharmaceuticals care management in an integrated health care delivery system with electronic health records.

Science.gov (United States)

Monroe, C Douglas; Chin, Karen Y

2013-05-01

The specialty pharmaceuticals market is expanding more rapidly than the traditional pharmaceuticals market. Specialty pharmacy operations have evolved to deliver selected medications and associated clinical services. The growing role of specialty drugs requires new approaches to managing the use of these drugs. The focus, expectations, and emphasis in specialty drug management in an integrated health care delivery system such as Kaiser Permanente (KP) can vary as compared with more conventional health care systems. The KP Specialty Pharmacy (KP-SP) serves KP members across the United States. This descriptive account addresses the impetus for specialty drug management within KP, the use of tools such as an electronic health record (EHR) system and process management software, the KP-SP approach for specialty pharmacy services, and the emphasis on quality measurement of services provided. Kaiser Permanente's integrated system enables KP-SP pharmacists to coordinate the provision of specialty drugs while monitoring laboratory values, physician visits, and most other relevant elements of the patient's therapy. Process management software facilitates the counseling of patients, promotion of adherence, and interventions to resolve clinical, logistic, or pharmacy benefit issues. The integrated EHR affords KP-SP pharmacists advantages for care management that should become available to more health care systems with broadened adoption of EHRs. The KP-SP experience may help to establish models for clinical pharmacy services as health care systems and information systems become more integrated.

Prevalence of Childhood Obesity among Young Multiethnic Children from a Health Maintenance Organization in Hawaii.

Science.gov (United States)

Novotny, Rachel; Oshiro, Caryn Etsuko Shima; Wilkens, Lynne Ross

2013-02-01

Pacific Islander, Asian, and mixed-ethnicity children are not described in national nutrition and health surveys. Data on BMI values of 4608 5- to 8-year-old children available from Kaiser Permanente Hawaii electronic medical records in 2010 were analyzed for prevalence of overweight and obesity and for ethnic differences in BMI and risk for overweight and obesity, controlling for age, sex, neighborhood education level, and on a subset (n=2169) that further controlled for maternal education and maternal age. Kaiser Permanente data allow for reporting of multiple ethnicities. Data revealed that 33% of this child population was of mixed ethnic ancestry. Prevalence of overweight and obesity was 32.6% (12.9% overweight and 19.7% obese). However, Samoan children and children of Native Hawaiian, Filipino, and mixed ethnic ancestries had higher levels of overweight and obesity than whites or Asians. Higher neighborhood education level, higher maternal education level, and older maternal age were associated with decreased risk of overweight and obesity, except for children whose mothers were between 21 and 30 years old, who had a higher risk for obesity than those whose mothers were under 20 years of age (odds ratio=1.34). Populations of mixed ethnicities in the Pacific region deserve further study related to healthy body size and acculturation to environment and lifestyle.

Le tecnologie mobili dell’apprendimento permanente, il progetto MOTILL

Directory of Open Access Journals (Sweden)

Marco Arrigo

2013-03-01

Full Text Available In questo articolo vengono presentati alcuni dei risultati del progetto MOTILL. MOTILL, ovvero «Le Tecnologie Mobili nell’apprendimento permanente: buone pratiche», è un progetto finanziato dalla Comunità Europea, nell’ambito del National Lifelong Learning Strategies (NLLS. Il progetto, durato un anno e terminato a Marzo 2010, si è focalizzato sull’uso delle tecnologie mobili in contesti di lifelong learning (LLL. L’articolo sarà dedicato a una breve introduzione del progetto, dei suoi obiettivi e delle azioni portate avanti, e a un rapido riassunto dei principali risultati ottenuti, i quali sono stati resi disponibili online alla comunità scientifica e diffusi ai policy makers impegnati nei programmi di apprendimento permanente.

Las enfermedades neoplásicas como causa de la incapacidad permanente

OpenAIRE

Ares Camerino, A.; Sainz Vera, B.; Marchena Aparicio, J.C.; Soto Pino, M.L.

2008-01-01

El cáncer es la primera causa de mortalidad en hombres y la segunda en mujeres, tras las enfermedades cardiovasculares. Desde el punto de vista económico, los costes atribuibles a las enfermedades neoplásicas son principalmente indirectos (pérdida de productividad asociada a la mortalidad o a la incapacidad permanente). Analizando las incapacidades permanentes producidas en la Diputación Provincial de Cádiz en el período 1990-2005, que fueron un total de 208, se concluye, por orden de frecuen...

‘God is groot en wij begrijpen Hem niet’: Kaisers populaire sterrenkunde en het einde van de fysiko-theologie

Directory of Open Access Journals (Sweden)

Frans van Lunteren

2011-06-01

Full Text Available Frederik Kaiser, popular astronomy, and the decline of natural theologyThroughout his remarkable career the Leiden astronomer Frederik Kaiser (1808-1872 struggled to revive Dutch astronomy, which at the time was rather moribund. His efforts comprised mobilizing public support through popularization. In spite of a lack of illustrations, his popular Starry Sky (1844 proved immensely successful with the general public. This work differed in many respects from earlier Dutch popular writings, and helped to establish the new genre of popular science. Kaiser enunciated his idiosyncratic views on popularization in a lecture which he later published as a brochure. Whereas his research reflects the shift from the dilettante to the professional scientist in being focussed on precision measurement, his popular work likewise testified to the transition from natural philosophy to modern science. Charged with the task of composing a natural theological work on astronomy, the deeply religious Kaiser, wriggled his way through the text. Feeling unable to advance the usual arguments, he finally found refuge in the book of Job: 'Behold, God is great and we know him not'. Arguably, the rise of popular science and the decline of natural theology were intimately connected.

Eocene Yegua Formation (Claiborne group) and Jackson group lignite deposits of Texas

Science.gov (United States)

Hook, Robert W.; Warwick, Peter D.; Swanson, Sharon M.; Hackley, Paul C.; Warwick, Peter D.; Karlsen, Alexander K.; Merrill, Matthew D.; Valentine, Brett J.

2011-01-01

The lignite deposits within the upper Eocene Yegua Formation (Claiborne Group) and the overlying Jackson Group are among the coal resources that were not quantitatively assessed as part of the U.S. Geological Survey's (USGS) National Coal Resource Assessment (NCRA) program in the Gulf Coastal Plain coal province. In the past, these lignite-bearing stratigraphic units often have been evaluated together because of their geographic and stratigraphic proximity (Fisher, 1963; Kaiser, 1974; Kaiser et al., 1980; Jackson and Garner, 1982; Kaiser, 1996) (Figures 1, 2). The term “Yegua-Jackson trend“ is used informally herein for the lignite-bearing outcrops of these Late Eocene deposits in Texas. Lignite beds in the Yegua-Jackson trend generally are higher both in ash yield and sulfur content than those of the underlying Wilcox Group (Figure 2). Recent studies (Senkayi et al., 1987; Ruppert et al., 1994; Warwick et al., 1996, 1997) have shown that some lignite beds within the Yegua-Jackson trend contain partings of volcanic ash and host elevated levels of trace elements that have been identified as potentially hazardous air pollutants (HAPs) in the United States Clean Air Amendments of 1990. Lignite beds within the Yegua Formation are thin (less than or equal to 6 ft) and laterally discontinuous in comparison with most Wilcox Group deposits (Ayers, 1989a); in contrast, the Jackson Group lignite beds range up to 12 ft in total thickness and are relatively continuous laterally, extending nearly 32 mi along strike.

Review of HIV Pre exposure prophylaxis (PrEP) and example of HIV PrEP Toolkit

Science.gov (United States)

2017-08-28

at Initiation of Sexual Activity Correct & Consistent Condom Use Prevention of mother-to- child transmission July 16, 2012: FDA approves...Okulicz JF, Medicine 2016 PrEP Utilization in a Managed Care System (Kaiser Permanente) 1200 ~ 1045 1000 . 800 600 . 400 200 0 835 657 0

EDUCAÇÃO PERMANENTE EM SAÚDE: Reflexões e desafios

OpenAIRE

Palhares Guimarães,Eliane Marina; Haueisen Martin,Sandra; Paolinelli Rabelo,Flávia Cristina

2010-01-01

Este trabalho é resultado de uma reflexão sobre o processo de educação permanente em saúde e na enfermagem. Tem como objetivo apresentar algumas perspectivas e tendências da educação em saúde e na enfermagem, com ênfase em educação permanente. Analisa a importância dos avanços tecnológicos e sua incorporação no processo de ensinar e de aprender. O texto é dividido em três partes, abordando inicialmente as mudanças organizacionais e, conseqüentemente, na educação, decorrentes da incorporação t...

Association between personal health record enrollment and patient loyalty.

Science.gov (United States)

Turley, Marianne; Garrido, Terhilda; Lowenthal, Alex; Zhou, Yi Yvonne

2012-07-01

To examine the association between patient loyalty, as measured by member retention in the health plan, and access to My Health Manager (MHM), Kaiser Permanente's PHR, which is linked to its electronic health record, KP HealthConnect. We conducted a retrospective cohort observational quality improvement project from the third quarter of 2005 to the fourth quarter of 2008 for approximately 394,000 Kaiser Permanente Northwest members. To control for self-selection bias, we used propensity scores to perform exact 1-to-1 matching without replacement between MHM users and nonusers. We estimated retention rates of the matched data and assessed the association between MHM use and retention versus voluntary termination. We also estimated odds ratios of significant variables impacting member retention. The probability of remaining a member or being involuntarily terminated versus voluntary termination was 96.7% for users (95% confidence interval [CI], 96.6%-96.7%) and 92.2% for nonusers (95% CI, 92.1%-92.4%; P loyalty, retention is critical to healthcare organizations.

Joint Venture Arrangement for RN to BSN: A Model of Synergy between Academia and Service.

Science.gov (United States)

Bargagliotti, L. Antoinette; And Others

1991-01-01

Joint venture among educational and practice institutions is well on its way toward becoming the norm in nursing education and practice. Kaiser Permanente and the University of San Francisco School of Nursing offer a venture that allows registered nurses to pursue a bachelor of science in nursing degree. (JOW)

Crack Identification in CFRP Laminated Beams Using Multi-Resolution Modal Teager–Kaiser Energy under Noisy Environments

Science.gov (United States)

Xu, Wei; Cao, Maosen; Ding, Keqin; Radzieński, Maciej; Ostachowicz, Wiesław

2017-01-01

Carbon fiber reinforced polymer laminates are increasingly used in the aerospace and civil engineering fields. Identifying cracks in carbon fiber reinforced polymer laminated beam components is of considerable significance for ensuring the integrity and safety of the whole structures. With the development of high-resolution measurement technologies, mode-shape-based crack identification in such laminated beam components has become an active research focus. Despite its sensitivity to cracks, however, this method is susceptible to noise. To address this deficiency, this study proposes a new concept of multi-resolution modal Teager–Kaiser energy, which is the Teager–Kaiser energy of a mode shape represented in multi-resolution, for identifying cracks in carbon fiber reinforced polymer laminated beams. The efficacy of this concept is analytically demonstrated by identifying cracks in Timoshenko beams with general boundary conditions; and its applicability is validated by diagnosing cracks in a carbon fiber reinforced polymer laminated beam, whose mode shapes are precisely acquired via non-contact measurement using a scanning laser vibrometer. The analytical and experimental results show that multi-resolution modal Teager–Kaiser energy is capable of designating the presence and location of cracks in these beams under noisy environments. This proposed method holds promise for developing crack identification systems for carbon fiber reinforced polymer laminates. PMID:28773016

Educação permanente em enfermagem em um hospital universitário

OpenAIRE

Jesus,Maria Cristina Pinto de; Figueiredo,Mariangela Aparecida Gonçalves; Santos,Sueli Maria dos Reis; Amaral,Arlete Maria Moreira do; Rocha,Letícia de Oliveira; Thiollent,Michel Jean Marie

2011-01-01

A educação permanente enfatiza a interdisciplinaridade da equipe de saúde, focaliza a prática como fonte do conhecimento e coloca o profissional para atuar ativamente no processo educativo. Este estudo objetivou identificar demandas e expectativas, fatores que interferem na qualificação de trabalhadores de enfermagem de um hospital universitário e propor práticas de capacitação na perspectiva da educação permanente. O processo investigativo fundamentado nos princípios da pesquisa-ação foi rea...

Restorative Integral Support (RIS) for Older Adults Experiencing Co-Occurring Disorders

Science.gov (United States)

Larkin, Heather; MacFarland, Nicole S.

2012-01-01

The Restorative Integral Support (RIS) model is a whole person response that assists people to overcome adversity. The Adverse Childhood Experiences (ACE) Study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention shows the association between stressors in childhood and multiple later-life health and social problems.…

Flexibilidad laboral: ¿fin del trabajo permanente?

Directory of Open Access Journals (Sweden)

Carmen Añez Hernández

2016-05-01

Full Text Available Los trabajos transitorios o atípicos, siguen posicionándose y funcionando trastocando la protección del sistema de regulación y protección del trabajo permanente. De ahí, la importancia de reflexionar teóricamente sobre el tema. Para su desarrollo se plantean los siguientes objetivos: demostrar que la flexibilización laboral ha incidido en la ruptura de las relaciones laborales, caracterizar como la subcontratación laboral encubre dichas relaciones, analizar el despido laboral y sus consecuencias en los trabajadores. El artículo se desarrolló teóricamente, especialmente tomando como referencia autores como: Bravo (2010, Quintero (2010, González (2012 De La Garza (2007, Ugarte (2007, entre otros, lo cual permitió analizar la temática abordada. Los resultados reflejan que dicha estrategia está impulsando la agudización de las condiciones precarias de los derechos laborales, con lo cual se está ante un capitalismo irracional, que tiene como propósito que los trabajadores sufraguen los efectos de las pretensiones de los capitalistas por conseguir mayores tasas de ganancia y niveles más altos de productividad. En consecuencia, la flexibilización de las relaciones laborales está destinada a ocultar los derechos de los trabajadores, agudizar el despido laboral, y propiciar el fin de un trabajo permanente.

Compliance and persistence of antidepressants versus anticonvulsants in patients with neuropathic pain during the first year of therapy.

Science.gov (United States)

Gharibian, Derenik; Polzin, Jennifer K; Rho, Jay P

2013-05-01

Neuropathic pain (NP) is a chronic condition that has human, social, and economic consequences. A variety of agents can be used for treatment; however, antidepressants and anticonvulsants are the 2 classes most widely studied and represent first-line agents in the management of NP. Little information is known about the adherence patterns of these medications during the first year of therapy in patients with NP. To examine the compliance and persistence of antidepressants versus anticonvulsants in patients with NP during the first year of therapy. Using electronic medical and pharmacy data for the Kaiser Permanente Southern California region, the adherence patterns for patients with a NP diagnosis prescribed an antidepressant or an anticonvulsant were studied. Compliance and persistence were measured using the medication possession ratio and the Refill-Sequence model, respectively. The study included 1817 patients with NP diagnosis taking either an antidepressant or an anticonvulsant. Within the antidepressant group, 42.9% were considered compliant, compared with 43.7% in the anticonvulsant group. Subanalysis of the 2 cohorts revealed that patients on venlafaxine were the most compliant (69.4%) compared with patients taking gabapentin (44.4%) and tricyclic antidepressants (41.8%) (Panticonvulsant group were considered persistent with their medication refills. Compliance and persistence rates were similar for patients with NP diagnosis taking antidepressants and anticonvulsants. Higher compliance was observed among patients taking venlafaxine; however, this population did have a small sample size.

Accreditation Council for Graduate Medical Education Core Competencies at a Community Teaching Hospital: Is There a Gap in Awareness?

Science.gov (United States)

Al-Temimi, Mohammed; Kidon, Michael; Johna, Samir

2016-01-01

Reports evaluating faculty knowledge of the Accreditation Council for Graduate Medical Education (ACGME) core competencies in community hospitals without a dedicated residency program are uncommon. Faculty evaluation regarding knowledge of ACGME core competencies before a residency program is started. Physicians at the Kaiser Permanente Fontana Medical Center (N = 480) were surveyed for their knowledge of ACGME core competencies before starting new residency programs. Knowledge of ACGME core competencies. Fifty percent of physicians responded to the survey, and 172 (71%) of respondents were involved in teaching residents. Of physicians who taught residents and had complete responses (N = 164), 65 (39.7%) were unsure of their knowledge of the core competencies. However, most stated that they provided direct teaching to residents related to the knowledge, skills, and attitudes stated in each of the 6 competencies as follows: medical knowledge (96.3%), patient care (95.7%), professionalism (90.7%), interpersonal and communication skills (86.3%), practice-based learning (85.9%), and system-based practice (79.6%). Physician specialty, years in practice (1-10 vs > 10), and number of rotations taught per year (1-6 vs 7-12) were not associated with knowledge of the competencies (p > 0.05); however, full-time faculty (teaching 10-12 rotations per year) were more likely to provide competency-based teaching. Objective assessment of faculty awareness of ACGME core competencies is essential when starting a residency program. Discrepancy between knowledge of the competencies and acclaimed provision of competency-based teaching emphasizes the need for standardized teaching methods that incorporate the values of these competencies.

Los entornos personales de aprendizaje en el marco de la educación permanente

Directory of Open Access Journals (Sweden)

Elvira E. Navas

2013-01-01

Full Text Available En este trabajo se presenta un estudio documental sobre el surgimiento, evolución y estado actual de la utilización y desarrollo de los Entornos Personales de Aprendizaje (Personal Learning Environment, PLE en el marco de la Educación Permanente o Aprendizaje para Toda la vida (Lifelong Learning. En primer lugar, se hace una revisión del concepto de Educación Permanente desde la literatura de inicios de siglo XX. A continuación, se procede a estudiar el término PLE, desde sus orígenes hasta la interpretación actual. Se presentan experiencias tanto nacionales como internacionales donde se ejemplifica de forma práctica la utilización de PLE en la educación universitaria. Finalmente, se hace una reflexión de cierre sobre las proyecciones de futuro del uso de los PLE en el marco de la educación permanente.

Agenesia en dentición permanente

OpenAIRE

Beltrán Morera, Jazmín

2009-01-01

Objetivo Determinar la frecuencia de agenesia dental en dentición permanente.Materiales y Métodos Se incluyeron 112 pacientes que acudieron al servicio de imagenología de la Facultad de Odontología, Universidad Nacional Autónoma de México, de enero a julio del 2008, mayores de 13 años, sin extracciones dentales ni síndromes genéticos, a quienes se les tomó ortopantomografía. Se registraron variablessociodemográficas y antecedentes familiares de agenesia dental. Lainformación se procesó en SPS...

Experimental and numerical study of the Kaiser effect in cyclic Brazilian tests with disk rotation

CSIR Research Space (South Africa)

Lavrov, A

2002-04-01

Full Text Available Sensitivity of the Kaiser effect to the deviations of the directions of sigma(1)-principal stress experienced by rock in Successive loading cycles has an important impact on the application of this effect for stress measurements in rocks. The paper...

La incapacidad permanente y su impacto en el sistema español de Seguridad Social

Directory of Open Access Journals (Sweden)

César Luis Gómez Garcillán

Full Text Available Se analizan datos de incapacidad permanente de los últimos años en la seguridad social. Conclusiones: El desglose provincial muestra grandes diferencias a nivel territorial cuyo origen o motivación no se puede determinar actualmente en tanto no se dispone de dos parámetros básicos, el código de diagnóstico de la patología principal determinante de la incapacidad permanente y el código identificativo de la actividad laboral (profesión habitual del interesado que permitirían realizar un análisis fiable de la situación. Entre los factores que podrían incidir de alguna manera en la mayor o menor incidencia de la incapacidad permanente, podemos analizar dos grandes componentes, la población protegida y su composición a nivel de regímenes y la iniciativa en la incoación de los procedimientos. El grupo de provincias con una incidencia más elevada en incapacidad permanente acusa tasas de paro también más elevadas que el grupo con incidencia menor. La tendencia en el número de procedimientos de IP incoados resulta claramente a la baja con una caída de más del 9% en cinco años. El INSS desestima un porcentaje creciente de los mismos, la razón de ese comportamiento no reside en una valoración restrictiva o más exigente por parte de la gestora, sino porque se instruyen menos procesos de incapacidad permanente y porque va tomando mayor protagonismo en la iniciativa de incoación el procedimiento a instancia de parte, cuyo porcentaje de desestimación es el más elevado.

Cohort profile: Study of Transition, Outcomes and Gender (STRONG) to assess health status of transgender people.

Science.gov (United States)

Quinn, Virginia P; Nash, Rebecca; Hunkeler, Enid; Contreras, Richard; Cromwell, Lee; Becerra-Culqui, Tracy A; Getahun, Darios; Giammattei, Shawn; Lash, Timothy L; Millman, Andrea; Robinson, Brandi; Roblin, Douglas; Silverberg, Michael J; Slovis, Jennifer; Tangpricha, Vin; Tolsma, Dennis; Valentine, Cadence; Ward, Kevin; Winter, Savannah; Goodman, Michael

2017-12-27

The Study of Transition, Outcomes and Gender (STRONG) was initiated to assess the health status of transgender people in general and following gender-affirming treatments at Kaiser Permanente health plans in Georgia, Northern California and Southern California. The objectives of this communication are to describe methods of cohort ascertainment and data collection and to characterise the study population. A stepwise methodology involving computerised searches of electronic medical records and free-text validation of eligibility and gender identity was used to identify a cohort of 6456 members with first evidence of transgender status (index date) between 2006 and 2014. The cohort included 3475 (54%) transfeminine (TF), 2892 (45%) transmasculine (TM) and 89 (1%) members whose natal sex and gender identity remained undetermined from the records. The cohort was matched to 127 608 enrollees with no transgender evidence (63 825 women and 63 783 men) on year of birth, race/ethnicity, study site and membership year of the index date. Cohort follow-up extends through the end of 2016. About 58% of TF and 52% of TM cohort members received hormonal therapy at Kaiser Permanente. Chest surgery was more common among TM participants (12% vs 0.3%). The proportions of transgender participants who underwent genital reconstruction surgeries were similar (4%-5%) in the two transgender groups. Results indicate that there are sufficient numbers of events in the TF and TM cohorts to further examine mental health status, cardiovascular events, diabetes, HIV and most common cancers. STRONG is well positioned to fill existing knowledge gaps through comparisons of transgender and reference populations and through analyses of health status before and after gender affirmation treatment. Analyses will include incidence of cardiovascular disease, mental health, HIV and diabetes, as well as changes in laboratory-based endpoints (eg, polycythemia and bone density), overall and in relation to

Evaluation of Rock Stress Estimation by the Kaiser effect

International Nuclear Information System (INIS)

Lehtonen, A.

2005-11-01

The knowledge of in situ stress is the key input parameter in many rock mechanics analyses. Information on stress allows the definition of boundary conditions for various modelling and engineering tasks. Presently, the estimation of stresses in bedrock is one of the most difficult, time-consuming and high-priced rock mechanical investigations. In addition, the methods used today have not evolved significantly in many years. This brings out a demand for novel, more economical and practical methods for stress estimation. In this study, one such method, Kaiser effect based on acoustic emission of core samples, has been evaluated. It can be described as a 'memory' in rock that is indicated by a change in acoustic emission emitted during uniaxial loading test. The most tempting feature of this method is the ability to estimate the in situ stress state from core specimens in laboratory conditions. This yields considerable cost savings compared to laborious borehole measurements. Kaiser effect has been studied in order to determine in situ stresses for decades without any major success. However, recent studies in Australia and China have been promising and made the estimation of stress tensor possible from differently oriented core samples. The aim of this work has been to develop a similar estimation method in Finland (including both equipment and data reduction), and to test it on samples obtained from Olkiluoto, Eurajoki. The developed measuring system proved to work well. The quality of obtained data varied, but they were still interpretable. The results obtained from these tests were compared with results of previous overcoring measurements, and they showed quite good correlation. Thus, the results were promising, but the method still needs further development and more testing before the final decision on its feasibility can be made. (orig.)

Consider outsourcing IT projects when cutting-edge technology, specialized focus are needed.

Science.gov (United States)

1999-05-01

Looking outside to meet information technology needs proves a smart way to avert extra staffing costs. Kaiser Permanente saves thousands each year by contracting out cutting-edge IT projects instead of hiring more full-time staff it doesn't need. Learn how the organization incorporates outsourcing and other temporary work methods into its IT staffing strategy.

Mineralogical control on thermal damage and the presence of a thermal Kaiser effect during temperature-cycling experiments

Science.gov (United States)

Browning, J.; Daoud, A.; Meredith, P. G.; Mitchell, T. M.

2017-12-01

Volcanic and geothermal systems are in part controlled by the mechanical and thermal stresses acting on them and so it is important to understand the response of volcanic rocks to thermo-mechanical loading. One such response is the well-known `Kaiser stress-memory' effect observed under cyclic mechanical loading. By contrast, the presence of an analogous `Kaiser temperature-memory effect' during cyclic thermal loading has received little attention. We have therefore explored the possibility of a Kaiser temperature-memory effect using three igneous rocks of different composition, grain size and origin; Slaufrudalur Granophyre (SGP), Nea Kameni Andesite (NKA) and Seljadalur Basalt (SB). We present results from a series of thermal stressing experiments in which acoustic emissions (AE) were recorded contemporaneously with changing temperature. Samples of each rock were subjected to both a single heating and cooling cycle to a maximum temperature of 900 °C and multiple heating/cooling cycles to peak temperatures of 350°C, 500°C, 700°C and 900 °C (all at a constant rate of 1°C/min on heating and a natural cooling rate of memory effect in SGP, but not in either NKA and SB. We further find that the vast majority of thermal crack damage is generated upon cooling in the finer grained materials (NKA and SB), but that substantial thermal crack damage is generated during heating in the coarser grained SGP. The total amount of crack damage generated due to heating or cooling is dependent on the mineral composition and, most importantly, the grain size and arrangement, as well as the maximum temperature to which the rock is exposed. Knowledge of thermal stress history and the presence of a Kaiser temperature-memory effect is potentially important in understanding magma chamber dynamics, where the cyclic nature of mechanical and thermal inflation and deflation can lead to sequential accumulation of damage, potentially leading to critical rupture.

Reply to Nicholson's comment on "Consistent calculation of aquatic gross production from oxygen triple isotope measurements" by Kaiser (2011

Directory of Open Access Journals (Sweden)

J. Kaiser

2012-08-01

Full Text Available The comment by Nicholson (2011a questions the "consistency" of the "definition" of the "biological end-member" used by Kaiser (2011a in the calculation of oxygen gross production. "Biological end-member" refers to the relative oxygen isotope ratio difference between photosynthetic oxygen and Air-O₂ (abbreviated ¹⁷δ_P and ¹⁸δ_P for ¹⁷O/¹⁶O and ¹⁸O/¹⁶O, respectively. The comment claims that this leads to an overestimate of the discrepancy between previous studies and that the resulting gross production rates are "30% too high". Nicholson recognises the improved accuracy of Kaiser's direct calculation ("dual-delta" method compared to previous approximate approaches based on ¹⁷O excess (¹⁷Δ and its simplicity compared to previous iterative calculation methods. Although he correctly points out that differences in the normalised gross production rate (g are largely due to different input parameters used in Kaiser's "base case" and previous studies, he does not acknowledge Kaiser's observation that iterative and dual-delta calculation methods give exactly the same g for the same input parameters (disregarding kinetic isotope fractionation during air-sea exchange. The comment is based on misunderstandings with respect to the "base case" ¹⁷δ_P and ¹⁸δ_P values. Since direct measurements of ¹⁷δ_P and ¹⁸δ_Pdo not exist or have been lost, Kaiser constructed the "base case" in a way that was consistent and compatible with literature data. Nicholson showed that an alternative reconstruction of ¹⁷δ_P gives g values closer to previous studies. However, unlike Nicholson, we refrain from interpreting either reconstruction as a benchmark for the accuracy of g. A number of publications over the last 12 months

Educação permanente: reflexão na prática da enfermagem hospitalar.

Directory of Open Access Journals (Sweden)

José Reginaldo PINTO

2015-08-01

Full Text Available Na prática hospitalar, a Educação Permanente é indispensável à formação dos trabalhadores, os quais necessitam ter conhecimentos renovados em sua prática profissional. Nesta perspectiva, buscou-se analisar por meio dessa pesquisa a percepção dos enfermeiros de um hospital de ensino acerca da educação permanente no ambiente hospitalar. Trata-se de uma pesquisa descritiva com abordagem qualitativa, realizada com nove enfermeiros coordenadores de setores, utilizando-se três grupos focais, constituído por três enfermeiros em cada grupo. A investigação ocorreu no Hospital do Coração do município de Sobral, Ceará. Utilizaram-se entrevistas que foram gravadas nas reuniões dos grupos. A análise de conteúdo de Bardin estruturou os achados encontrados. Esses resultados foram separados por unidades temáticas. Foram respeitados os princípios éticos de acordo com a resolução 466/12. A primeira unidade temática investigou o conhecimento dos sujeitos acerca da Educação Permanente, Continuada e em Serviço. Os primeiros achados identificaram divergências de opiniões dos participantes quando conceituaram a diferenciação entre as modalidades de educação em saúde. A segunda unidade resgatou a opinião dos sujeitos sobre as estratégias para implantar uma comissão de educação permanente no hospital. As falas dos participantes revelaram que a comissão deveria motivar os profissionais a continuarem se qualificando no serviço. Ainda indagaram que essas comissões deveria ter caráter multidisciplinar. A última unidade analisada referiu-se a forma de atuar das comissões de educação permanente. Os investigados assinalaram que elas deveriam proporcionar a melhoria do ensino aos profissionais aplicando as metodologias ativas.

del establecimiento permanente

Directory of Open Access Journals (Sweden)

V. Ma. Antonieta Martin Granados

2002-01-01

Full Text Available A pesar de que en México se han realizado adiciones a la legislación en materia civil y mercantil relacionadas con el uso de medios electrónicos como instrumentos para realizar actos jurídicos, éstas resultan insuficientes, pues nada se ha hecho en materia procesal, penal y laboral, entre otras. En este trabajo se presentan, en materia fiscal, algunas consideraciones acerca del concepto de establecimiento permanente tanto en la legislación mexicana como en el Convenio Modelo (CM de la Organización para la Cooperación y Desarrollo Económico (OCDE y se argumenta que a pesar de que la definición de la legislación mexicana es mucho más amplia que la que se encuentra en el mencionado convenio, el comercio electrónico presenta algunos retos para determinar el lugar en donde residen las partes involucradas, el lugar en donde se celebran las operaciones y se pagan o cobran, sobre todo tratándose de servicios o adquisición de bienes intangibles. Por último, se señala que en materia fiscal es necesario que las autoridades mexicanas permitan el uso de la factura electrónica

Adding Group Psychotherapy to Medication Treatment in Dysthymia

Science.gov (United States)

Hellerstein, David J.; Little, Suzanne A. S.; Samstag, Lisa Wallner; Batchelder, Sarai; Muran, J. Christopher; Fedak, Michael; Kreditor, David; Rosenthal, Richard N.; Winston, Arnold

2001-01-01

Patients with dysthymia have been shown to respond to treatment with antidepressant medications, and to some degree to psychotherapy. Even patients successfully treated with medication often have residual symptoms and impaired psychosocial functioning. The authors describe a prospective randomized 36-week study of dysthymic patients, comparing continued treatment with antidepressant medication (fluoxetine) alone and medication with the addition of group therapy treatment. After an 8-week trial of fluoxetine, medication-responsive subjects were randomly assigned to receive either continued medication only or medication plus 16 sessions of manualized group psychotherapy. Results provide preliminary evidence that group therapy may provide additional benefit to medication-responding dysthymic patients, particularly in interpersonal and psychosocial functioning. PMID:11264333

LA FORMACIÓN AMBIENTAL PERMANENTE DEL DIRECTIVO EDUCACIONAL DEL SIGLO XXI

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Mavel Moré Estupiñán

2013-12-01

Full Text Available La situación ambiental actual impone nuevos retos a los sistemas educativos, entre ellos el de incorporar la educación ambiental para el desarrollo sostenible al proceso pedagógico en los diferentes subsistemas de educación. Para lograr este propósito, es decisivo el rol del directivo educacional, desde la implementación del sistema de dirección institucional. Por ello, la formación ambiental de este profesional constituye un imperativo y se declara como problema científico de la presente investigación, que se sustenta teórica y metodológicamente en los fundamentos de la formación ambiental permanente del directivo educacional y delimita como objetivo: proponer un Modelo para orientar hacia el desarrollo sostenible este proceso. Garantizan el cumplimiento del objetivo, el empleo de métodos teóricos, estadísticos y/o de procesamiento matemático y empíricos, de corte cuantitativo y cualitativo, que se articulan a partir de las técnicas de la investigación-acción-participativa. El Modelo constituye la contribución a la teoría pedagógica y son aportes de significación práctica los programas de las formas organizativas de la formación permanente. El criterio de la práctica, como resultado de la sistematización de una secuencia de ciclos, y las valoraciones de diferentes evaluadores confirman la pertinencia, relevancia y efectividad del Modelo de formación ambiental permanente del directivo educacional.

Medical group mergers: strategies for success.

Science.gov (United States)

Latham, Will

2014-01-01

As consolidation sweeps over the healthcare industry, many medical groups are considering mergers with other groups as an alternative to employment. While mergers are challenging and fraught with risk, an organized approach to the merger process can dramatically increase the odds for success. Merging groups need to consider the benefits they seek from a merger, identify the obstacles that must be overcome to merge, and develop alternatives to overcome those obstacles. This article addresses the benefits to be gained and issues to be addressed, and provides a tested roadmap that has resulted in many successful medical group mergers.

Using a High-Performance Planning Model to Increase Levels of Functional Effectiveness Within Professional Development.

Science.gov (United States)

Winter, Peggi

2016-01-01

Nursing professional practice models continue to shape how we practice nursing by putting families and members at the heart of everything we do. Faced with enormous challenges around healthcare reform, models create frameworks for practice by unifying, uniting, and guiding our nurses. The Kaiser Permanente Practice model was developed to ensure consistency for nursing practice across the continuum. Four key pillars support this practice model and the work of nursing: quality and safety, leadership, professional development, and research/evidence-based practice. These four pillars form the foundation that makes transformational practice possible and aligns nursing with Kaiser Permanente's mission. The purpose of this article is to discuss the pillar of professional development and the components of the Nursing Professional Development: Scope and Standards of Practice model (American Nurses Association & National Nursing Staff Development Organization, 2010) and place them in a five-level development framework. This process allowed us to identify the current organizational level of practice, prioritize each nursing professional development component, and design an operational strategy to move nursing professional development toward a level of high performance. This process is suggested for nursing professional development specialists.

Medical group management: a marketing orientation.

Science.gov (United States)

Bopp, K D; Allcorn, S

1986-09-01

This article considers the pragmatic aspects of conducting a situation/marketing audit for group medical practices. This audit is a key component in the formulation of a competitive strategy and the development of a marketing program. Given are a series of questions that may be used by medical groups to guide assessment of the opportunities and threats present in the environment as well as the strengths and weaknesses of the organization in meeting the environmental challenges. Furthermore, the article provides a framework for thinking about strategy and the variables that should be considered and aligned to achieve effective implementation of strategy. Finally, the parameters are outlined for deciding on a marketing program: the mix of marketing tools (service design, distribution channels, pricing and promotion) that should be employed to offensively and/or defensively position the medical group in the competitive marketplace.

Rapid spread of complex change: a case study in inpatient palliative care

Directory of Open Access Journals (Sweden)

Filipski Marta I

2009-12-01

Full Text Available Abstract Background Based on positive findings from a randomized controlled trial, Kaiser Permanente's national executive leadership group set an expectation that all Kaiser Permanente and partner hospitals would implement a consultative model of interdisciplinary, inpatient-based palliative care (IPC. Within one year, the number of IPC consultations program-wide increased almost tenfold from baseline, and the number of teams nearly doubled. We report here results from a qualitative evaluation of the IPC initiative after a year of implementation; our purpose was to understand factors supporting or impeding the rapid and consistent spread of a complex program. Methods Quality improvement study using a case study design and qualitative analysis of in-depth semi-structured interviews with 36 national, regional, and local leaders. Results Compelling evidence of impacts on patient satisfaction and quality of care generated 'pull' among adopters, expressed as a remarkably high degree of conviction about the value of the model. Broad leadership agreement gave rise to sponsorship and support that permeated the organization. A robust social network promoted knowledge exchange and built on an existing network with a strong interest in palliative care. Resource constraints, pre-existing programs of a different model, and ambiguous accountability for implementation impeded spread. Conclusions A complex, hospital-based, interdisciplinary intervention in a large health care organization spread rapidly due to a synergy between organizational 'push' strategies and grassroots-level pull. The combination of push and pull may be especially important when the organizational context or the practice to be spread is complex.

Trends in Red Blood Cell Transfusion and 30-Day Mortality among Hospitalized Patients

Science.gov (United States)

Roubinian, Nareg H; Escobar, Gabriel J; Liu, Vincent; Swain, Bix E; Gardner, Marla N; Kipnis, Patricia; Triulzi, Darrell J; Gottschall, Jerome L; Wu, Yan; Carson, Jeffrey L; Kleinman, Steven H; Murphy, Edward L

2014-01-01

Background Blood conservation strategies have been shown to be effective in decreasing red blood cell (RBC) utilization in specific patient groups. However, few data exist describing the extent of RBC transfusion reduction or their impact on transfusion practice and mortality in a diverse inpatient population. Methods We conducted a retrospective cohort study using comprehensive electronic medical record data from 21 medical facilities in Kaiser Permanente Northern California (KPNC). We examined unadjusted and risk-adjusted RBC transfusion and 30-day mortality coincident with implementation of RBC conservation strategies. Findings The inpatient study cohort included 391,958 patients who experienced 685,753 hospitalizations. From 2009 to 2013, the incidence of RBC transfusion decreased from 14.0% to 10.8% of hospitalizations; this change coincided with a decline in pre-transfusion hemoglobin levels from 8.1 to 7.6 g/dL. Decreased RBC utilization affected broad groups of admission diagnoses and was most pronounced in patients with a nadir hemoglobin level between 8 and 9 g/dL (n=73,057; 50.8% to 19.3%). During the study period, the standard deviation of risk adjusted RBC transfusion incidence across hospitals decreased by 44% (p blood conservation strategies, RBC transfusion incidence and pre-transfusion hemoglobin levels decreased broadly across medical and surgical patients. Variation in RBC transfusion incidence across hospitals decreased from 2010 to 2013. Consistent with clinical trial data, more restrictive transfusion practice did not appear to impact 30-day mortality. PMID:25135770

Movements of permanent health education triggered by the training of facilitators Movimientos de la educación permanente en salud desencadenados a partir de la formación de facilitadores Movimentos da educação permanente em saúde, desencadeados a partir da formação de facilitadores

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Cinira Magali Fortuna

2011-04-01

Full Text Available This study mapped the movements of Permanent Health Education in the region of Araraquara, São Paulo, Brazil, begun by the Permanent Health Education Facilitators program, promoted by the Ministry of Health and the National School of Public Health. This qualitative study was grounded on the theoretical framework of institutional and schizoanalysis. Data were collected from operative groups of individuals who finished the program. The results were grouped into two plans: micropolitics and organization. Micropolitics indicates the production of different concepts concerning permanent education and different ways to establish it. Autonomy and control and also a tenuous relationship between tutorship and autonomy were highlighted, in the plan of organization. In conclusion, the program was an important device that suffered captures/overcoding but also produced changes in practice.Se tuvo por objetivo cartografiar los movimientos de educación permanente en salud, en la región de Araraquara, Sao Paulo, Brasil, iniciados a partir del curso de Facilitadores de Educación Permanente en Salud, del Ministerio de la Salud y Escuela Nacional de Salud Pública. Es un estudio de abordaje cualitativo, sustentado por el referencial teórico del análisis institucional en la línea esquizoanalítica, siendo los datos recolectados mediante grupos operativos con alumnos terminando el referido curso. Los resultados fueron agrupados en dos planos: micropolítica y organización. Con relación a la micropolítica, apuntan que hubo producción de diferentes conceptos sobre educación permanente y diferentes formas de institucionalización de la misma. En el plano de la organización se destacan la autonomía y el control y también la tenue relación entre tutela y autonomía. Concluimos que el curso fue un importante dispositivo que sufrió capturas, pero también produjo cambios en las prácticas.Tem-se, aqui, por objetivo, cartografar os movimentos de educa

Implement the medical group revenue function. Create competitive advantage.

Science.gov (United States)

Colucci, C

1998-01-01

This article shows medical groups how they can employ new financial management and information technology techniques to safeguard their revenue and income streams. These managerial techniques stem from the application of the medical group revenue function, which is defined herein. This article also describes how the medical group revenue function can be used to create value by employing a database and a decision support system. Finally, the article describes how the decision support system can be used to create competitive advantage. Through the wise use of internally generated information, medical groups can negotiate better contract terms, improve their operations, cut their costs, embark on capital investment programs and improve market share. As medical groups gain market power by improving in these areas, they will be more attractive to potential strategic allies, payers and investment bankers.

Evaluación de la formación permanente del profesorado: enfoque de resultados || Evaluation of permanent teacher training: approach of results

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José Domínguez

2015-07-01

Full Text Available La evolución del sistema educativo ha provocado cambios significativos en la formación permanente del profesorado, por tanto, es necesario un diagnóstico de necesidades utilizando instrumentos y metodologías que informen de las demandas formativas profesionales. En este sentido, el objetivo principal del estudio se centra en aportar luz sobre las percepciones y expectativas del profesorado acerca de la formación permanente en la Comunidad Autónoma de Galicia. Para ello, se utilizó una metodología evaluativa centrada en el contexto, entrada, proceso y producto (diseño CIPP. Los resultados confirman que la evolución de la formación se viene incrementando en su oferta pero disminuyendo su eficacia. Además, se ha comprobado la necesidad de reestructurar la formación permanente, apostando por un modelo más global, con cobertura en todas las necesidades formativas del profesorado. El gran reto de la formación permanente del profesorado es la transferibilidad de la misma al contexto del aula, una cuestión sencilla pero muy difícil de evaluar. Mejorar la calidad educativa depende directamente de la eficiencia y excelencia en la formación docente, la cual debería someterse a un proceso de revisión y actualización permanente.

Standardization and Implementation of a Standard Emergency Code Call System within Estern Region Medical Command

Science.gov (United States)

2009-03-01

ACHs) exist the same way that Kaiser has established different levels of services within a geographical region ( Hawaii : Hilo , Kona, Honolulu, Maui...California, Hawaii , etc., the Army MHS is divided into regions. Within these regions, Army Medical Centers (MEDCENSs) and Army Community Hospitals

Análisis de series temporales en estaciones permanentes GPS

OpenAIRE

García Cañada, Laura

2016-01-01

En los ultimos años el número de estaciones permanentes GPS ha aumentado considerablemente para diferentes aplicaciones geodésicas y se comienza a disponer de series de coordenadas suficientemente largas como para poder aplicar ánalisis de series temporales. El principal objetivo de esta tesis es estudiar la influencia de la red de estaciones utilizada, marco de referencia y/o estrategia de procesado en las series temporales de coordenadas de estaciones CGPS y todos aquellos parámetros que se...

Análisis de series temporales en estaciones permanentes GPS

OpenAIRE

García Cañada, Laura

2015-01-01

En los ultimos años el número de estaciones permanentes GPS ha aumentado considerablemente para diferentes aplicaciones geodésicas y se comienza a disponer de series de coordenadas suficientemente largas como para poder aplicar ánalisis de series temporales. El principal objetivo de esta tesis es estudiar la influencia de la red de estaciones utilizada, marco de referencia y/o estrategia de procesado en las series temporales de coordenadas de estaciones CGPS y todos aquellos parámetros que s...

How dentists diagnose and treat defective restorations: evidence from the dental practice-based research network

DEFF Research Database (Denmark)

Gordan, Valeria V; Garvan, Cynthia W; Richman, Joshua S

2009-01-01

, Norway and Sweden. METHODS: A questionnaire was sent to all DPBRN practitioner-investigators who reported doing some restorative dentistry (n = 901). Questions included clinical case scenarios that used text and clinical photographs of defective restorations. Dentists were asked what type of treatment......OBJECTIVES: To (1) identify and quantify the types of treatment that dentists use to manage defective dental restorations and (2) identify characteristics that are associated with these dentists' decisions to replace existing restorations. The Dental Practice-Based Research Network (DPBRN) consists...... of dentists in outpatient practices from five regions: AL/MS: Alabama/Mississippi; FL/GA: Florida/Georgia; MN: dentists employed by HealthPartners and private practitioners in Minnesota; PDA: Permanente Dental Associates in cooperation with Kaiser Permanente's Center for Health Research and SK: Denmark...

Consolidation of medical groups into physician practice management organizations.

Science.gov (United States)

Robinson, J C

1998-01-14

Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed. Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality

Educación permanente y continua en una perspectiva de integridad del ser

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Izabel Cristina Feijó de Andrade

2014-12-01

Full Text Available Este artículo buscó discutir las articulaciones y distinciones entre los conceptos de educación permanente y educación continua de modo que favorezca la perspectiva de integridad del ser, vínculo que requiere saberes hasta entonces poco privilegiados en las Universidades y que demandan el rescate de dimensiones basadas en la experiencia, la didáctica y la existencia del educador, tanto individual, comportamental, cultural, social y espiritual. Consideramos que las nociones de educación permanente y educación continua poseen elementos entrelazables que nos permiten desarrollar la capacidad de reaccionar críticamente por medio de una relación autoformativa. Las revisiones teóricas implementadas permitieron algunas consideraciones sobre los procesos formativos actuales y las prácticas de profesores rumbo a una Educación para la Integridad. Concluimos provisoriamente que las aproximaciones y distinciones entre EP y EC pueden proporcionar a los profesores la toma de conciencia de su vinculación todo/parte y del sentido de la vida.

The growth of medical groups paid through capitation in California.

Science.gov (United States)

Robinson, J C; Casalino, L P

1995-12-21

In California, it is common for health maintenance organizations (HMOs) to contract with large medical groups that are paid through capitation and are responsible for managing a full spectrum of medical services. We studied six large medical groups in California--Bristol Park Medical, Friendly Hills HealthCare Network, HealthCare Partners Medical Group, Mullikin Medical Centers, Palo Alto Medical Foundation, and San Jose Medical Group--that are paid through capitation and that are growing as a result of contracts with managed-care organizations. We conducted interviews and obtained data on factors such as patient enrollment, capitation and other revenue, numbers of days spent by enrollees in the hospital, and numbers of visits to physicians per enrollee. Between 1990 and 1994, the number of HMO enrollees whose care was paid for through capitation in the six medical groups increased by 91 percent, from 398,359 to 759,474. In 1994, the mean number of hospital days per 1000 HMO enrollees ranged from 120 to 149 for non-Medicare patients and from 643 to 936 days for Medicare patients. By comparison, in 1993 the mean numbers of hospital days per 1000 HMO enrollees not covered by Medicare were 232 for California and 297 for the United States; for HMO enrollees covered by Medicare, the numbers were 1337 for California and 1698 for the United States. In 1994, the average annual number of visits to physicians for HMO patients in the six groups not covered by Medicare ranged from 3.1 to 3.9; for Medicare patients, it ranged from 7.2 to 9.3; these rates were slightly lower than statewide and national rates. Four of the groups have sold their assets (such as facilities, supplies, equipment, and patients' charts) to outside investors; the physicians remain employed by physician-owned professional corporations. Medical groups paid through capitation offer a model for the status of physicians in managed-care systems that differs from the employee status offered by staff-model HMOs

Improving Refill Adherence in Medicare Patients With Tailored and Interactive Mobile Text Messaging: Pilot Study

Science.gov (United States)

Jeong, Erwin W; Feger, Erin; Noble, Harmony K; Kmiec, Magdalen; Prayaga, Ram S

2018-01-01

Background Nonadherence is a major concern in the management of chronic conditions such as hypertension, cardiovascular disease, and diabetes where patients may discontinue or interrupt their medication for a variety of reasons. Text message reminders have been used to improve adherence. However, few programs or studies have explored the benefits of text messaging with older populations and at scale. In this paper, we present a program design using tailored and interactive text messaging to improve refill rates of partially adherent or nonadherent Medicare members of a large integrated health plan. Objective The aim of this 3-month program was to gain an understanding of whether tailored interactive text message dialogues could be used to improve medication refills in Medicare patients with one or more chronic diseases. Methods We used the mPulse Mobile interactive text messaging solution with partially adherent and nonadherent Medicare patients (ie, over age 65 years or younger with disabilities) of Kaiser Permanente Southern California (KP), a large integrated health plan, and compared refill rates of the text messaging group (n=12,272) to a group of partially adherent or nonadherent Medicare patients at KP who did not receive text messages (nontext messaging group, n=76,068). Both groups were exposed to other forms of refill and adherence outreach including phone calls, secure emails, and robo-calls from December 2016 to February 2017. Results The text messaging group and nontext messaging group were compared using an independent samples t test to test difference in group average of refill rates. There was a significant difference in medication refill rates between the 2 groups, with a 14.07 percentage points higher refill rate in the text messaging group (Pimprove medication refill rates among Medicare patients. These findings also support using interactive text messaging as a cost-effective, convenient, and user-friendly solution for patient engagement

Evaluation of medical staff and patient satisfaction of Chinese hospitals and measures for improvement.

Science.gov (United States)

Li, Min; Huang, Chengyu; Lu, Xiangchan; Chen, Siyuan; Zhao, Pan; Lu, Hongzhou

2015-06-01

Our goal is to establish criteria for evaluating satisfaction of medical staff and patients of Chinese hospitals and propose measures for improvement. A survey was conducted among medical staff and patients of infectious disease hospitals in three locations, i.e., Shanghai, Chongqing, and Nanning. The analyses included item analysis, factor analysis, reliability analysis, Pearson correlation and one-way analysis of variance. For the patient group, Kaiser-Meyer-Olkin (KMO) = 0.973, Cronbach's α = 0.962 and the Pearson correlation coefficients among the five dimensions of satisfaction ranged from 0.583 to 0.795. For the medical staff group, KMO = 0.972, Cronbach's α = 0.970, and the Pearson correlation coefficients among the five dimensions of satisfaction ranged from 0.603 to 0.854. The means on the five dimensions of satisfaction for the patient group were 0.74 to 1.34, 0.81 to 1.17, 0.78 to 1.07, 0.89 to 1.34, and 0.71 to 1.10. The means on the five dimensions of satisfaction for the medical staff group were 0.17 to 1.03, ‒ 0.16 to 0.60, ‒ 0.18 to 0.74, 0.23 to 0.72, and ‒ 0.39 to 0.37. The clinicians were less satisfied with the hospitals than the patients. Medical staff and patients in Shanghai were relatively more satisfied. Improving the evaluation criteria and survey methods with respect to medical staff and patient satisfaction with Chinese hospitals may increase clinician and patient satisfaction and improve the health care environment in China.

Genetics as a modernization program: biological research at the Kaiser Wilhelm Institutes and the political economy of the Nazi State.

Science.gov (United States)

Gausemeier, Bernd

2010-01-01

During the Third Reich, the biological institutes of the Kaiser Wilhelm Society (KWG, Kaiser-Wilhelm-Gesellschaft) underwent a substantial reorganization and modernization. This paper discusses the development of projects in the fields of biochemical genetics, virus research, radiation genetics, and plant genetics that were initiated in those years. These cases exemplify, on the one hand, the political conditions for biological research in the Nazi state. They highlight how leading scientists advanced their projects by building close ties with politicians and science-funding organizations and companies. On the other hand, the study examines how the contents of research were shaped by, and how they contributed to, the aims and needs of the political economy of the Nazi system. This paper therefore aims not only to highlight basic aspects of scientific development under Nazism, but also to provide general insights into the structure of the Third Reich and the dynamics of its war economy.

Mothers of children diagnosed with attention-deficit/hyperactivity disorder: health conditions and medical care utilization in periods before and after birth of the child.

Science.gov (United States)

Ray, G Thomas; Croen, Lisa A; Habel, Laurel A

2009-01-01

Analyzing health conditions and medical utilization of mothers of children with attention-deficit/hyperactivity disorder (ADHD) can shed light on biologic, environmental, and psychosocial factors relating to ADHD. To examine health conditions, health care utilization, and costs of mothers of children with ADHD in periods before the child was diagnosed. Using automated data from Northern California Kaiser Permanente we identified mothers of children with ADHD, mothers of children without ADHD, and mothers of children with asthma. Mothers' diagnostic clusters, health care utilization, and costs were compared. Mothers of children with ADHD were compared with mothers of children without ADHD and, separately, to mothers of children with asthma. Compared with mothers of children without ADHD, mothers of children with ADHD were more likely to be diagnosed with numerous medical and mental health problems in the 2 years after birth of their child, including depression [odds ratio (OR): 1.88], anxiety neuroses (OR: 1.64), obesity (OR: 1.70), and musculoskeletal symptoms (OR: 1.51). Results were similar for the year before delivery. Mothers of children with ADHD also had higher total health care costs per person in the year before ($1,003) and the 2 years after ($953) the birth of their child. Mothers of children with ADHD also were diagnosed with more health conditions and had higher health care costs than mothers of children with asthma. Our findings suggest that the likelihood of being diagnosed with ADHD is related to maternal conditions and use of health services that precede the child's diagnosis. Future studies are needed to clarify whether this is due to biologic, psychosocial, or environmental factors, or a combination.

Building clinical data groups for electronic medical record in China.

Science.gov (United States)

Tu, Haibo; Yu, Yingtao; Yang, Peng; Tang, Xuejun; Hu, Jianping; Rao, Keqin; Pan, Feng; Xu, Yongyong; Liu, Danhong

2012-04-01

This article aims at building clinical data groups for Electronic Medical Records (EMR) in China. These data groups can be reused as basic information units in building the medical sheets of Electronic Medical Record Systems (EMRS) and serve as part of its implementation guideline. The results were based on medical sheets, the forms that are used in hospitals, which were collected from hospitals. To categorize the information in these sheets into data groups, we adopted the Health Level 7 Clinical Document Architecture Release 2 Model (HL7 CDA R2 Model). The regulations and legal documents concerning health informatics and related standards in China were implemented. A set of 75 data groups with 452 data elements was created. These data elements were atomic items that comprised the data groups. Medical sheet items contained clinical records information and could be described by standard data elements that exist in current health document protocols. These data groups match different units of the CDA model. Twelve data groups with 87 standardized data elements described EMR headers, and 63 data groups with 405 standardized data elements constituted the body. The later 63 data groups in fact formed the sections of the model. The data groups had two levels. Those at the first level contained both the second level data groups and the standardized data elements. The data groups were basically reusable information units that served as guidelines for building EMRS and that were used to rebuild a medical sheet and serve as templates for the clinical records. As a pilot study of health information standards in China, the development of EMR data groups combined international standards with Chinese national regulations and standards, and this was the most critical part of the research. The original medical sheets from hospitals contain first hand medical information, and some of their items reveal the data types characteristic of the Chinese socialist national health system

Biobanking for research: a survey of patient population attitudes and understanding

OpenAIRE

Rahm, Alanna Kulchak; Wrenn, Michelle; Carroll, Nikki M.; Feigelson, Heather Spencer

2013-01-01

Population-based biobanks are a critical resource for genetic research. It is important to know what potential participants understand about the risks and benefits of providing samples in order to ensure adequate informed consent. Kaiser Permanente Colorado (KPCO) is currently planning a biobank where adult members would be asked to contribute an additional tube of blood during a routine blood draw. Adult KPCO members in clinic waiting rooms were asked to read an informational brochure and in...

Safe Routes to School Local School Project: A health evaluation at 10 low-income schools

OpenAIRE

Cooper, Jill F MSW; McMillan, Tracy MPH, PHD

2010-01-01

fe Routes to School National Partnership (Partnership) founded the Local School Project (Project) in 2008 to assist ten schools in lowincome communities to: 1) develop and evaluate a school-based SRTS program, 2) build local capacity to apply for state or federal SRTS funding, and 3) increase safe walking and bicycling to and from the school and in the community. The Centers for Disease Control and Prevention, Kaiser Permanente, and the Robert Wood Johnson Foundation provided funding for the ...

Valoración "in vitro" de las fuerzas de adhesión de un sistema adhesivo convencional y otro autograbante en esmalte de dientes temporales y permanentes

OpenAIRE

Herrera Martínez, Gilberto de Jesús

2012-01-01

El presente trabajo trata de aportar más información sobre un nuevo adhesivo autograbante a esmalte de dientes temporales y permanentes. El objetivo es valorar las fuerzas de adhesión en MPa de los sistemas adhesivos (convencional y autograbante),en el esmalte de dientes temporales y permanentes. Métodos: utilizando una muestra de 160 dientes (temporales y permanentes)a nivel de la estructura del esmalte, divididos en cuatro grupos, no tomándose en cuenta para el criterio de selección la p...

Modernizing dermatology interest groups in medical school: Certificate programs.

Science.gov (United States)

Wang, Jordan V; Korta, Dorota Z; Keller, Matthew

2017-11-15

This commentary addresses the increasingly competitive nature of applying to dermatology residency programs and how both interest groups in medical schools and their dermatology departments can help to better prepare applicants. As previous literature argued that dermatology has been underemphasized in medical school curricula, we propose five fundamental options that interest groups can implement in order to offer increased exposure to our field in medical training. Furthermore, with therecent trend of many schools conferring certificates in various specialized concentrations, we also discuss interest groups pioneering certificate-grantingprograms in dermatology competency. The pros and cons of having a recognized certificate program in dermatology are presented.

El establecimiento permanente en un contexto virtual

Directory of Open Access Journals (Sweden)

Andrés Mauricio Rengifo

2002-01-01

Full Text Available La inmediatez, la informalidad y la total irrelevancia de la localización, la distancia y los límites nacionales son ventajas innegables del comercio en Internet. Al mismo, tiempo, son características que plantean interrogantes para los Estados, quienes, conscientes de la importancia de controlar el volumen y la magnitud de las operaciones realizadas en red (al gravarlas directa o indirectamente pueden conseguir fuentes de ingreso para el mantenimiento de las estructuras y la financiación de gastos gubernamentales se cuestionan cuál debe ser el sujeto pasivo de las obligaciones tributarias en un mercado donde las empresas están deslocalizadas o aún, no existen físicamente. El presente artículo aporta a la resolución del problema tras un completo estudio del concepto de establecimiento Permanente de carácter virtual, elaborado por la Organización para la Cooperación y el Desarrollo Económico.

El establecimiento permanente en un contexto virtual

Directory of Open Access Journals (Sweden)

Andrés Mauricio Rengifo

2002-06-01

Full Text Available La inmediatez, la informalidad y la total irrelevancia de la localización, la distancia y los límites nacionales son ventajas innegables del comercio en Internet. Al mismo, tiempo, son características que plantean interrogantes para los Estados, quienes, conscientes de la importancia de controlar el volumen y la magnitud de las operaciones realizadas en red (al gravarlas directa o indirectamente pueden conseguir fuentes de ingreso para el mantenimiento de las estructuras y la financiación de gastos gubernamentales se cuestionan cuál debe ser el sujeto pasivo de las obligaciones tributarias en un mercado donde las empresas están deslocalizadas o aún, no existen físicamente. El presente artículo aporta a la resolución del problema tras un completo estudio del concepto de establecimiento Permanente de carácter virtual, elaborado por la Organización para la Cooperación y el Desarrollo Económico.

Using Population Dose to Evaluate Community-level Health Initiatives.

Science.gov (United States)

Harner, Lisa T; Kuo, Elena S; Cheadle, Allen; Rauzon, Suzanne; Schwartz, Pamela M; Parnell, Barbara; Kelly, Cheryl; Solomon, Loel

2018-05-01

Successful community-level health initiatives require implementing an effective portfolio of strategies and understanding their impact on population health. These factors are complicated by the heterogeneity of overlapping multicomponent strategies and availability of population-level data that align with the initiatives. To address these complexities, the population dose methodology was developed for planning and evaluating multicomponent community initiatives. Building on the population dose methodology previously developed, this paper operationalizes dose estimates of one initiative targeting youth physical activity as part of the Kaiser Permanente Community Health Initiative, a multicomponent community-level obesity prevention initiative. The technical details needed to operationalize the population dose method are explained, and the use of population dose as an interim proxy for population-level survey data is introduced. The alignment of the estimated impact from strategy-level data analysis using the dose methodology and the data from the population-level survey suggest that dose is useful for conducting real-time evaluation of multiple heterogeneous strategies, and as a viable proxy for existing population-level surveys when robust strategy-level evaluation data are collected. This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Toward a social capital theory of competitive advantage in medical groups.

Science.gov (United States)

Hoelscher, Mark L; Hoffman, James J; Dawley, David

2005-01-01

Social capital can have a positive impact on medical group performance. We forward our theory based on the integration of theories in social capital, resource advantage, and the resource-based view of the firm. Further, we suggest specific ways in which medical groups can increase their levels of social capital. First, medical groups should design or redesign the workplace so that there is ample interaction among employees. Second, employee participation within the community should be encouraged. Third, medical groups should recognize that social capital becomes ingrained in organizational culture. Therefore, medical groups should take steps to ensure a culture that supports its social capital. Fourth, hiring procedures should be designed (or redesigned) to ensure that new employees add social capital to the organization. Finally, trust must be fostered at the employee level.

Educação permanente em saúde e no trabalho de enfermagem: perspectiva de uma práxis transformadora.

OpenAIRE

da Silva, Luiz Anildo Anacleto; Centro de Educação Superior Norte da Universidade Federal de Santa Maria; Ferraz, Fabiane; Universidade Federal de Santa Catarina; Lino, Mônica Motta; Universidade Federal de Santa Catarina; Backes, Vânia Marli Schubert; Universidade Federal de Santa Catarina; Schmidt, Sandra Marcia Soares; Universidade Federal de Santa Maria

2011-01-01

Trata-se de uma reflexão teórica que tem por objetivo estimular os leitores a repensar o papel da educação permanente dos sujeitos-trabalhadores da saúde e de enfermagem na perspectiva do desenvolvimento individual e coletivo, por meio da práxis transformadora. Procurou-se fazer uma articulação reflexiva dos princípios da práxis transformadora apresentada pelo filósofo Adolfo Sánchez Vázquez com os preceitos de educação permanente em saúde e no trabalho de enfermagem. Tal articulação apresent...

A educação permanente da equipe de enfermagem para o cuidado nos serviços de saúde mental

OpenAIRE

Tavares,Cláudia Mara de Melo

2006-01-01

Estudio exploratório, cuyo objetivo fue analizar la necesidad de la educación permanente del equipo de enfermera para cuidar en los servicios de la salud mental. Fueron estudiadas treinta siete profesionales de enfermería mental. Como resultados, se verificó que él equipe de la enfermería demanda calificación de vasto espectro. Se concluye que la educación permanente del equipo del oficio de enfermera de la salud mental exige más allá de programas educativos establecidos en la def...

Marketing the academic medical center group practice.

Science.gov (United States)

Eudes, J A; Divis, K L

1992-01-01

From a marketing perspective, there are many differences between private and academic medical center (AMC) group practices. Given the growing competition between the two, write John Eudes and Kathy Divis, it is important for the AMC group practice to understand and use these differences to develop a competitive market advantage.

A systematic review of interventions conducted in clinical or community settings to improve dual-task postural control in older adults

OpenAIRE

Agmon M; Belza B; Nguyen HQ; Logsdon RG; Kelly VE

2014-01-01

Maayan Agmon,1 Basia Belza,2 Huong Q Nguyen,2,3 Rebecca G Logsdon,2 Valerie E Kelly41The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa, Israel; 2School of Nursing, University of Washington, Seattle, WA, USA; 3Department of Research and Evaluation, Kaiser Permanente, CA, USA; 4School of Medicine, University of Washington, Seattle, WA, USABackground: Injury due to falls is a major problem among older adults. Decrements in dual-task postu...

Teager-Kaiser Energy and Higher-Order Operators in White-Light Interference Microscopy for Surface Shape Measurement

Directory of Open Access Journals (Sweden)

Abdel-Ouahab Boudraa

2005-10-01

Full Text Available In white-light interference microscopy, measurement of surface shape generally requires peak extraction of the fringe function envelope. In this paper the Teager-Kaiser energy and higher-order energy operators are proposed for efficient extraction of the fringe envelope. These energy operators are compared in terms of precision, robustness to noise, and subsampling. Flexible energy operators, depending on order and lag parameters, can be obtained. Results show that smoothing and interpolation of envelope approximation using spline model performs better than Gaussian-based approach.

Manual dexterity aptitude testing: a soap carving study.

Science.gov (United States)

Tang, Christopher G; Hilsinger, Raymond L; Cruz, Raul M; Schloegel, Luke J; Byl, Fred M; Rasgon, Barry M

2014-03-01

Currently there are few validated metrics for predicting surgical skill among otolaryngology residency applicants. To determine whether manual dexterity aptitude testing in the form of soap carving during otolaryngology residency interviews at Kaiser Permanente Medical Center Oakland predicts surgical skill at the time of graduation from otolaryngology residency programs. This study was conducted to determine how applicants with the best and worst soap carvings compared at the time of graduation with respect to various metrics including visuospatial ability and manual dexterity. Over the last 25 years, applicants to the residency program at Kaiser Permanente Oakland were required to carve soap during their residency interview. The 3 best and 3 worst soap carvings from 1990 through 2006 were determined. Of the individuals who carved those soaps, 62 qualified for the study and matriculated into otolaryngology residency programs. Surveys were sent to the 62 individuals' residency programs to evaluate those individuals on a 5-point Likert scale in various categories as well as to rank those individuals as being in the top 50% or bottom 50% of their graduating class. All else being equal, we hypothesized that applicants who had the manual dexterity and visuospatial skills to accurately carve a bar of soap would more likely possess the skills necessary to become a good surgeon. There was no difference between individuals with the best soap carvings and those with the worst soap carvings in all categories: cognitive knowledge, visuospatial ability, manual dexterity, decision making, and overall score (P > .10 for all categories). There was a 95% response rate, with 35 of 37 residency programs responding and 59 of 62 surveys returned. Manual dexterity aptitude testing in the form of soap carving does not appear to correlate with surgical skill at the time of graduation. Further studies need to be conducted to determine the role of manual dexterity and visuospatial

Structuring group medical practices: tax planning aspects.

Science.gov (United States)

Gassman, A S; Conetta, T F

1992-01-01

This article is the first in a series addressing the structuring of group medical practice entities, shareholder relationships, and general representation factors. In this article, a general background in federal tax planning is provided, including strategies for minimization of income tax payment and the potential problems that may be encountered when a group practice is not carefully structured.

Prevalencia preoperatoria de la fibrilación auricular permanente en cirugía cardíaca

Directory of Open Access Journals (Sweden)

Fernando Hornero

2005-07-01

Conclusiones: La FA permanente se presenta en nuestro medio quirúrgico preoperatorio en el 13,6%, preferentemente asociada a enfermedad mitral. Los factores de riesgo cardiovasculares están presentes con similar prevalencia en los pacientes con FA que en el resto, excepto el tamaño auricular.

A RFID grouping proof protocol for medication safety of inpatient.

Science.gov (United States)

Huang, Hsieh-Hong; Ku, Cheng-Yuan

2009-12-01

In order to provide enhanced medication safety for inpatients, the medical mechanism which adopts the modified grouping proof protocol is proposed in this paper. By using the grouping proof protocol, the medical staffs could confirm the authentication and integrity of a group of Radio-Frequency Identification (RFID) tags which are embedded on inpatient bracelets and the containers of drugs. This mechanism is designed to be compatible with EPCglobal Class-1 Generation-2 standard which is the most popular specification of RFID tags. Due to the light-weight computational capacity of passive tags, only the pseudo-random number generator (PRNG) and cyclic redundancy code (CRC) are allowed to be used in the communication protocol. Furthermore, a practical scenario of using this proposed mechanism in hospital to examine the medication safety is also presented.

The Medicaid Medically Improved Group, Losing Disability...

Data.gov (United States)

U.S. Department of Health & Human Services — According to findings reported in, The Medicaid Medically Improved Group, Losing Disability Status and Growing Earnings, published in Volume 4, Issue 1 of the...

Type C investigation of electrical fabrication projects in ICF Kaiser shops

International Nuclear Information System (INIS)

Huckfeldt, R.A.

1995-06-01

A Type C Investigation Board was convened to investigate an electrical miswiring problem found during the operation of the electrical distribution trailer for the TWRS Rotary Mode Core Sampling Truck number-sign 2. The trailer was designed by WHC and fabricated ICF KH on site for use in the Characterization Program. This problem resulted in a serious safety hazard since the support truck frame/chassis became electrically energized. This final report provides results of the ''Type C Investigation, Electrical Fabrication Projects in ICF KH Shops, June, 1995.'' It contains the investigation scope, executive summary, relevant facts, analysis, conclusions and corrective actions. DOE Order 5484.1, ''Environmental Protection, Safety and Health Protection Information Reporting Requirements,'' was followed in preparation of this report. Because the incident was electrical in nature and involved both Westinghouse Hanford Company and ICF Kaiser Hanford organizations, the board included members from both contractors and members with considerable electrical expertise

Armouring facility? Nuclear-weapon and reactor reseach at the Kaiser-Wilhelm Institute for Physics; Eine Waffenschmiede? Kernwaffen- und Reaktorforschung am Kaiser-Wilhelm-Institut fuer Physik

Energy Technology Data Exchange (ETDEWEB)

Hachtmann, R. (ed.); Walker, M.

2005-07-01

The Kaiser Wilhelm Institute for Physics is best known as the place where Werner Heisenberg worked on nuclear weapons for Hitler. Although this is essentially true, there is more to the story. At the start of World War II this institute was taken over by the German Army Ordnance to be the central, but not exclusive site for a research project into the economic and military applications of nuclear fission. The Army physicist Kurt Diebner was installed in the institute as its commissarial director. Heisenberg was affiliated with the institute as an advisor at first, and became the director in 1942. Heisenberg and his colleagues, including in particular Karl-Heinz Hoecker, Carl Friedrich von Weizsaecker, and Karl Wirtz, worked on nuclear reactors and isotope separation with the clear knowledge that these were two different paths to atomic bombs [Atombomben]. However, they were clearly ambivalent about what they were doing. New documents recently returned from Russian archives shed new light on this work and the scientists' motivations. (orig.)

Medical Genetics at McGill: The History of a Pioneering Research Group.

Science.gov (United States)

Canning, Christopher; Weisz, George; Tone, Andrea; Cambrosio, Alberto

2013-01-01

The McGill Group in Medical Genetics was formed in 1972, supported by the Medical Research Council and successor Canadian Institutes for Health Research until September 2009, making it the longest active biomedical research group in the history of Canada. We document the history of the McGill Group and situate its research within a broader history of medical genetics. Drawing on original oral histories with the Group's members, surviving documents, and archival materials, we explore how the Group's development was structured around epistemological trends in medical genetics, policy choices made by research agencies, and the development of genetics at McGill University and its hospitals.

Influence of Individual and Group Priming on Medical Students

OpenAIRE

McGeown, Helen Rosemary

2009-01-01

This study investigated the impact of information on level of prototypicality of the ingroup ‘medical students’, comparing self-esteem effects for those primed as individuals with self-esteem effects for those primed as group members. Indication of prototypicality was given by false feedback on purported individual levels of empathy, an important group norm for medical students. As well as priming type having interactive effects with prototypicality information, it was hypothesized that initi...

Obesity during childhood and adolescence increases susceptibility to multiple sclerosis after accounting for established genetic and environmental risk factors.

Science.gov (United States)

Gianfrancesco, Milena A; Acuna, Brigid; Shen, Ling; Briggs, Farren B S; Quach, Hong; Bellesis, Kalliope H; Bernstein, Allan; Hedstrom, Anna K; Kockum, Ingrid; Alfredsson, Lars; Olsson, Tomas; Schaefer, Catherine; Barcellos, Lisa F

2014-01-01

To investigate the association between obesity and multiple sclerosis (MS) while accounting for established genetic and environmental risk factors. Participants included members of Kaiser Permanente Medical Care Plan, Northern California Region (KPNC) (1235 MS cases and 697 controls). Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CI). Body mass index (BMI) or body size was the primary predictor of each model. Both incident and prevalent MS cases were studied. In analyses stratified by gender, being overweight at ages 10 and 20 were associated with MS in females (pchildhood and adolescence obesity confer increased risk of MS in females beyond established heritable and environmental risk factors. Strong evidence for a dose-effect of BMI in 20s and MS was observed. The magnitude of BMI association with MS is as large as other known MS risk factors. Copyright © 2014 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Group processes in medical education: learning from social identity theory.

Science.gov (United States)

Burford, Bryan

2012-02-01

The clinical workplace in which doctors learn involves many social groups, including representatives of different professions, clinical specialties and workplace teams. This paper suggests that medical education research does not currently take full account of the effects of group membership, and describes a theoretical approach from social psychology, the social identity approach, which allows those effects to be explored. The social identity approach has a long history in social psychology and provides an integrated account of group processes, from the adoption of group identity through a process of self-categorisation, to the biases and conflicts between groups. This paper outlines key elements of this theoretical approach and illustrates their relevance to medical education. The relevance of the social identity approach is illustrated with reference to a number of areas of medical education. The paper shows how research questions in medical education may be usefully reframed in terms of social identity in ways that allow a deeper exploration of the psychological processes involved. Professional identity and professionalism may be viewed in terms of self-categorisation rather than simply attainment; the salience of different identities may be considered as influences on teamwork and interprofessional learning, and issues in communication and assessment may be considered in terms of intergroup biases. Social identity theory provides a powerful framework with which to consider many areas of medical education. It allows disparate influences on, and consequences of, group membership to be considered as part of an integrated system, and allows assumptions, such as about the nature of professional identity and interprofessional tensions, to be made explicit in the design of research studies. This power to question assumptions and develop deeper and more meaningful research questions may be increasingly relevant as the nature and role of the medical profession change

Shared familial transmission of autism spectrum and attention-deficit/hyperactivity disorders.

Science.gov (United States)

Musser, Erica D; Hawkey, Elizabeth; Kachan-Liu, Svetlana S; Lees, Paul; Roullet, Jean-Baptiste; Goddard, Katrina; Steiner, Robert D; Nigg, Joel T

2014-07-01

To determine whether familial transmission is shared between autism spectrum disorders and attention-deficit/hyperactivity disorder, we assessed the prevalence, rates of comorbidity, and familial transmission of both disorders in a large population-based sample of children during a recent 7 year period. Study participants included all children born to parents with the Kaiser Permanente Northwest (KPNW) Health Plan between 1 January 1998 and 31 December 2004 (n = 35,073). Children and mothers with physician-identified autism spectrum disorders (ASD) and/or attention-deficit/hyperactivity disorder (ADHD) were identified via electronic medical records maintained for all KPNW members. Among children aged 6-12 years, prevalence was 2.0% for ADHD and 0.8% for ASD; within those groups, 0.2% of the full sample (19% of the ASD sample and 9.6% of the ADHD sample) had co-occurring ASD and ADHD, when all children were included. When mothers had a diagnosis of ADHD, first born offspring were at 6-fold risk of ADHD alone (OR = 5.02, p disorders shares familial transmission with ADHD. ADHD and ASD have a partially overlapping diathesis. © 2014 The Authors. Journal of Child Psychology and Psychiatry. © 2014 Association for Child and Adolescent Mental Health.

Expanding Group Peer Review: A Proposal for Medical Education Scholarship.

Science.gov (United States)

Dumenco, Luba; Engle, Deborah L; Goodell, Kristen; Nagler, Alisa; Ovitsh, Robin K; Whicker, Shari A

2017-02-01

After participating in a group peer-review exercise at a workshop presented by Academic Medicine and MedEdPORTAL editors at the 2015 Association of American Medical Colleges Medical Education Meeting, the authors realized that the way their work group reviewed a manuscript was very different from the way by which they each would have reviewed the paper as an individual. Further, the group peer-review process yielded more robust feedback for the manuscript's authors than did the traditional individual peer-review process. This realization motivated the authors to reconvene and collaborate to write this Commentary to share their experience and propose the expanded use of group peer review in medical education scholarship.The authors consider the benefits of a peer-review process for reviewers, including learning how to improve their own manuscripts. They suggest that the benefits of a team review model may be similar to those of teamwork and team-based learning in medicine and medical education. They call for research to investigate this, to provide evidence to support group review, and to determine whether specific paper types would benefit most from team review (e.g., particularly complex manuscripts, those receiving widely disparate initial individual reviews). In addition, the authors propose ways in which a team-based approach to peer review could be expanded by journals and institutions. They believe that exploring the use of group peer review potentially could create a new methodology for skill development in research and scholarly writing and could enhance the quality of medical education scholarship.

Formación permanente y distribución del profesorado de Educación Secundaria por comarcas y departamentos. El caso de Asturias

OpenAIRE

Paula GONZÁLEZ-VALLINAS; José Luis SAN FABIÁN MAROTO

2009-01-01

Este estudio se centra en la formación del profesorado y explora las relaciones existentes entre la formación permanente y diversas características del profesorado, las comarcas y departamentos de los IES en Asturias. Como resultado de una investigación basada en el análisis de datos secundarios cuantitativos del profesorado y municipios de Asturias se obtiene una radiografía de la formación permanente de su profesorado (modalidad y materia de formación). Se realizan análisis a nivel de depar...

Incidence and hospitalization rates of varicella and herpes zoster before varicella vaccine introduction: a baseline assessment of the shifting epidemiology of varicella disease.

Science.gov (United States)

Coplan, P; Black, S; Rojas, C; Shinefield, H; Ray, P; Lewis, E; Guess, H

2001-07-01

A 15-year postmarketing evaluation of the impact of varicella vaccine on the age distribution of varicella disease is being conducted at Kaiser Permanente Medical Care Program, Northern California (KPMCP). We report on a baseline assessment of the age-specific incidence and hospitalization rates of varicella and herpes zoster that was conducted before vaccine introduction. To assess the annual incidence of varicella, a telephone survey was conducted in a random sample of approximately 8,000 youths 5 to 19 years of age. The annual incidence of hospitalizations for varicella and herpes zoster in 1994 was assessed with the use of the computerized database at KPMCP. Varicella annual incidence was 10.3% in 5- to 9-year-olds, 1.9% in 10- to 14-year-olds and 1.2% in the 15- to 19-year age groups, respectively. Hospitalization rates among the entire KPMCP membership were 2.6 and 2.1 per 100,000 person years for varicella and zoster, respectively. Varicella incidence in the 15- to 19-year age group was higher among African-Americans than among Caucasians. Varicella rates were similar in the 5- to 9- and 10- to 14-year age groups to rates from other published studies conducted in 1972 to 1978, 1980 to 1988 and 1990 to 1992; however, the rate in 15- to 19-year-olds was 2 to 4 times higher than published rates in the same age category.

Estimation of spacial geo-stress components in rock samples by using the Kaiser effect of acoustic emission

International Nuclear Information System (INIS)

Kanagawa, Tadashi; Hayashi, Masao; Nakasa, Hiroyasu.

1976-01-01

The spacial remaining stress component of the rock core sample is experimentally obtained by using Kaiser effect of acoustic emission (AE), and the estimated ground pressure is compared with the natural ground pressure measured by the conventional over-coring method, in order to see the feasiblity of AE method. In this experiments of AE, 111 specimens were cut out in all directions of the rock cores (tuff) sampled from the place where the ground pressure was measured by the over-coring method, and the generation of AE caused by the load was measured. Whereby, the stress components in three directions are determined. As a result of comparison, t the AE method is proved to be effective enough to estimate the ground pressure of rock geo-dynamically. In the application of the Kaiser effect to the estimation of the geo-stress in rock samples, one of the most difficult problems is how to eliminate the obstruction of erroneous AE signals caused by the strong stress concentration at the end corners of the rock specimen. As the result of comparison, the values obtained by the AE method have a tendency of greater than the values obtained by the over-coring method. It is conceived that the AE method can easily detect the maximum stress value for geo historical long time, and that the stress concentration is apt to mix in AE method by boring. (Iwakiri, K.)

Predicting the 6-month risk of severe hypoglycemia among adults with diabetes: Development and external validation of a prediction model.

Science.gov (United States)

Schroeder, Emily B; Xu, Stan; Goodrich, Glenn K; Nichols, Gregory A; O'Connor, Patrick J; Steiner, John F

2017-07-01

To develop and externally validate a prediction model for the 6-month risk of a severe hypoglycemic event among individuals with pharmacologically treated diabetes. The development cohort consisted of 31,674 Kaiser Permanente Colorado members with pharmacologically treated diabetes (2007-2015). The validation cohorts consisted of 38,764 Kaiser Permanente Northwest members and 12,035 HealthPartners members. Variables were chosen that would be available in electronic health records. We developed 16-variable and 6-variable models, using a Cox counting model process that allows for the inclusion of multiple 6-month observation periods per person. Across the three cohorts, there were 850,992 6-month observation periods, and 10,448 periods with at least one severe hypoglycemic event. The six-variable model contained age, diabetes type, HgbA1c, eGFR, history of a hypoglycemic event in the prior year, and insulin use. Both prediction models performed well, with good calibration and c-statistics of 0.84 and 0.81 for the 16-variable and 6-variable models, respectively. In the external validation cohorts, the c-statistics were 0.80-0.84. We developed and validated two prediction models for predicting the 6-month risk of hypoglycemia. The 16-variable model had slightly better performance than the 6-variable model, but in some practice settings, use of the simpler model may be preferred. Copyright © 2017 Elsevier Inc. All rights reserved.

Otra aproximación a Carl Gangolf Kaiser (1837-1895), arquitecto de la corte del emperador Maximiliano

OpenAIRE

Drewes, Michael

2000-01-01

Michael Drewes ha estudiado el ambiente artístico que rodeó al que fuera segundo emperador de México, Maximiliano de Austria. En por lo menos dos artículos anteriores publicados en Anales del Instituto de Investigaciones Estéticas (números 59 y 63), se ocupó ya del arquitecto Carl Gangolf Kaiser, un artista que presentó diversos proyectos de construcción y remodelación para Maximiliano. Quizás por su juventud, los proyectos que entonces realizó este arquitecto para remodelar edificios tan imp...

Probabilidad de retención de segundos molares permanentes mandibulares (Estudio piloto

Directory of Open Access Journals (Sweden)

Paulo Sandoval Vidal

Full Text Available Objetivos: Determinar la frecuencia del segundo molar mandibular permanente (MM2 con probabilidad de impactación, en un grupo de pacientes de Ortodoncia de Temuco, Chile. Método: Estudio de corte transversal, con muestra por conveniencia. Se revisaron 2095 fichas de individuos de ambos sexos, con ausencia de patología sindrómica. Los datos recolectados se obtuvieron de radiografías panorámicas. Se midió el ángulo del segundo molar con respecto al plano oclusal, la invasión distal del primer molar y la distancia entre distal del primer molar y el borde anterior de la rama mandibular. Resultados: El promedio de edad de los pacientes relevados fue de 10 años. Se observó un 1,43% de probabilidad de retención de MM2 (n=30; en promedio y el plano el ángulo MM2 resultó de 27° el izquierdo y 26° el derecho; la invasión de MM2 en distal del primer molar resultó de 1,5 mm; el ángulo entre MM2 y el planos oclusal es de 123°; la distancia entre la cara distal del primer molar y el borde anterior de la rama mandibular fue 13 mm. Conclusiones: Existe una baja prevalencia de segundos molares mandibulares permanentes con probabilidad de impactación. La invasión a la cara distal del primer molar fue mayor en pacientes con riesgo de impactación

Achieving performance breakthroughs in an HMO business process through quality planning.

Science.gov (United States)

Hanan, K B

1993-01-01

Kaiser Permanente's Georgia Region commissioned a quality planning team to design a new process to improve payments to its suppliers and vendors. The result of the team's effort was a 73 percent reduction in cycle time. This team's experiences point to the advantages of process redesign as a quality planning model, as well as some general guidelines for its most effective use in teams. If quality planning project teams are carefully configured, sufficiently expert in the existing process, and properly supported by management, organizations can achieve potentially dramatic improvements in process performance using this approach.

La normativa de atribución de rentas a establecimientos permanentes en Colombia

OpenAIRE

Navarro Ibarrola, Aitor

2016-01-01

En el presente trabajo se analizan las reglas para la determinación de la renta de establecimientos permanentes situados en Colombia. A tal efecto, el autor lleva a cabo un estudio sobre la base de las pautas que la OCDE establece en la materia, ya que el sistema de conceptos propuesto por este organismo internacional se adoptó como referencia por parte del legislador colombiano a partir de 2012. En concreto, en el marco del concepto de entidad funcionalmente separada, se analiza el contenido...

Structuring group medical practices: shareholder and partnership agreements.

Science.gov (United States)

Gassman, A S

1992-01-01

This article is the second in a series addressing the structuring of group medical entities, shareholder relationships, and general representation factors. In this article, a number of the legal and business considerations for entering into shareholder and partnership agreements are discussed, and various types of practice structures and recommended group practice agreement provisions are described.

Educação Permanente no cotidiano da Atenção Básica no Mato Grosso do Sul

Directory of Open Access Journals (Sweden)

Jacinta de Fátima Franco Pereira Machado

Full Text Available O artigo analisou as ações de Educação Permanente em Saúde na Atenção Básica em Mato Grosso do Sul, Brasil, na perspectiva de 184 equipes participantes da primeira fase do Programa de Melhoria do Acesso e da Qualidade (PMAQ, de junho de 2012 a fevereiro de 2013. Entre as ações de Educação Permanente, os cursos presenciais foram mais prevalentes, seguidos por troca de experiência, teleducação, ensino à distância e tutoria/preceptoria, tanto na capital quanto no interior. As ações de planejamento e apoio à gestão foram mais prevalentes na capital. As ações de apoio da gestão estavam diretamente relacionadas com o planejamento e a organização do processo de trabalho.

An empirical assessment of high-performing medical groups: results from a national study.

Science.gov (United States)

Shortell, Stephen M; Schmittdiel, Julie; Wang, Margaret C; Li, Rui; Gillies, Robin R; Casalino, Lawrence P; Bodenheimer, Thomas; Rundall, Thomas G

2005-08-01

The performance of medical groups is receiving increased attention. Relatively little conceptual or empirical work exists that examines the various dimensions of medical group performance. Using a national database of 693 medical groups, this article develops a scorecard approach to assessing group performance and presents a theory-driven framework for differentiating between high-performing versus low-performing medical groups. The clinical quality of care, financial performance, and organizational learning capability of medical groups are assessed in relation to environmental forces, resource acquisition and resource deployment factors, and a quality-centered culture. Findings support the utility of the performance scorecard approach and identification of a number of key factors differentiating high-performing from low-performing groups including, in particular, the importance of a quality-centered culture and the requirement of outside reporting from third party organizations. The findings hold a number of important implications for policy and practice, and the framework presented provides a foundation for future research.

Using an electronic prescribing system to ensure accurate medication lists in a large multidisciplinary medical group.

Science.gov (United States)

Stock, Ron; Scott, Jim; Gurtel, Sharon

2009-05-01

Although medication safety has largely focused on reducing medication errors in hospitals, the scope of adverse drug events in the outpatient setting is immense. A fundamental problem occurs when a clinician lacks immediate access to an accurate list of the medications that a patient is taking. Since 2001, PeaceHealth Medical Group (PHMG), a multispecialty physician group, has been using an electronic prescribing system that includes medication-interaction warnings and allergy checks. Yet, most practitioners recognized the remaining potential for error, especially because there was no assurance regarding the accuracy of information on the electronic medical record (EMR)-generated medication list. PeaceHealth developed and implemented a standardized approach to (1) review and reconcile the medication list for every patient at each office visit and (2) report on the results obtained within the PHMG clinics. In 2005, PeaceHealth established the ambulatory medication reconciliation project to develop a reliable, efficient process for maintaining accurate patient medication lists. Each of PeaceHealth's five regions created a medication reconciliation task force to redesign its clinical practice, incorporating the systemwide aims and agreed-on key process components for every ambulatory visit. Implementation of the medication reconciliation process at the PHMG clinics resulted in a substantial increase in the number of accurate medication lists, with fewer discrepancies between what the patient is actually taking and what is recorded in the EMR. The PeaceHealth focus on patient safety, and particularly the reduction of medication errors, has involved a standardized approach for reviewing and reconciling medication lists for every patient visiting a physician office. The standardized processes can be replicated at other ambulatory clinics-whether or not electronic tools are available.

Factors Influencing Electronic Clinical Information Exchange in Small Medical Group Practices

Science.gov (United States)

Kralewski, John E.; Zink, Therese; Boyle, Raymond

2012-01-01

Purpose: The purpose of this study was to identify the organizational factors that influence electronic health information exchange (HIE) by medical group practices in rural areas. Methods: A purposive sample of 8 small medical group practices in 3 experimental HIE regions were interviewed to determine the extent of clinical information exchange…

"Presumed fair: Ironic effects of organizational diversity structures": Correction to Kaiser et al. (2013).

Science.gov (United States)

2016-06-01

Reports an error in "Presumed fair: Ironic effects of organizational diversity structures" by Cheryl R. Kaiser, Brenda Major, Ines Jurcevic, Tessa L. Dover, Laura M. Brady and Jenessa R. Shapiro (Journal of Personality and Social Psychology, 2013[Mar], Vol 104[3], 504-519). In the article, a raw data merging error in one racial discrimination claim condition from Experiment 6 inadvertently resulted in data analyses on an inaccurate data set. When the error was discovered by the authors and corrected, all analyses reported in Experiment 6 for claim validity, seriousness of the claim, and support for the claimant were inaccurate and none were statistically significant. The conclusions should be altered to indicate that participants with management experience who reflected on their own workplace diversity policies did not show the predicted effects. The literature review, remaining five studies, and remaining conclusions in the article are unaffected by this error. Experiment 6 should also report that 26.4% (not 26.4.7%) of participants had a graduate degree and eight participants (not 8%) did not provide educational data. Experiment 5 should have referred to the claim validity measure as a six-item measure ( .92) rather than a five-item measure; analyses on claim validity are accurate in text. Table 2's note should have said standard errors, not standard deviations. (The following abstract of the original article appeared in record 2012-31077-001.) This research tests the hypothesis that the presence (vs. absence) of organizational diversity structures causes high-status group members (Whites, men) to perceive organizations with diversity structures as procedurally fairer environments for underrepresented groups (racial minorities, women), even when it is clear that underrepresented groups have been unfairly disadvantaged within these organizations. Furthermore, this illusory sense of fairness derived from the mere presence of diversity structures causes high

Deming, quality and the small medical group administrator.

Science.gov (United States)

Noll, D C

1992-01-01

As administrators, writes Douglas Noll, we can coordinate and implement quality measures affecting our practices and which impact the patient's total medical experience. Unfortunately, many smaller groups cannot hire an outside consultant or single employee whose sole purpose would be to monitor quality. Noll offers several simple practices that administrators can use to improve the quality of service in their groups.

La incapacidad permanente en una empresa pública en el periodo 1995-2009 Permanent incapacity in a public company from 1995-2009

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José Carlos Marchena Aparicio

2011-09-01

Full Text Available Objetivos: La cuantificación de las relaciones entre salud, medio laboral y capacidad para el trabajo nos permite descifrar aspectos importantes de la incapacidad permanente. Este trabajo tiene como objetivo describir las características de la población trabajadora de la Diputación Provincial de Cádiz a la que se le concedió una incapacidad permanente en el periodo 1995-2009. Métodos: Se llevó a cabo un estudio descriptivo retrospectivo sobre el total de trabajadores/as con incapacidad permanente en el periodo descrito que considera las siguientes variables: sexo, edad, antigüedad, tipo de ocupación, causa de la incapacidad permanente, días de incapacidad temporal y número de incapacidades temporales concedidas en los 5 años previos, recogidas a través de archivos documentales. Resultados: El número de incapacidades permanentes concedidas ascendió a 192. Un 53,1% fueron mujeres; funcionarios el 59,9%; la edad de concesión fue de 54,06 años de media con 24,98 años de antigüedad en la empresa; el tipo de trabajo en el que más incapacidad permanente se concedieron es el manual, 44,8%; El tipo de patología más frecuente de incapacidad permanente fueron las enfermedades músculo-esqueléticas (29,7%, neoplasias (23,4% y trastornos mentales (18,8%, asociándose significativamente dicha variable con el sexo (p=0,006, el tipo de trabajo desempeñado (p=0,007, la edad de concesión (pObjectives: The quantifying relationship between health, working environment and work capacity allows us to unravel important aspects of permanent incapacity (PI. One of the objectives of this study is to describe working population characteristics of the Provincial Council of Cadiz who were granted permanent incapacity from 1995 to 2009. Method: A retrospective descriptive study was carried out amongst all the workers with PI in the period described with the following variables taken into account: gender, age, time working for the company, type of

Medical Team Training: Using Simulation as a Teaching Strategy for Group Work

Science.gov (United States)

Moyer, Michael R.; Brown, Rhonda Douglas

2011-01-01

Described is an innovative approach currently being used to inspire group work, specifically a medical team training model, referred to as The Simulation Model, which includes as its major components: (1) Prior Training in Group Work of Medical Team Members; (2) Simulation in Teams or Groups; (3) Multidisciplinary Teamwork; (4) Team Leader…

A Selective Group Authentication Scheme for IoT-Based Medical Information System.

Science.gov (United States)

Park, YoHan; Park, YoungHo

2017-04-01

The technology of IoT combined with medical systems is expected to support advanced medical services. However, unsolved security problems, such as misuse of medical devices, illegal access to the medical server and so on, make IoT-based medical systems not be applied widely. In addition, users have a high burden of computation to access Things for the explosive growth of IoT devices. Because medical information is critical and important, but users have a restricted computing power, IoT-based medical systems are required to provide secure and efficient authentication for users. In this paper, we propose a selective group authentication scheme using Shamir's threshold technique. The property of selectivity gives the right of choice to users to form a group which consists of things users select and access. And users can get an access authority for those Things at a time. Thus, our scheme provides an efficient user authentication for multiple Things and conditional access authority for safe IoT-based medical information system. To the best of our knowledge, our proposed scheme is the first in which selectivity is combined with group authentication in IoT environments.

Evaluation Techniques of Creating Coherence in Poems of Kaiser Aminpour Relying on the Theory of Halliday’s Linguistics

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Reza Sattari

2016-05-01

Full Text Available AbstractOne of the linguistics theories that are utilized in present age in the analysis of literary texts is the theory of Halliday’s linguistics which is called theory of systemic - functional linguistics. Halliday’s theory in the second half of the twentieth century, in contrast to the "generative linguistics" approach, which is based on formal language like a mental and individual phenomenon.    Hallidayan called the semantic, literal, syntax and logical relationship of words as coherence of a text and believes that the coherence of the text, includes all the semantic relations by which, every piece of speech or writing can serve as text. Hence, cohesion, referred to relations that relates all elements of a sentence to the elements of other sentences. From Hallidayan's  point of view, elements of coherence of a text are divided into two parts: grammatical and lexical. Grammatical cohesion includes factors such as referrals, replacements, removals and relevancy, and lexical coherence includes repetition and collocation in literary language.   Kaiser is one of the contemporary famous poets that have composed many poets in different molds of poetry. Kaiser Manipur's poems benefit the integration due to the poet's fluency in Persian and his familiarity with the vocabulary and grammatical and lexical capacities of Persian literature. In this research, we have studied the cohesion in Kaiser Manipur's poems from two views of lexical and grammatical by using Holidaying theory of coherence as well as the techniques that the poet has applied to reach the cohesion in his poems.    The method of research in the present paper is descriptive-analytical and all the information and data has been collected from the sources of library and electronic. In this paper, we first briefly discussed the Holidaying coherence theory, and then, with a special approach to this theory, the most important techniques that Kaiser Manipur has

Medication errors in home care: a qualitative focus group study.

Science.gov (United States)

Berland, Astrid; Bentsen, Signe Berit

2017-11-01

To explore registered nurses' experiences of medication errors and patient safety in home care. The focus of care for older patients has shifted from institutional care towards a model of home care. Medication errors are common in this situation and can result in patient morbidity and mortality. An exploratory qualitative design with focus group interviews was used. Four focus group interviews were conducted with 20 registered nurses in home care. The data were analysed using content analysis. Five categories were identified as follows: lack of information, lack of competence, reporting medication errors, trade name products vs. generic name products, and improving routines. Medication errors occur frequently in home care and can threaten the safety of patients. Insufficient exchange of information and poor communication between the specialist and home-care health services, and between general practitioners and healthcare workers can lead to medication errors. A lack of competence in healthcare workers can also lead to medication errors. To prevent these, it is important that there should be up-to-date information and communication between healthcare workers during the transfer of patients from specialist to home care. Ensuring competence among healthcare workers with regard to medication is also important. In addition, there should be openness and accurate reporting of medication errors, as well as in setting routines for the preparation, alteration and administration of medicines. To prevent medication errors in home care, up-to-date information and communication between healthcare workers is important when patients are transferred from specialist to home care. It is also important to ensure adequate competence with regard to medication, and that there should be openness when medication errors occur, as well as in setting routines for the preparation, alteration and administration of medications. © 2017 John Wiley & Sons Ltd.

Un estudio de las concepciones docentes acerca de la formación permanente Um estudo das concepções docentes sobre a formação permanente A Survey of Teachers' Thoughts on Continuing Education

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Irene Marina Macera

2012-12-01

Full Text Available Este trabajo presenta las concepciones docentes acerca de su formación permanente. Se identificaron distintos puntos de análisis relacionados con la antigüedad en la profesión, intereses metodológicos, intereses de actualización de conocimientos, intereses de incorporación de nuevos saberes y, por último, el lugar que ocupa la formación en la subjetividad docente. En los inicios de la docencia, la formación permanente funciona y se concibe como un modo de mantenerse activos mientras se insertan en el mercado laboral. En cambio, para los docentes que ya tienen una trayectoria, esta se concibe como una fuga del trabajo, un recurso que en ocasiones le otorga sentido al trabajo, asumiendo de este modo un lugar subjetivo importante en el quehacer docente. Pero, cualquiera que sea la motivación, la adquisición de nuevos saberes es la razón más antigua que los docentes asumen para formarse.Este trabalho apresenta as concepções docentes sobre sua formação permanente. Identificaram-se diferentes pontos de análise relacionados com a antiguidade na profissão, interesses metodológicos, interesses de atualização de conhecimentos, interesses de incorporação de novos saberes e, por último, o lugar que a formação ocupa na subjetividade docente. No início da docência, a formação permanente funciona e se concebe como um modo de se manterem ativos enquanto se inserem no mercado de trabalho. Em compensação, para os docentes que já têm uma trajetória, esta se concebe como uma fuga do trabalho, um recurso que em ocasiões outorga sentido ao trabalho e assume, desse modo, um lugar subjetivo importante no fazer docente. Contudo, qualquer que seja a motivação, a aquisição de novos saberes é a razão mais antiga que os docentes assumem para se formar.This study delves into what teachers think about their own continuing education. Different points of analysis are identified with respect to seniority in the profession

DEVELOPMENT OF COORDINATION ABILITIES OF SPECIAL MEDICAL GROUPS STUDENTS IN PHYSICAL EDUCATION PROCESS

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E. N. Dotsenko

2013-08-01

Full Text Available Purpose. To analyze the problem of motor abilities development and health of students of special medical group in the process of physical education in technical universities. Determine the major factors, characteristics, and the relationship of physical development, physical fitness and coordination abilities of female students in special medical group. Establish regularities in precise movements mastering of different coordination structure and develop model characteristics of the relationship of coordination abilities and motor characteristics of students in special medical group. To substantiate and verify efficiency of coordination abilities development method of female students with regard to their functional status in the course of physical education in higher school. Methodology. Theoretical and methodological argument, characteristic of the experimental program in physical education teaching process of students in special medical group was shown. Findings. Research is to develop the training content in special medical groups with the use of coordinating elements and exercises to enhance the motor abilities of female students. Their influence on the level of physical development, functional training, as well as regularities in mastering and movement control of different coordinating structure at the female students of special medical group was studied. The comparative characteristic of female students athletic ability in the dynamics of the educational process, differentiated into groups according to nosology was presented. The criterion of spare capacities upgrade of the motor system in controlling the movements of different coordination structure was determined. Originality. The method of coordination abilities development of female students in special medical group, that aims on the formation and correction of motor control system of different coordination structure, a sense of body position and its individual parts in space, improving

Formación permanente del profesorado en Jalisco: evaluación y propuesta

OpenAIRE

Camacho Buenrostro, Benita

2016-01-01

Este trabajo tiene como objetivo realizar una evaluación del modelo de formación permanente para docentes de Educación Básica implementado en Jalisco durante el período 2007-2012. La investigación se ubica en el paradigma naturalista o interpretativo y busca lograr el objetivo a través del enfoque de la evaluación comprensiva. También utiliza métodos cualitativo y cuantitativo y se apoya en distintas técnicas: análisis de documentos, observación directa de este fenómeno, entrevistas a funcion...

Educação permanente no contexto da enfermagem e na saúde

OpenAIRE

Mancia,Joel Rolim; Cabral,Leila Chaves; Koerich,Magda Santos

2004-01-01

Neste trabalho os autores discutem a proposta atual de educação permanente do Ministério da Saúde, voltada para a formação de recursos humanos para o Sistema Único de Saúde. Traz um resgate da educação em geral e especificamente da educação de adultos, questão que afeta diretamente a enfermagem, visto que esta contribui com o maior contingente de trabalhadoras na área da saúde, constituindo-se em foco central das políticas públicas. Assim apresentam as principais controvérsias e apontam para ...

Melanoma in patients with chronic lymphocytic leukemia and non-Hodgkin lymphoma.

Science.gov (United States)

Famenini, Shannon; Martires, Kathryn J; Zhou, Hui; Xavier, Marin F; Wu, Jashin J

2015-01-01

The relationship between melanoma and chronic lymphocytic leukemia (CLL) or non-Hodgkin lymphoma (NHL) has been minimally investigated. The objective of this study was to examine the incidence of melanoma in patients with a history of CLL or NHL, and their associated mortality. Cohorts of Kaiser Permanente Southern California members with a history of CLL and NHL were identified. Age-adjusted incidence density rates of melanoma among patients with CLL or NHL were compared with rates of melanoma among the general population of Kaiser Permanente Southern California patients. The mortality of patients with melanoma was examined using Cox proportional hazards modeling. The age-adjusted incidence rate per 100,000 person-years for melanoma among patients with either CLL or NHL was 107 (95% confidence interval 84.4-129.6) versus 25.9 among the general population (95% confidence interval 84.4-129.6, P < .001). Patients with melanoma and a history of CLL or NHL had 2.46 greater odds of death compared with those without CLL or NHL (95% confidence interval 1.77-3.41). This study was retrospective in nature; the International Classification of Diseases, Ninth Revision codes used may contain diagnostic errors; and only overall survival was used in our analysis. Patients with a history of CLL or NHL have a higher incidence of melanoma. Patients with CLL or NHL who are subsequently given the diagnosis of melanoma have a higher mortality than patients with melanoma without a preceding diagnosis of CLL. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

A proposta da educação permanente em saúde na atualização da equipe de saúde em diabetes mellitus

OpenAIRE

Rodrigues,Andreia Cristinha Seabra; Vieira,Gisele de Lacerda Chaves; Torres,Heloisa de Carvalho

2010-01-01

O objetivo do estudo foi relatar a experiência da Educação Permanente em Saúde na atualização da equipe de saúde de uma Unidade Básica de Saúde para a atenção integral e humanizada às pessoas com diabetes tipo 2. A metodologia de escolha para a capacitação das equipes de saúde foi a Educação em Permanente em Saúde, por meio de oficinas educativas em diabetes com enfoque na problematização do processo educativo e profissional. Buscou-se, assim, construir um programa de educação em diabetes vis...

Managing medical groups: 21st century challenges and the impact of physician leadership styles.

Science.gov (United States)

Martin, William E; Keogh, Timothy J

2004-01-01

Physician group managers and administrators charged with leading medical groups in the 21st century face a set of old and new challenges and opportunities. Leadership is assumed to make the difference between a successful and not-so-successful medical group. Yet, there is little research about how physician manager leadership styles contribute to the success of medical group practices. This article is a study of physician leadership styles using the DiSC, based upon a sample of 232 physician managers. Dominance (D) and conscientiousness (C) were the two dominant styles found in this study. Moreover, the two dominant combination leadership styles fall under the categories of the "creative" and the 'perfectionist." The article formulates practical recommendations for both physician managers and administrators for leading medical groups to respond more effectively to the challenges and opportunities facing medical groups in the 21st century.

Something is amiss in Denmark: A comparison of preventable hospitalisations and readmissions for chronic medical conditions in the Danish Healthcare system and Kaiser Permanente

DEFF Research Database (Denmark)

Schiøtz, Michaela Louise; Price, Mary; Frølich, Anne

2011-01-01

As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison...

Workplace learning through peer groups in medical school clerkships.

Science.gov (United States)

Chou, Calvin L; Teherani, Arianne; Masters, Dylan E; Vener, Margo; Wamsley, Maria; Poncelet, Ann

2014-01-01

When medical students move from the classroom into clinical practice environments, their roles and learning challenges shift dramatically from a formal curricular approach to a workplace learning model. Continuity among peers during clinical clerkships may play an important role in this different mode of learning. We explored students' perceptions about how they achieved workplace learning in the context of intentionally formed or ad hoc peer groups. We invited students in clerkship program models with continuity (CMCs) and in traditional block clerkships (BCs) to complete a survey about peer relationships with open-ended questions based on a workplace learning framework, including themes of workplace-based relationships, the nature of work practices, and selection of tasks and activities. We conducted qualitative content analysis to characterize students' experiences. In both BCs and CMCs, peer groups provided rich resources, including anticipatory guidance about clinical expectations of students, best practices in interacting with patients and supervisors, helpful advice in transitioning between rotations, and information about implicit rules of clerkships. Students also used each other as benchmarks for gauging strengths and deficits in their own knowledge and skills. Students achieve many aspects of workplace learning in clerkships through formal or informal workplace-based peer groups. In these groups, peers provide accessible, real-time, and relevant resources to help each other navigate transitions, clarify roles and tasks, manage interpersonal challenges, and decrease isolation. Medical schools can support effective workplace learning for medical students by incorporating continuity with peers in the main clinical clerkship year.

Ätiologie und Prävalenz permanenter kindlicher Hörstörungen in Deutschland

OpenAIRE

Spormann-Lagodzinski, ME; Nubel, K; König, O; Gross, M; Gross, M

2003-01-01

Permanente Hörstörungen bei Kindern haben in den letzten Jahren bezüglich Ätiologie und Prävalenz einen deutlichen Wandel erlebt. In den westlichen Industrienationen ist sie auf 1 bis 3 pro 1.000 Neugeborene gesunken. Nach Ergebnissen des Deutschen Zentralregisters für kindliche Hörstörungen (DZH) liegt die Prävalenz in Deutschland bei ca. 1,2:1.000. Von 6.200 ausgewerteten Datensätzen des DZH haben 36% aller permanenten Hörstörungen eine (vermutlich oder gesichert) genetische Ursache, 18% si...

Minería de datos en la encuesta permanente de hogares 2009, universidad nacional del litoral, argentina

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Denis Lizazo Torres

2011-04-01

Full Text Available En este trabajo se aplicó por primera vez la Minería de Datos a la información generada por la Encuesta Permanente de Hogares del año 2009, del Observatorio Social de la Universi-dad del Litoral en Santa Fe, Argentina. El objetivo fue utilizar algoritmos de clasificación que poseen enfoques descriptivos, y es una de las tareas más utilizada en Minería de Datos para obtener nuevos conocimientos sobre la familia santafecina. La base de datos fue confeccio-nada con la información en el relevamiento de 2009, denominado Onda 2009, y se procesó con el software de minería de datos Weka 3.6.2. Los algoritmos de clasificación que mejores resultados aportaron fueron: ZeroR, Ridor y J48, pertenecientes a los grupos de Reglas y Árboles de Decisión, siendo el algoritmo de clasificación J48 el que mejor clasifica a la En-cuesta Permanente de Hogares 2009 del Observatorio Social de la Universidad Nacional del Litoral. In this work it was applied the Data Mining for the first time, to the information generated by the Permanent Survey of Homes of the year 2009, of the Social Observatory of the University of the Litoral in Santa Fe, Argentina. The objective was to use classification algorithms that possess descriptive focuses and it is one of the tasks more used in Data Mining, to obtain new knowledge on the family of Santa Fe. The database was made with the information of the Permanent Survey of Homes of the year 2009 and it was processed with the software of data mining Weka 3.6.2. The classification algorithms that better results contributed were: ZeroR, Ridor and J48, belonging to the groups of Rules and Trees of Decision, being the classifica-tion algorithm J48 the one that better it classifies to the Permanent Survey of Homes 2009, of the Social Observatory of the National University of the Litoral.

Report of the Study Group on Medical Uses of Accelerators

International Nuclear Information System (INIS)

1978-01-01

Medical uses of accelerators to raise the welfare of peoples are advancing rapidly due to the improvement of using technology. Under the situation, the Study Group on Medical Uses of Accelerators set up in the Science and Technology Agency has surveyed the status in Japan of radiation therapy of cancers and nuclear medicine with accelerators, and has studied on the future research and development in this field. The present report should contribute to the plans by the Government for the future. The results obtained by the study Group are described: the trends of medicine for the next ten years, especially the advances of cancer diagnosis and treatment and nuclear medicine; and medical radiation sources and the accelerators as their generators expected to be in practical utilization. As for the particles from accelerators used for medical purposes, there are fast neutrons, protons, helium particles, charged heavy particles, and π-mesons. For diagnosis and treatment, the radiation sources must be chosen according to the purposes, and their combination becomes necessary. (Mori, K.)

Tratamiento de un molar permanente inmaduro necrótico mediante pulpotomía

OpenAIRE

Boj Quesada, Juan Ramón; Cortés Lillo, Olga; Canalda Sahli, Carlos

1995-01-01

Se describe un caso que afecta al primer molar permanente inferior derecho, con tumefacción, fluctuación y fístula , con ápices no cerrados. El tratamiento de elección hubiese sido una técnica clásica de apicoformación con hidróxido de calcio. Pero por motivos de colaboración, se realizó una pulpotomía con hidróxido de calcio. Tras los controles radiológicos a los 3 meses, al año y al año y medio se comprobó que continuaba el desarrollo radicular y finalizaba el cierre apical.

A novel power harmonic analysis method based on Nuttall-Kaiser combination window double spectrum interpolated FFT algorithm

Science.gov (United States)

Jin, Tao; Chen, Yiyang; Flesch, Rodolfo C. C.

2017-11-01

Harmonics pose a great threat to safe and economical operation of power grids. Therefore, it is critical to detect harmonic parameters accurately to design harmonic compensation equipment. The fast Fourier transform (FFT) is widely used for electrical popular power harmonics analysis. However, the barrier effect produced by the algorithm itself and spectrum leakage caused by asynchronous sampling often affects the harmonic analysis accuracy. This paper examines a new approach for harmonic analysis based on deducing the modifier formulas of frequency, phase angle, and amplitude, utilizing the Nuttall-Kaiser window double spectrum line interpolation method, which overcomes the shortcomings in traditional FFT harmonic calculations. The proposed approach is verified numerically and experimentally to be accurate and reliable.

The effectiveness of group visits for patients with heart failure on knowledge, quality of life, self-care, and readmissions: a systematic review protocol.

Science.gov (United States)

Slyer, Jason T; Ferrara, Lucille R

.The process of the group visit was first developed in 1991 by Dr. John C. Scott at the Kaiser Permanente system in Colorado, United States. Dr. Scott and a nurse held monthly group visits lasting 60 minutes with a group of 15 to 20 patients to manage their complex medical conditions. The group visit model can vary across settings, including from 6-20 patients over a 1-2 hour period with varying times devoted to education and discussion of health concerns. The group visit typically incorporates a one-on-one physical examination with a physician or nurse practitioner in conjunction with a group discussion and medical management. Group visits have shown to be beneficial in improving patient outcomes for conditions such as diabetes, hypertension, and other chronic illness.The goal of group visits for patients with HF is to increase patient knowledge and self-care abilities, while improving self-efficacy. Self-care incorporates the decision making process a patient undergoes when deciding on a course of action to maintain stability as a result of a change in symptoms. Improved self-care can improve symptoms, which will likely result in an increase in quality of life and a reduction in hospitalizations related to decompensation. Quality of life (QOL) refers to a patient's perception of the impact of a health condition and treatment on the patient's health status and can be measured with valid and reliable tools such as the Minnesota Living with Heart Failure Questionnaire (MLHFQ) or the Kansas City Cardiomyopathy Questionnaire (KCCQ). Self-care abilities can be measured using an instrument such as the Self-Care Heart Failure Index (SCHFI). HF knowledge can be measured using an instrument such as the Atlanta Heart Failure Knowledge Test. Group visits can be used to continue to optimize medication therapy while providing a forum for knowledge acquisition and fostering support.A search of the Cochrane Library of Systematic Reviews, the Joanna Briggs Library of Systematic Reviews

Armouring facility? Nuclear-weapon and reactor reseach at the Kaiser-Wilhelm Institute for Physics

International Nuclear Information System (INIS)

Hachtmann, R.; Walker, M.

2005-01-01

The Kaiser Wilhelm Institute for Physics is best known as the place where Werner Heisenberg worked on nuclear weapons for Hitler. Although this is essentially true, there is more to the story. At the start of World War II this institute was taken over by the German Army Ordnance to be the central, but not exclusive site for a research project into the economic and military applications of nuclear fission. The Army physicist Kurt Diebner was installed in the institute as its commissarial director. Heisenberg was affiliated with the institute as an advisor at first, and became the director in 1942. Heisenberg and his colleagues, including in particular Karl-Heinz Hoecker, Carl Friedrich von Weizsaecker, and Karl Wirtz, worked on nuclear reactors and isotope separation with the clear knowledge that these were two different paths to atomic bombs [Atombomben]. However, they were clearly ambivalent about what they were doing. New documents recently returned from Russian archives shed new light on this work and the scientists' motivations. (orig.)

PS3-18: Use of Antidepressant and Anti-Anxiety Medications Among Breast Cancer Survivors in a HMO

Science.gov (United States)

Avila, Chantal; Haque, Reina; Quinn, Virginia; Schottinger, Joanne; Fisher, Alice

2010-01-01

Background: Almost 200,000 U.S. women are diagnosed each year with breast cancer and over 40,000 women will die of the disease. In addition to the medical and functional consequences of the diagnosis and treatment, women experience worry, persistent anxiety, fear and depressive disorders. Overall, 30% of women diagnosed with breast cancer suffer significant distress at some point in their illness trajectory. National health organizations including the Institute of Medicine and National Cancer Institute call for treatment of common symptoms among breast cancer patients such as depression and anxiety. To date, there are only limited reports on the prevalence of treatment, and even fewer studies have examined potential differences by race/ethnicity, age, or tumor characteristics. Aim: To describe the prevalence of pharmacotherapy for depressive symptoms/anxiety among patients diagnosed with breast cancer in a large HMO. Methods: We identified all women diagnosed with primary breast cancer between 2000–2006 (n=10,408) who had been members of Kaiser Permanente Southern California (KPSC) for 1+ years prior to diagnosis. KPSC is a nonprofit comprehensive prepaid health plan serving 3.2 million socioeconomically diverse members. Data was obtained from the KPSC SEER-affiliated cancer registry and automated clinical, pharmacy, and membership databases. We examined patient and tumor characteristics associated with new use of pharmacotherapy for depression/anxiety. Univariate odds ratios (OR) and 95% confidence intervals (CI) were estimated using logistic regression. Results: We found 35% of women (3,611 of 10,408) were newly prescribed either anti-depressant or anti-anxiety medications within a year of breast cancer diagnosis. Younger women (e.g., OR=1.44, CI=1.28–1.63 for 40–49 year olds v. 60–69) and women with higher stage (e.g., OR=3.40, CI=2.87–4.04 for Stage 3 v. Stage 0) were more likely to be prescribed these medications, while African-American (OR=0.81, CI

Prevalence of migraine in a diverse community--electronic methods for migraine ascertainment in a large integrated health plan.

Science.gov (United States)

Pressman, Alice; Jacobson, Alice; Eguilos, Roderick; Gelfand, Amy; Huynh, Cynthia; Hamilton, Luisa; Avins, Andrew; Bakshi, Nandini; Merikangas, Kathleen

2016-04-01

The growing availability of electronic health data provides an opportunity to ascertain diagnosis-specific cases via systematic methods for sample recruitment for clinical research and health services evaluation. We developed and implemented a migraine probability algorithm (MPA) to identify migraine from electronic health records (EHR) in an integrated health plan. We identified all migraine outpatient diagnoses and all migraine-specific prescriptions for a five-year period (April 2008-March 2013) from the Kaiser Permanente, Northern California (KPNC) EHR. We developed and evaluated the MPA in two independent samples, and derived prevalence estimates of medically-ascertained migraine in KPNC by age, sex, and race. The period prevalence of medically-ascertained migraine among KPNC adults during April 2008-March 2013 was 10.3% (women: 15.5%, men: 4.5%). Estimates peaked with age in women but remained flat for men. Prevalence among Asians was half that of whites. We demonstrate the feasibility of an EHR-based algorithm to identify cases of diagnosed migraine and determine that prevalence patterns by our methods yield results comparable to aggregate estimates of treated migraine based on direct interviews in population-based samples. This inexpensive, easily applied EHR-based algorithm provides a new opportunity for monitoring changes in migraine prevalence and identifying potential participants for research studies. © International Headache Society 2015.

Multidimensional digital image representations using generalized Kaiser-Bessel window functions.

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Lewitt, R M

1990-10-01

Inverse problems that require the solution of integral equations are inherent in a number of indirect imaging applications, such as computerized tomography. Numerical solutions based on discretization of the mathematical model of the imaging process, or on discretization of analytic formulas for iterative inversion of the integral equations, require a discrete representation of an underlying continuous image. This paper describes discrete image representations, in n-dimensional space, that are constructed by the superposition of shifted copies of a rotationally symmetric basis function. The basis function is constructed using a generalization of the Kaiser-Bessel window function of digital signal processing. The generalization of the window function involves going from one dimension to a rotationally symmetric function in n dimensions and going from the zero-order modified Bessel function of the standard window to a function involving the modified Bessel function of order m. Three methods are given for the construction, in n-dimensional space, of basis functions having a specified (finite) number of continuous derivatives, and formulas are derived for the Fourier transform, the x-ray transform, the gradient, and the Laplacian of these basis functions. Properties of the new image representations using these basis functions are discussed, primarily in the context of two-dimensional and three-dimensional image reconstruction from line-integral data by iterative inversion of the x-ray transform. Potential applications to three-dimensional image display are also mentioned.

Impact of a Social Media Group Page on Undergraduate Medical Physiology Learning.

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Shakoori, Tania Ahmed; Mahboob, Usman; Strivens, Janet; Willis, Ian

2017-07-01

To investigate the impact of associating classroom learning of medical physiology with a Facebook group page in an all-women medical college of a conservative small city in Pakistan. Qualitative interpretivist study using semi-structured interviews. Women Medical College Abbottabad, Pakistan, from March to December 2014. Aclosed Facebook study group was established at a local medical college in Pakistan. It was used to upload learning resources and initiate discussions, coordinated with classroom lectures of physiology. Thirteen semistructured interviews were conducted with volunteer students according to a standard protocol. Five major themes were identified. Facebook group is something new and exciting; it motivated self-study, research, collaborative learning and improved class attendance. Convenience of easily accessible resources allowed the students to concentrate on the lecture rather than note taking. It was easier to communicate with the instructor through Facebook than face to face. Lurkers were also learning. High achievers who had adapted to the current didactic system of teaching were less receptive of the collaborative learning and favored teaching geared towards exam preparation. Using social media for e-learning in undergraduate medical education can enhance the student learning experience, especially in resource-limited regions where Information and communication technology is not an integrated part of the teaching process.

Performance Anxiety at English PBL Groups Among Taiwanese Medical Students: A Preliminary Study

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Cheng-Sheng Chen

2008-03-01

Full Text Available Students' performance anxiety can impact negatively on the effectiveness of medical education reform, including performance in problem-based learning (PBL and in using English in discussion. This study aimed to investigate the nature of performance anxiety among Taiwanese medical students in an English-language PBL group. Eighteen Taiwanese, one American and four Asian medical students who were attending an international PBL workshop were enrolled. A questionnaire seeking demographic data and experience in use of PBL and eight questions evaluating performance anxiety were administered. The performance anxiety of Taiwanese medical students was compared to that of the Asians and the one American. Frequencies of each performance anxiety were calculated. The results suggested that the Taiwanese students showed more anxiety than the one student from the United States, but less than other Asian students. The acts of giving a report, being the center of attention, and talking in the PBL group were the most common situations related to anxiety in PBL groups. Using English and working in a new PBL environment are possible sources of anxiety. The presence of anxiety among the Taiwanese medical students in English PBL groups implies the necessity for developing an effective strategy to deal with students' performance anxiety.

Medical specialty preferences in early medical school training in Canada.

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Vo, Anthony; McLean, Laurie; McInnes, Matthew D F

2017-11-14

To understand what medical students consider when choosing their specialty, prior to significant clinical exposure to develop strategies to provide adequate career counseling. A cross-sectional study was performed by distributing optional questionnaires to 165 first-year medical students at the University of Ottawa in their first month of training with a sample yield of 54.5% (n=90).  Descriptive statistics, analysis of variance, Spearman's rank correlation, Cronbach's alpha coefficient, Kaiser-Meyer-Olkin Measure, and exploratory factor analyses were used to analyze the anonymized results. "Job satisfaction", "lifestyle following training" and, "impact on the patient" were the three highest rated considerations when choosing a specialty.  Fifty-two and seventeen percent (n=24) and 57.89% (n=22) of males and females ranked non-surgical specialties as their top choice. Student confidence in their specialty preferences was moderate, meaning their preference could likely change (mean=2.40/5.00, SD=1.23). ANOVA showed no significant differences between confidence and population size (F(2,86)=0.290, p=0.75) or marital status (F(2,85)=0.354, p=0.70) in both genders combined. Five underlying factors that explained 44.32% of the total variance were identified. Five themes were identified to enhance career counseling. Medical students in their first month of training have already considered their specialty preferences, despite limited exposure. However, students are not fixed in their specialty preference. Our findings further support previous results but expand what students consider when choosing their specialty early in their training. Medical educators and administrators who recognize and understand the importance of these considerations may further enhance career counseling and medical education curricula.

EDUCAÇÃO PERMANENTE NO CONTEXTO HOSPITALAR: A EXPERIÊNCIA QUE RESSIGNIFICA O CUIDADO EM ENFERMAGEM

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Flores,Giovana Ely; Oliveira,Dora Lúcia Leidens de; Zocche,Denise Antunes de Azambuja

2016-01-01

Resumo O artigo aborda o processo de formação vivenciado por enfermeiras educadoras no contexto hospitalar, na perspectiva da educação permanente em saúde, com destaques para as experiências que constituíram esse processo, os sentidos dessa formação e as mudanças decorridas no desenvolvimento do cuidado de enfermagem com base nas aprendizagens significativas. Tratou-se de estudo qualitativo exploratório-descritivo, desenvolvido por meio de grupos focais com sete enfermeiras que atuavam no Pro...

Evolution, current structure, and role of a primary care clinical pharmacy service in an integrated managed care organization.

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Heilmann, Rachel M F; Campbell, Stephanie M; Kroner, Beverly A; Proksel, Jenel R; Billups, Sarah J; Witt, Daniel M; Helling, Dennis K

2013-01-01

The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.

Systematic review of economic evaluation studies and budget impact on ambulatory monitoring of capillary glucose in type 2 diabetics.

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Olry de Labry Lima, Antonio; Moya Garrido, María Natividad; Espín Balbino, Jaime

2014-04-01

Realise a review of studies of economic evaluation about the ambulatory monitoring of capillary glucose (AMGC) in diabetic type II persons. A review of the literature was conducted, in MedLine, various websites, referenced paper and provided by expert's persons. Five studies concluded that the AMGC was a cost-effective strategic, of this papers use Kaiser Permanente data base, its make that these studies could be considered a solely one study. The rest of the papers did not find difference in the AMGC use. The use of AMGC has an uncertainty efficiency. More studies are needed. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Environmental aspects of Kaiser S2 harvester utilization in mountain terrains

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Jozef Slugeň

2012-01-01

Full Text Available This paper deals with evaluating the ecological impacts of Kaiser S2 harvester utilization in mountain terrains. The harvester was used in bark beetle calamity and secondary felling in mixed forest (spruce, fir, beech stand with average incline of 70%. Assisting its movement in these extreme conditions were two supporting bases, which were used to stabilize it in the stand. Our aim was to determine the damage to the trees, underwood and stand soil. The resulting damage of remaining stand was 6.19%, which is, considering the demanding terrain conditions and in comparison with the outcomes of other research, a relatively acceptable value. Damage to the underwood was not found, due to its insufficient height and low representation. Measurements of damage to the soil by its compression indicated that the heaviest damage was under the supporting bases, where a heavy surface damage was found by creation of holes up to 15 cm deep. This type of damage is not dangerous, because it does not create a continuous track dangerous in storm rainfall and subsequent soil erosion. Soil compression in the track and on unimpaired soil reached lower levels. All of the measurements of compression by static penetration were carried out only to the depth of 15 cm due to high soil skeleton. This also negatively affected the measurements, which had to be repeated in many cases.

Antecedentes históricos del proceso de formación permanente del maestro tutor y su sistematización

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MSc. Nirma Pérez-Pelipiche

2016-02-01

Full Text Available El estudio histórico realizado permitió evidenciar que la formación permanente de los maestros tutores de los estudiantes de Licenciatura en Educación Primaria ha transitado desde de una concepción espontánea, ocasional y a veces improvisada, hacia una más organizada en la que se han asumido posiciones de constantes cambios a favor del proceso formativo universitario pedagógico. Sin embargo, aún persisten restricciones epistemológicas y praxiológicas que limitan su efectividad, siendo notorio en el contexto de la microuniversidad durante la práctica laboral de los estudiantes en formación. Los estudios revelan que si bien el maestro tutor se erige en una figura esencial del proceso formativo pedagógico, no siempre su preparación ha sido efectiva, por lo que se requiere de una dinámica contextualizada de formación permanente que propicie nuevos sistemas de relaciones, vías y actitudes que actualicen y renueven las formas de ejercer sus funciones formativas en correspondencia con la realidad educativa contemporánea.

Medical Student Perspectives of Active Learning: A Focus Group Study.

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Walling, Anne; Istas, Kathryn; Bonaminio, Giulia A; Paolo, Anthony M; Fontes, Joseph D; Davis, Nancy; Berardo, Benito A

2017-01-01

Phenomenon: Medical student perspectives were sought about active learning, including concerns, challenges, perceived advantages and disadvantages, and appropriate role in the educational process. Focus groups were conducted with students from all years and campuses of a large U.S. state medical school. Students had considerable experience with active learning prior to medical school and conveyed accurate understanding of the concept and its major strategies. They appreciated the potential of active learning to deepen and broaden learning and its value for long-term professional development but had significant concerns about the efficiency of the process, the clarity of expectations provided, and the importance of receiving preparatory materials. Most significantly, active learning experiences were perceived as disconnected from grading and even as impeding preparation for school and national examinations. Insights: Medical students understand the concepts of active learning and have considerable experience in several formats prior to medical school. They are generally supportive of active learning concepts but frustrated by perceived inefficiencies and lack of contribution to the urgencies of achieving optimal grades and passing United States Medical Licensing Examinations, especially Step 1.

CREATE Wellness: A multi-component behavioral intervention for patients not responding to traditional Cardiovascular disease management.

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Miller-Rosales, Chris; Sterling, Stacy A; Wood, Sabrina B; Ross, Thekla; Makki, Mojdeh; Zamudio, Cindy; Kane, Irene M; Richardson, Megan C; Samayoa, Claudia; Charvat-Aguilar, Nancy; Lu, Wendy Y; Vo, Michelle; Whelan, Kimberly; Uratsu, Connie S; Grant, Richard W

2017-12-01

Cardiovascular disease (CVD) is the leading cause of death in the US. Many patients do not benefit from traditional disease management approaches to CVD risk reduction. Here we describe the rationale, development, and implementation of a multi-component behavioral intervention targeting patients who have persistently not met goals of CVD risk factor control. Informed by published evidence, relevant theoretical frameworks, stakeholder advice, and patient input, we developed a group-based intervention (Changing Results: Engage and Activate to Enhance Wellness; "CREATE Wellness") to address the complex needs of patients with elevated or unmeasured CVD-related risk factors. We are testing this intervention in a randomized trial among patients with persistent (i.e > 2 years) sub-optimal risk factor control despite being enrolled in an advanced and highly successful CVD disease management program. The CREATE Wellness intervention is designed as a 3 session, group-based intervention combining proven elements of patient activation, health system engagement skills training, shared decision making, care planning, and identification of lifestyle change barriers. Our key learnings in designing the intervention included the value of multi-level stakeholder input and the importance of pragmatic skills training to address barriers to care. The CREATE Wellness intervention represents an evidence-based, patient-centered approach for patients not responding to traditional disease management. The trial is currently underway at three medical facilities within Kaiser Permanente Northern California and next steps include an evaluation of efficacy, adaptation for non-English speaking patient populations, and modification of the curriculum for web- or phone-based versions. NCT02302612.

Telephone-Based Coaching.

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Boccio, Mindy; Sanna, Rashel S; Adams, Sara R; Goler, Nancy C; Brown, Susan D; Neugebauer, Romain S; Ferrara, Assiamira; Wiley, Deanne M; Bellamy, David J; Schmittdiel, Julie A

2017-03-01

Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations. Retrospective cohort study comparing wellness coaching participants with two groups of controls. Kaiser Permanente Northern California, a large integrated health care delivery system. Two hundred forty-one patients who participated in telephonic tobacco cessation coaching from January 1, 2011, to March 31, 2012, and two control groups: propensity-score-matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing-based coaching sessions that engaged the patient, evoked their reason to consider quitting, and helped them establish a quit plan. Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up. Logistic regressions adjusting for age, gender, race/ethnicity, and primary language. After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, p Coaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, p coaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health.

Telephone-Based Coaching: A Comparison of Tobacco Cessation Programs in an Integrated Health Care System

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Boccio, Mindy; Sanna, Rashel S.; Adams, Sara R.; Goler, Nancy C.; Brown, Susan D.; Neugebauer, Romain S.; Ferrara, Assiamira; Wiley, Deanne M.; Bellamy, David J.; Schmittdiel, Julie A.

2016-01-01

Purpose Many Americans continue to smoke, increasing their risk of disease and premature death. Both telephone-based counseling and in-person tobacco cessation classes may improve access for smokers seeking convenient support to quit. Little research has assessed whether such programs are effective in real-world clinical populations. Design Retrospective cohort study comparing wellness coaching participants with two groups of controls. Setting Kaiser Permanente, Northern California (KPNC), a large integrated health care delivery system. Subjects 241 patients who participated in telephonic tobacco cessation coaching from 1/1/2011–3/31/2012, and two control groups: propensity-score matched controls, and controls who participated in a tobacco cessation class during the same period. Wellness coaching participants received an average of two motivational interviewing based coaching sessions that engage the patient, evoke their reason to consider quitting and help them establish a quit plan. Measures Self-reported quitting of tobacco and fills of tobacco cessation medications within 12 months of follow-up. Analysis Logistic regressions adjusting for age, gender, race/ethnicity, and primary language. Results After adjusting for confounders, tobacco quit rates were higher among coaching participants vs. matched controls (31% vs. 23%, PCoaching participants and class attendees filled tobacco-cessation prescriptions at a higher rate (47% for both) than matched controls (6%, Pcoaching was as effective as in-person classes and was associated with higher rates of quitting compared to no treatment. The telephonic modality may increase convenience and scalability for health care systems looking to reduce tobacco use and improve health. PMID:26559720

Student pharmacist experiences as inpatient psychiatry medication education group leaders during an early immersion program.

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McLaughlin, Jacqueline E; Kennedy, Lindsey; Garris, Shauna; Harris, Suzanne C; Hillman, Ashley; Pinelli, Nicole R; Rhoney, Denise H

2017-09-01

While research suggests that pharmacists generally hold positive attitudes toward consumers of psychiatric medications, they often feel less comfortable talking about these medications and providing services for patients with mental illness. The purpose of this program was to train second and third year student pharmacists as psychiatry medication education groups leaders and to examine resulting student self-efficacy and mental health stigma. In partnership with the University of North Carolina (UNC) Eshelman School of Pharmacy, the inpatient psychiatry service at UNC Medical Center expanded weekly medication education groups with the help of trained student pharmacists. All second- and third-year student pharmacists were invited to participate. Pre/post surveys and reflection statements were collected from 13 students that received training, provided informed consent, and participated in one or more medication education groups. Data were analyzed with a mixed methods approach. Student responses revealed an increase in student self-efficacy (p appreciation for pharmacists and the workplace while developing self-efficacy and strategies for engaging with patients with mental illness as a part of medication education groups. Copyright © 2017 Elsevier Inc. All rights reserved.

Pre-Enrollment Reimbursement Patterns of Medicare Beneficiaries Enrolled in “At-Risk” HMOs

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Eggers, Paul W.; Prihoda, Ronald

1982-01-01

The Health Care Financing Administration (HCFA) has initiated several demonstration projects to encourage HMOs to participate in the Medicare program under a risk mechanism. These demonstrations are designed to test innovative marketing techniques, benefit packages, and reimbursement levels. HCFA's current method for prospective payments to HMOs is based on the Adjusted Average Per Capita Cost (AAPCC). An important issue in prospective reimbursement is the extent to which the AAPCC adequately reflects the risk factors which arise out of the selection process of Medicare beneficiaries into HMOs. This study examines the pre-enrollment reimbursement experience of Medicare beneficiaries who enrolled in the demonstration HMOs to determine whether or not a non-random selection process took place. The three demonstration HMOs included in the study are the Fallon Community Health Plan, the Greater Marshfield Community Health Plan, and the Kaiser-Permanente medical program of Portland, Oregon. The study includes 18,085 aged Medicare beneficiaries who had enrolled in the three plans as of April, 1981. We included comparison groups consisting of a 5 percent random sample of aged Medicare beneficiaries (N = 11,240) living in the same geographic areas as the control groups. The study compares the groups by total Medicare reimbursements for the years 1976 through 1979. Adjustments were made for AAPCC factor differences in the groups (age, sex, institutional status, and welfare status). In two of the HMO areas there was evidence of a selection process among the HMOs enrollees. Enrollees in the Fallon and Kaiser health plans were found to have had 20 percent lower Medicare reimbursements than their respective comparison groups in the four years prior to enrollment. This effect was strongest for inpatient services, but a significant difference also existed for use of physician and outpatient services. In the Marshfield HMO there was no statistically significant difference in pre

Educação permanente e qualidade da assistência à saúde: aprendizagem significativa no trabalho da enfermagem

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Fernanda Maria do Carmo da Silveira Neves de Oliveira

2011-01-01

Full Text Available El objetivo de este artículo es analizar la educación permanente en la práctica de la enfermería. En la actualidad, existe preocupación por los cambios introducidos en la estructura de enseñanza y la aplicación de metodologías activas para capacitar profesionales de salud. En el artículo se reflexiona sobre aspectos cotidianos de la enfermería y la manera actual de suministrar o proporcionar información tecnocientífica al enfermero durante la práctica en el hospital, tratando de enriquecer la asistencia de enfermería mediante la educación permanente. Se describen las prácticas trasformadoras aplicadas por el enfermero asistencial como elemento facilitador del proceso enseñanza-aprendizaje. Se lleva a cabo una revisión amplia de las bases de datos informáticas. En consecuencia, la selección de los textos se basa en los criterios de inclusión y exclusión, y dio origen a 50 artículos científicos. En años recientes, la educación permanente se introdujo como un método en el área de la salud, convirtiéndose en un aspecto indispensable en las prácticas de formación, atención, gestión, formulación de políticas públicas y control social. Así se estableció la idea de cuidado total y se trasformaron e integraron los saberes y las prácticas en el ámbito real del público al que va dirigido. Se concluye que la motivación para actualizar permanentemente la práctica profesional del equipo de enfermería prevé la aplicación de un instrumento interdisciplinario de solubilidad que promueva la visibilidad de las acciones por los clientes y sus familias.

Parálisis facial permanente: corrección quirúrgica con la técnica de Labbé

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Rubén Yangali

2008-12-01

Full Text Available La parálisis facial genera un gran déficit estético y funcional. Las diversas técnicas quirúrgicas han ido evolucionando, a fin de corregir este defecto de la forma más estructural y fisiológica posible. Consideramos que la mioplastia de alargamiento del temporal constituye actualmente la técnica de elección para corregir los casos de parálisis facial permanente.

Mediación de la cultura docente en los proyectos de formación permanente (Mediation of culture teaching in lifelong learning projects (Médiation de la culture de l'enseignant dans les projets de formation continue (Mediação da cultura docente nos projectos de formação permanente

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Rosa Amaya-de Rebolledo

2010-12-01

Full Text Available ResumenLa formación permanente del docente juega un papel clave en el cambio educativo; sin embargo, su con- creción práctica representa un reto epistemológico y metodológico. La problemática ha sido abordada des- de diferentes ángulos, en los cuales la relación entre cultura docente y formación permanente no ha sido claramente desvelada. En este artículo, que constituye un avance en la investigación de tesis doctoral de la Facultad de Ciencias de la Educación de la Universidad de Carabobo, se analiza por qué la cultura docente necesita ser reconocida como una realidad dinámica, dialéctica y relacional que afecta la calidad de la for- mación permanente del docente venezolano.AbstractThe continuous training of the teacher plays a key role in educational change; however, to take it to the practice rep- resents an epistemological and meth- odological challenge. The problem has been approached from different angles, where the relation between culture of the teacher and continuous training has not been clearly discussed. In this article, which constitutes an advance in the investigation of doctoral thesis of the Faculty of Sciences of the Education of Carabobo's University, it is analyzed why the culture of the teacher needs to be recognized as a dynamic reality, dialectic and relational that affects the quality of the continuous training in Venezuelan.RésuméLa formation continue des enseignants joue un rôle essentiel dans le changement éducatif, cependant, sa concrétion prati- que représente un défi épistémologique et méthodologique. La problématique a été envisagée dès perspectives différen- tes, dans lesquelles la relation entre la culture de l'enseignant et la formation continue n'a pas encore été nettement dévoilée. Dans cet article, qui constitue une avance dans la recherche de thèse doctorale de la Faculté de Sciences de l'Éducation de l'Université de Carabobo, on

Medical students perceive better group learning processes when large classes are made to seem small.

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Hommes, Juliette; Arah, Onyebuchi A; de Grave, Willem; Schuwirth, Lambert W T; Scherpbier, Albert J J A; Bos, Gerard M J

2014-01-01

Medical schools struggle with large classes, which might interfere with the effectiveness of learning within small groups due to students being unfamiliar to fellow students. The aim of this study was to assess the effects of making a large class seem small on the students' collaborative learning processes. A randomised controlled intervention study was undertaken to make a large class seem small, without the need to reduce the number of students enrolling in the medical programme. The class was divided into subsets: two small subsets (n=50) as the intervention groups; a control group (n=102) was mixed with the remaining students (the non-randomised group n∼100) to create one large subset. The undergraduate curriculum of the Maastricht Medical School, applying the Problem-Based Learning principles. In this learning context, students learn mainly in tutorial groups, composed randomly from a large class every 6-10 weeks. The formal group learning activities were organised within the subsets. Students from the intervention groups met frequently within the formal groups, in contrast to the students from the large subset who hardly enrolled with the same students in formal activities. Three outcome measures assessed students' group learning processes over time: learning within formally organised small groups, learning with other students in the informal context and perceptions of the intervention. Formal group learning processes were perceived more positive in the intervention groups from the second study year on, with a mean increase of β=0.48. Informal group learning activities occurred almost exclusively within the subsets as defined by the intervention from the first week involved in the medical curriculum (E-I indexes>-0.69). Interviews tapped mainly positive effects and negligible negative side effects of the intervention. Better group learning processes can be achieved in large medical schools by making large classes seem small.

Differences in attitudes towards medication between population groups in the Durban Metropolitan Area of South Africa.

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Suleman, Fatima; Ally, Shabnam; Bayat, Samirah; Essack, Razia; Moodley, Renalda; Mtembu, Thobekile; Ramalingham, Emily

2009-08-01

Personal factors, especially attitude, have been implicated in the utilization of health care services, and in access to medical treatment. There is little information on the attitudes of the general public in South Africa towards medications and whether attitudes differ across population groups or among the different users of the health care system. This study aimed to determine the general attitude of a local population to medications, self-care orientation and health professional contact, and whether differences existed between age groups, gender and race groups. METHODS We carried out a randomized, cross-sectional quantitative study via telephonic questionnaire survey (adapted from a previous study) of a sample of 1132 telephone numbers. The setting was the Durban Metropolitan Area, KwaZulu-Natal, South Africa. KEY FINDINGS A total of 500 (44.2%) people responded. The majority had a positive attitude towards medication. An increase in age resulted in increased medication use. Females were more likely than males to use medication and seek professional health care (P = 0.0406). Most of the respondents (86.0%) were self-care-orientated and displayed moderate medication knowledge (46.2%). Some 295 (59.0%) of the 500 respondents had visited a pharmacy within the last 6 months. Conclusions Health care professionals can adopt an informed approach to address the needs of the population with regard to medication, by targeting groups more likely to use medication (females and the older age group). In addition, gaps in medication knowledge were identified which could be used for health-promotion interventions by health care workers.

Effect of weight loss on urinary incontinence in women

OpenAIRE

Whitcomb, Emily L; Subak, Leslee L

2011-01-01

Emily L Whitcomb1, Leslee L Subak21Southern California Permanente Medical Group, Female Pelvic Medicine and Reconstructive Surgery, Orange County-Irvine Medical Center, Irvine, CA, USA; 2University of California San Francisco, UCSF Departments of Obstetrics, Gynecology and Reproductive Sciences, and Urology, and Epidemiology and Biostatistics, SF Veterans Affairs Medical Center, San Francisco, CA, USABackground: The purpose of this research was review the epidemiology of the association of ob...

Neuropathological research at the "Deutsche Forschungsanstalt fuer Psychiatrie" (German Institute for Psychiatric Research) in Munich (Kaiser-Wilhelm-Institute). Scientific utilization of children's organs from the "Kinderfachabteilungen" (Children's Special Departments) at Bavarian State Hospitals.

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Steger, Florian

2006-09-01

During National Socialism, the politically motivated interest in psychiatric genetic research lead to the founding of research departments specialized in pathological-anatomical brain research, the two Kaiser Wilhelm-Institutes (KWI) in Berlin and Munich. The latter was indirectly provided with brain material by Bavarian State Hospitals, to three of which "Kinderfachabteilungen" (Special Pediatric Units) were affiliated. As children became victims of the systematically conducted child "euthanasia" in these Special Pediatric Units, this paper will address the question whether and to which extent the organs from victims of child "euthanasia" were used for (neuro-) pathological research at the KWI in Munich. By means of case studies and medical histories (with focus on the situation in Kaufbeuren-Irsee), I will argue that pediatric departments on a regular base delivered slide preparations, that the child "euthanasia" conduced in these departments systematically contributed to neuropathological research and that slide preparations from victims of child "euthanasia" were used in scientific publications after 1945.

Small group effectiveness during pharmacology learning sessions in a Nepalese medical school.

Science.gov (United States)

Shankar, Pr; Gurung, Sb; Jha, N; Bajracharya, O; Karki, Bms; Thapa, Tp

2011-01-01

Small group learning sessions are used in pharmacology at the KIST Medical College, Lalitpur, Nepal. Feedback about student behaviours that enhance and hinder small group effectiveness was obtained. This will help us improve the small group sessions and will also be useful to educators using small groups in other medical schools. The small groups were self-managing with a group leader, time-keeper, recorder and presenter. Small group effectiveness was measured using the Tutorial Group Effectiveness Instrument (TGEI) developed by Singaram and co-authors. The instrument was administered in June 2010 and key findings obtained were shared with students and facilitators. The instrument was administered again in August. The mean cognitive, motivational, demotivational and overall scores were compared among different categories of respondents in June and August. Scores were also compared between June and August 2010. A total of 89 students participated in the study in June and 88 in August 2010. In June, females rated overall group productivity higher compared to males. The cognitive and motivational scores were higher in August 2010 while the demotivational score was lower. The small group effectiveness was higher in August after the educational intervention which utilised feedback about problems observed, theoretical considerations of effective small groups and how this information can be applied in practice.

75 FR 43557 - TA-W-73,682, Hartford Financial Services Group, Incorporated, Medical Bill Processing and...

Science.gov (United States)

2010-07-26

... Leased Workers From Beeline: Aurora, IL; TA-W-73,682A, Hartford Financial Services Group, Incorporated..., applicable to workers of Hartford Financial Services Group, Incorporated, Medical Bill Processing and Production Center Support, Aurora, Illinois and Hartford Financial Services Group, Incorporated, Medical Bill...

Is the modernisation of postgraduate medical training in the Netherlands successful? Views of the NVMO Special Interest Group on Postgraduate Medical Education

NARCIS (Netherlands)

Scheele, Fedde; Van Luijk, Scheltus; Mulder, Hanneke; Baane, Coby; Den Rooyen, Corry; De Hoog, Matthijs; Fokkema, Joanne; Heineman, Erik; Sluiter, Henk

Background: Worldwide, the modernisation of medical education is leading to the design and implementation of new postgraduate curricula. In this article, the Special Interest Group for postgraduate medical education of the Netherlands Association for Medical Education (NVMO) reports on the

Differential impact of student behaviours on group interaction and collaborative learning: medical students' and tutors' perspectives.

Science.gov (United States)

Iqbal, Maha; Velan, Gary M; O'Sullivan, Anthony J; Balasooriya, Chinthaka

2016-08-22

Collaboration is of increasing importance in medical education and medical practice. Students' and tutors' perceptions about small group learning are valuable to inform the development of strategies to promote group dynamics and collaborative learning. This study investigated medical students' and tutors' views on competencies and behaviours which promote effective learning and interaction in small group settings. This study was conducted at UNSW Australia. Five focus group discussions were conducted with first and second year medical students and eight small group tutors were interviewed. Data were transcribed verbatim and thematic analysis was conducted. Students and tutors identified a range of behaviours that influenced collaborative learning. The main themes that emerged included: respectfulness; dominance, strong opinions and openness; constructiveness of feedback; active listening and contribution; goal orientation; acceptance of roles and responsibilities; engagement and enthusiasm; preparedness; self- awareness and positive personal attributes. An important finding was that some of these student behaviours were found to have a differential impact on group interaction compared with collaborative learning. This information could be used to promote higher quality learning in small groups. This study has identified medical students' and tutors' perceptions regarding interactional behaviours in small groups, as well as behaviours which lead to more effective learning in those settings. This information could be used to promote learning in small groups.

Is the modernisation of postgraduate medical training in the Netherlands successful? Views of the NVMO Special Interest Group on Postgraduate Medical Education

NARCIS (Netherlands)

Scheele, Fedde; van Luijk, Scheltus; Mulder, Hanneke; Baane, Coby; den Rooyen, Corry; de Hoog, Matthijs; Fokkema, Joanne; Heineman, Erik; Sluiter, Henk

2014-01-01

Worldwide, the modernisation of medical education is leading to the design and implementation of new postgraduate curricula. In this article, the Special Interest Group for postgraduate medical education of the Netherlands Association for Medical Education (NVMO) reports on the experiences in the

Las ciencias naturales me generan... emociones vinculadas a las ciencias en la formación docente permanente

OpenAIRE

Mengascini, Adriana

2017-01-01

Presentamos y discutimos resultados de una indagación realizada en el contexto de una propuesta de formación docente permanente, respecto de las emociones asociadas a las ciencias naturales, a su enseñanza y a la realización de trabajos experimentales entre docentes de primaria y secundaria de Argentina. Las emociones manifestadas hacia las ciencias fueron positivas (interés, atracción, motivación), aunque respecto de su enseñanza y la realización de actividades experimentales se expresaron a...

Utility of a dermatology interest group blog: the impact of medical student interest groups and Web 2.0 tools as educational resources

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Jalalat SZ

2014-09-01

Full Text Available Sheila Z Jalalat, Richard F Wagner Jr Department of Dermatology, University of Texas Medical Branch, Galveston, TX, USA Abstract: The open access University of Texas Dermatology Interest Group blog was established in 2004 for the purposes of increasing communication and collaboration between medical students and dermatology faculty, residents, and alumni, as well as to promote educational opportunities and the missions for which the interest group was created. This blog is unique because of its longevity and continuous postings directed toward the educational and professional needs of medical students and residents. A blog user survey was performed to assess viewers' thoughts, purpose of viewing, demographic profile, subscriber status, usage of the blog and other Web 2.0 tools (forums, Facebook, blogs, Twitter, podcasts, and perceived usefulness. Sixty-one anonymous online surveys were completed during a 1-month period. Statistical analyses of the responses demonstrated that the utilization of web-based tools and the blog were valuable resources for students, especially for blog subscribers, those more involved in an interest group, and those reading the blog for a longer period of time. The usefulness and impact of this method of communication and dissemination of information in medical education may encourage other student groups, faculty advisors, and educators to implement similar educational tools at their institutions. Keywords: education, medical student, dermatology, blog

Medical Students Perceive Better Group Learning Processes when Large Classes Are Made to Seem Small

Science.gov (United States)

Hommes, Juliette; Arah, Onyebuchi A.; de Grave, Willem; Schuwirth, Lambert W. T.; Scherpbier, Albert J. J. A.; Bos, Gerard M. J.

2014-01-01

Objective Medical schools struggle with large classes, which might interfere with the effectiveness of learning within small groups due to students being unfamiliar to fellow students. The aim of this study was to assess the effects of making a large class seem small on the students' collaborative learning processes. Design A randomised controlled intervention study was undertaken to make a large class seem small, without the need to reduce the number of students enrolling in the medical programme. The class was divided into subsets: two small subsets (n = 50) as the intervention groups; a control group (n = 102) was mixed with the remaining students (the non-randomised group n∼100) to create one large subset. Setting The undergraduate curriculum of the Maastricht Medical School, applying the Problem-Based Learning principles. In this learning context, students learn mainly in tutorial groups, composed randomly from a large class every 6–10 weeks. Intervention The formal group learning activities were organised within the subsets. Students from the intervention groups met frequently within the formal groups, in contrast to the students from the large subset who hardly enrolled with the same students in formal activities. Main Outcome Measures Three outcome measures assessed students' group learning processes over time: learning within formally organised small groups, learning with other students in the informal context and perceptions of the intervention. Results Formal group learning processes were perceived more positive in the intervention groups from the second study year on, with a mean increase of β = 0.48. Informal group learning activities occurred almost exclusively within the subsets as defined by the intervention from the first week involved in the medical curriculum (E-I indexes>−0.69). Interviews tapped mainly positive effects and negligible negative side effects of the intervention. Conclusion Better group learning processes can be

Competitive forces in the medical group industry: a stakeholder perspective.

Science.gov (United States)

Blair, J D; Buesseler, J A

1998-01-01

Applying Porter's model of competitive forces to health care, stakeholder concepts are integrated to analyze the future of medical groups. Using both quantitative survey and qualitative observational data, competitors, physician suppliers, integrated systems new entrants, patient and managed care buyers, and hospitals substitutes are examined.

Conceptual foundations of classes with the disciples of special medical group in secondary schools

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Y. V. Vaskov

2014-09-01

Full Text Available Purpose: study and scientific rationale for new approaches to the organization of educational work with students of special medical group in secondary schools. Material : analyzed 15 scientific sources regarding the approaches of different authors to develop educational programs for students of special medical group. Results : focuses on the outstanding issues in a substantive, logistical and human aspects. Found that the selection of the content of educational material for special medical groups is an empirical question. Selection is carried out by copying the existing curriculum of physical culture for healthy children with an indication of the load reduction and exemption of complex elements. Established a complete absence of evaluation of educational achievements of pupils. Based on modern approaches to teaching students based on biomedical and didactic aspects: Leading defined function of each stage of training, fleshed main goals and objectives of the educational process, substantiated various kinds of sports activity, taking into account the diagnosis of diseases and the needs of students of different ages and gender. Conclusions : the main controversy in the decision of the designated problem. Substantiated leading features of each stage of training in special medical groups. A system of assessment of students' achievements.

Outcomes in Patients Treated with a Novel, Simple Method for Hemostasis of Dermal Avulsion Injuries.

Science.gov (United States)

Dowling, Sean Taylor; Lin, Brian Wai

2017-10-01

A recently described technique proposes a simple method to achieve permanent hemostasis of distal fingertip dermal avulsion injuries. It is simple to learn and easy to perform with readily available materials found in most emergency departments. However, long-term outcomes for patients treated with this technique have not yet been evaluated. A primary objective of the current article is to provide safety data for the technique using an off-label product indication. Emergency department of Kaiser Permanente Medical Center, San Francisco, California. Six patients were treated in the emergency department for fingertip dermal avulsion injuries using a tourniquet and tissue adhesive glue (Dermabond by Ethicon, Somerville, New Jersey). Patients were subsequently contacted to assess healing and satisfaction with cosmetic outcome through interview and photographs of their wounds at 9 months following the date of injury. All 6 patients were satisfied with the cosmetic outcome of treatment, and none received a diagnosis of serious complications. This series demonstrates cosmetic outcomes for injuries treated with the technique, highlights potential problems that may be perceived by patients during their clinical course, and creates the groundwork for a larger clinical study examining the use of the technique.

Career ladder program for registered nurses in ambulatory care.

Science.gov (United States)

Nelson, Joan; Sassaman, Becky; Phillips, Alison

2008-01-01

RN ladder programs are designed to inspire and reward clinical excellence. Kaiser Permanente Colorado's (KPCO) career ladder program emerged as a result of a labor-management partnership. Career ladder point assignments are reflective of the organization's priorities and values. KPCO's career ladder point tool awards RNs for formal and continuing education, professional presentations, organizational experience and experience as an RN, certifications and active professional memberships, leadership activities, research and publications, and nursing-related volunteer work. Participation in the RN career ladder requires that the nurse achieve a self-determined, manager-approved, measurable goal that will improve patient care. Career ladder nurses at KPCO were significantly more involved in leadership and interdisciplinary activities, quality improvement projects, and preceptorship.

Group-sparse representation with dictionary learning for medical image denoising and fusion.

Science.gov (United States)

Li, Shutao; Yin, Haitao; Fang, Leyuan

2012-12-01

Recently, sparse representation has attracted a lot of interest in various areas. However, the standard sparse representation does not consider the intrinsic structure, i.e., the nonzero elements occur in clusters, called group sparsity. Furthermore, there is no dictionary learning method for group sparse representation considering the geometrical structure of space spanned by atoms. In this paper, we propose a novel dictionary learning method, called Dictionary Learning with Group Sparsity and Graph Regularization (DL-GSGR). First, the geometrical structure of atoms is modeled as the graph regularization. Then, combining group sparsity and graph regularization, the DL-GSGR is presented, which is solved by alternating the group sparse coding and dictionary updating. In this way, the group coherence of learned dictionary can be enforced small enough such that any signal can be group sparse coded effectively. Finally, group sparse representation with DL-GSGR is applied to 3-D medical image denoising and image fusion. Specifically, in 3-D medical image denoising, a 3-D processing mechanism (using the similarity among nearby slices) and temporal regularization (to perverse the correlations across nearby slices) are exploited. The experimental results on 3-D image denoising and image fusion demonstrate the superiority of our proposed denoising and fusion approaches.

Small group effectiveness during pharmacology learning sessions in a Nepalese medical school

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Shankar PR

2011-06-01

Full Text Available BackgroundSmall group learning sessions are used in pharmacology atthe KIST Medical College, Lalitpur, Nepal. Feedback aboutstudent behaviours that enhance and hinder small groupeffectiveness was obtained. This will help us improve thesmall group sessions and will also be useful to educatorsusing small groups in other medical schools.MethodThe small groups were self-managing with a group leader,time-keeper, recorder and presenter. Small groupeffectiveness was measured using the Tutorial GroupEffectiveness Instrument (TGEI developed by Singaram andco-authors. The instrument was administered in June 2010and key findings obtained were shared with students andfacilitators. The instrument was administered again inAugust. The mean cognitive, motivational, demotivationaland overall scores were compared among differentcategories of respondents in June and August. Scores werealso compared between June and August 2010.ResultsA total of 89 students participated in the study in June and88 in August 2010. In June, females rated overall groupproductivity higher compared to males. The cognitive andmotivational scores were higher in August 2010 while thedemotivational score was lower.ConclusionThe small group effectiveness was higher in August after theeducational intervention which utilised feedback aboutproblems observed, theoretical considerations of effectivesmall groups and how this information can be applied inpractice.

La formación del profesorado de Historia en Chile. La formación inicial y permanente de los educadores de la V región en el marco de la reforma educacional

OpenAIRE

Vásquez Lara, Nelson Lorenzo

2004-01-01

[spa] Objetivos Generales:A. Conocer las principales características que ha tenido la formación inicial de los Profesores de Historia, Geografía y Ciencias Sociales chilenos.B. Conocer las principales características que ha tenido la formación permanente de los profesores de Historia, Geografía y Ciencias Sociales chilenos.C. Averiguar la percepción que los profesores de historia chilenos tienen sobre el grado de utilidad de la formación inicial y permanente.D. Averiguar la percepción que lo...

Formación del profesorado de Historia en Chile. La formación inicial y permanente de los educadores de la V región en el marco de la reforma educacional, La

OpenAIRE

Vásquez Lara, Nelson Lorenzo

2004-01-01

Objetivos Generales:A. Conocer las principales características que ha tenido la formación inicial de los Profesores de Historia, Geografía y Ciencias Sociales chilenos.B. Conocer las principales características que ha tenido la formación permanente de los profesores de Historia, Geografía y Ciencias Sociales chilenos.C. Averiguar la percepción que los profesores de historia chilenos tienen sobre el grado de utilidad de la formación inicial y permanente.D. Averiguar la percepción que los prof...

MERCOSUR ambiental. El aporte del Laudo 1/2012 del Tribunal Permanente de Revisión

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Alberto Cesar Moreira

2014-03-01

Full Text Available El trabajo reflexiona acerca de la dimensión ambiental del MERCOSUR, identificando los desarrollos institucionales y normativos más significativos e intentando desentrañar algunas de las causas que dificultan su consolidación. En ese orden de ideas, destaca la escasa utilización que los Estados han hecho del sistema de solución de controversias de este esquema y pone de resalto el aporte del laudo 1/2012 del Tribunal Permanente de Revisión, ya que al resolver sobre su competencia en razón de la materia, reconoce y acompaña a las distintas dimensiones que el MERCOSUR ha ido desarrollado, entre ellas la ambiental.

Heart rate calculation from ensemble brain wave using wavelet and Teager-Kaiser energy operator.

Science.gov (United States)

Srinivasan, Jayaraman; Adithya, V

2015-01-01

Electroencephalogram (EEG) signal artifacts are caused by various factors, such as, Electro-oculogram (EOG), Electromyogram (EMG), Electrocardiogram (ECG), movement artifact and line interference. The relatively high electrical energy cardiac activity causes EEG artifacts. In EEG signal processing the general approach is to remove the ECG signal. In this paper, we introduce an automated method to extract the ECG signal from EEG using wavelet and Teager-Kaiser energy operator for R-peak enhancement and detection. From the detected R-peaks the heart rate (HR) is calculated for clinical diagnosis. To check the efficiency of our method, we compare the HR calculated from ECG signal recorded in synchronous with EEG. The proposed method yields a mean error of 1.4% for the heart rate and 1.7% for mean R-R interval. The result illustrates that, proposed method can be used for ECG extraction from single channel EEG and used in clinical diagnosis like estimation for stress analysis, fatigue, and sleep stages classification studies as a multi-model system. In addition, this method eliminates the dependence of additional synchronous ECG in extraction of ECG from EEG signal process.

La aspiración de Brasil al asiento permanente en el Consejo de Seguridad de la Organización de las Naciones Unidas: un breve panorama

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Renata de Melo Rosa

2009-12-01

Full Text Available Este artículo analiza la posición de Brasil frente a la aspiración de un asiento permanente al Consejo de Seguridad de las Naciones Unidas. Los esfuerzos entabulados por Brasil en el escenario internacional, los discursos del primer rango del gobierno, así como un protagonismo más acelerado frente a los vecinos latino-americanos confirman esta aspiración. Pero, Brasil aún enfrenta serios problemas internos de seguridad nacional y tendrá que enfrentar otros compañeros regionales también, aspirantes a un assiento de miembro permanente en el Consejo de Seguridad de la ONU, como Canadá, por ejemplo. La ocupación del assiento temporario en el bienio de 2010-2011 también es uno de los factores analizados en este trabajo.

Ten-year detection rate of brain arteriovenous malformations in a large, multiethnic, defined population.

Science.gov (United States)

Gabriel, Rodney A; Kim, Helen; Sidney, Stephen; McCulloch, Charles E; Singh, Vineeta; Johnston, S Claiborne; Ko, Nerissa U; Achrol, Achal S; Zaroff, Jonathan G; Young, William L

2010-01-01

To evaluate whether increased neuroimaging use is associated with increased brain arteriovenous malformation (BAVM) detection, we examined detection rates in the Kaiser Permanente Medical Care Program of northern California between 1995 and 2004. We reviewed medical records, radiology reports, and administrative databases to identify BAVMs, intracranial aneurysms (IAs: subarachnoid hemorrhage [SAH] and unruptured aneurysms), and other vascular malformations (OVMs: dural fistulas, cavernous malformations, Vein of Galen malformations, and venous malformations). Poisson regression (with robust standard errors) was used to test for trend. Random-effects meta-analysis generated a pooled measure of BAVM detection rate from 6 studies. We identified 401 BAVMs (197 ruptured, 204 unruptured), 570 OVMs, and 2892 IAs (2079 SAHs and 813 unruptured IAs). Detection rates per 100 000 person-years were 1.4 (95% CI, 1.3 to 1.6) for BAVMs, 2.0 (95% CI, 1.8 to 2.3) for OVMs, and 10.3 (95% CI, 9.9 to 10.7) for IAs. Neuroimaging utilization increased 12% per year during the time period (PIAs (PIAs (P4) per 100 000 person-years, without heterogeneity between studies (P=0.25). Rates for BAVMs, OVMs, and IAs in this large, multiethnic population were similar to those in other series. During 1995 to 2004, a period of increasing neuroimaging utilization, we did not observe an increased rate of detection of unruptured BAVMs, despite increased detection of unruptured IAs.

Prevalence of migraine in a diverse community—electronic methods for migraine ascertainment in a large integrated health plan

Science.gov (United States)

Pressman, Alice; Jacobson, Alice; Eguilos, Roderick; Gelfand, Amy; Huynh, Cynthia; Hamilton, Luisa; Avins, Andrew; Bakshi, Nandini; Merikangas, Kathleen

2016-01-01

Introduction The growing availability of electronic health data provides an opportunity to ascertain diagnosis-specific cases via systematic methods for sample recruitment for clinical research and health services evaluation. We developed and implemented a migraine probability algorithm (MPA) to identify migraine from electronic health records (EHR) in an integrated health plan. Methods We identified all migraine outpatient diagnoses and all migraine-specific prescriptions for a five-year period (April 2008–March 2013) from the Kaiser Permanente, Northern California (KPNC) EHR. We developed and evaluated the MPA in two independent samples, and derived prevalence estimates of medically-ascertained migraine in KPNC by age, sex, and race. Results The period prevalence of medically-ascertained migraine among KPNC adults during April 2008–March 2013 was 10.3% (women: 15.5%, men: 4.5%). Estimates peaked with age in women but remained flat for men. Prevalence among Asians was half that of whites. Conclusions We demonstrate the feasibility of an EHR-based algorithm to identify cases of diagnosed migraine and determine that prevalence patterns by our methods yield results comparable to aggregate estimates of treated migraine based on direct interviews in population-based samples. This inexpensive, easily applied EHR-based algorithm provides a new opportunity for monitoring changes in migraine prevalence and identifying potential participants for research studies. PMID:26069243

CONTROL DE GESTIÓN: DIMENSIONES Y DIAGNÓSTICO PERMANENTE

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Maritza Hernández Torres

2003-04-01

Full Text Available

Los actuales entornos competitivos en los que se desarrolla la actividad empresarial, junto a la necesidad de responder de forma adecuada a los continuos cambios y constante incertidumbre a los que las organizaciones han de enfrentarse, conllevan una significativa modificación en lo que a la gestión empresarial se refiere, resultando esencial en este sentido, el papel del control de gestión, que como elemento del proceso de dirección, es el que más contribuye a mejorar las actuaciones de cualquier sistema. Las empresas deben tomar decisiones estratégicas adecuadas que permitan alcanzar alguna ventaja competitiva en la búsqueda de la excelencia empresarial a través de un proceso flexible de mejora continua. Para contribuir a tal propósito, en el presente trabajo se realizan algunas reflexiones acerca del control de gestión, abarcando desde el enfoque clásico hasta el moderno, su evolución y situación en las organizaciones cubanas; así como, el análisis de sus dimensiones soportado en un procedimiento para su permanente diagnóstico en correspondencia con las particularidades en que las diferentes empresas desarrollan su actividad.

Facebook Groups as a Powerful and Dynamic Tool in Medical Education: Mixed-Method Study.

Science.gov (United States)

Nicolai, Leo; Schmidbauer, Moritz; Gradel, Maximilian; Ferch, Sabine; Antón, Sofía; Hoppe, Boj; Pander, Tanja; von der Borch, Philip; Pinilla, Severin; Fischer, Martin; Dimitriadis, Konstantinos

2017-12-22

Social networking sites, in particular Facebook, are not only predominant in students' social life but are to varying degrees interwoven with the medical curriculum. Particularly, Facebook groups have been identified for their potential in higher education. However, there is a paucity of data on user types, content, and dynamics of study-related Facebook groups. The aim of this study was to identify the role of study-related Facebook group use, characterize medical students that use or avoid using Facebook groups (demographics, participation pattern, and motivation), and analyze student posting behavior, covered topics, dynamics, and limitations in Facebook groups with regards to educational usage. Using a multi-method approach (interviews, focus groups, and qualitative and quantitative analysis of Facebook posts), we analyzed two representative Facebook groups of medical preclinical semesters at Ludwig-Maximilians-University (LMU) Munich. Facebook primary posts and replies over one semester were extracted and evaluated by using thematic content analysis. We developed and applied a coding scheme for studying the frequency and distribution of these posts. Additionally, we interviewed students with various degrees of involvement in the groups, as well as "new minorities," students not registered on Facebook. Facebook groups seem to have evolved as the main tool for medical students at LMU to complement the curriculum and to discuss study-related content. These Facebook groups are self-organizing and quickly adapt to organizational or subject-related challenges posed by the curriculum. A wide range of topics is covered, with a dominance of organization-related posts (58.35% [6916/11,853] of overall posts). By measuring reply rates and comments per category, we were able to identify learning tips and strategies, material sharing, and course content discussions as the most relevant categories. Rates of adequate replies in these categories ranged between 78% (11/14) and

Characteristics of Resistant Hypertension in a Large Ethnically Diverse Hypertension Population of an Integrated Health System

Science.gov (United States)

Sim, John J.; Bhandari, Simran K.; Shi, Jiaxiao; In Liu, Lu A.; Calhoun, David A.; McGlynn, Elizabeth A.; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.

2013-01-01

Objective To evaluate the prevalence and characterize resistant hypertension from a large representative population with successful hypertension management and reliable health information. Patient and Methods We performed a cross sectional study using clinical encounter, laboratory, and administrative information from the Kaiser Permanente Southern California health system during 1/1/2006–12/31/2007. From individuals age >17 years with hypertension, resistant hypertension was identified and prevalence determined. Multivariable logistic regression was used to calculate odds ratios (OR) with adjustments for demographics, clinical variables, and medication use. Results Among 470,386 hypertensive individuals, 12.8% were identified as resistant representing15.3% of those on medications. Overall, 37,061 (7.9%) had uncontrolled hypertension while on ≥ 3 medicines. OR (95% confidence interval) for resistant hypertension were greater for black race (1.68, 1.62–1.75), older age (1.11, 1.10–1.11 for every 5 year increase), males (1.06, 1.03–1.10), and obesity (1.46, 1.42–1.51). Medication adherence rates were higher in resistant hypertension (93 vs 90%, phypertension. Conclusion Within a more standardized hypertension treatment environment, we observed a rate of resistant hypertension comparable to past studies using more fragmented data sources. Past observations have been limited due to non-representative populations, reliability of the data, heterogeneity of the treatment environments, and less than ideal control rates. This cohort which was established with an electronic medical record based approach has the potential to provide a better understanding of resistant hypertension and outcomes. PMID:24079679

Use of blood biomarkers to screen for obstructive sleep apnea

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Fleming WE

2018-06-01

Full Text Available Wesley Elon Fleming,1 Jon-Erik C Holty,2 Richard K Bogan,3 Dennis Hwang,4 Aliya S Ferouz-Colborn,4 Rohit Budhiraja,5 Susan Redline,5 Edith Mensah-Osman,6 Nadir Ishag Osman,6 Qing Li,7 Armaghan Azad,1 Susann Podolak,1 Michael K Samoszuk,8 Amabelle B Cruz,8 Yang Bai,8 Jiuliu Lu,8 John S Riley,8 Paula C Southwick8 1Sleep Center Orange County, Irvine, CA, USA; 2Stanford Medical School, VA Palo Alto Health Care System, Pulmonary, Critical Care and Sleep Medicine Section, Palo Alto, CA, USA; 3SleepMed Inc., Bogan Sleep Consultants, LLC, Columbia, SC, USA; 4Sleep Medicine Department, Southern California Permanente Medical Group, Kaiser Permanente, Fontana Medical Center, Fontana, CA, USA; 5Division of Sleep Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA; 6EENA Comprehensive Neurology and Sleep Center, Boynton Beach, FL, USA; 7South Bend Medical Foundation, New Technology and Test Development, South Bend, IN, USA; 8Clinical Research Department, Beckman Coulter, Inc., Brea, CA, USAPurpose: Obstructive sleep apnea (OSA is a highly prevalent disorder associated with increased risk for cardiovascular disease, diabetes, and other chronic conditions. Unfortunately, up to 90% of individuals with OSA remain without a diagnosis or therapy. We assess the relationship between OSA and blood biomarkers, and test the hypothesis that combinations of markers provide a characteristic OSA signature with diagnostic screening value. This validation study was conducted in an independent cohort in order to replicate findings from a prior feasibility study.Patients and methods: This multicenter prospective study consecutively enrolled adult male subjects with clinically suspected OSA. All subjects underwent overnight sleep studies. An asymptomatic control group was also obtained. Five biomarkers were tested: glycated hemoglobin (HbA1c, C-reactive protein (CRP, uric acid, erythropoietin (EPO, and interleukin-6 (IL-6.Results: The study

Gestión de la formación permanente del docente: reflexión y propuesta

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MSc. Silvia M. Sarmiento-Berrezueta

2015-11-01

Full Text Available La práctica educativa actual exige implementar un nuevo Modelode Gestión de la formación permanente de los docentes basado en los estándares de calidad. Este artículo se centra en cómo alcanzar la calidad de la gestión formativa profesional mediante una propuesta de autoformación y co-formación basada sobre la reflexión, valoración y motivación, normada desde el Código de Convivencia, que conlleva a aprender y desaprender en los colectivos de docentes de educación básica superior en el Ecuador.

A influência da perda bilateral do primeiro molar inferior permanente na morfologia dentofacial: um estudo cefalométrico The influence of bilateral lower first permanent molar loss on dentofacial morfology: a cephalometric study

Directory of Open Access Journals (Sweden)

David Normando

2010-12-01

Full Text Available OBJETIVO: avaliar as alterações cefalométricas em pacientes com perda bilateral do primeiro molar inferior permanente. MÉTODOS: foram analisadas 68 telerradiografias laterais de pacientes de consultórios particulares. A amostra foi dividida em dois grupos pareados quanto ao sexo e idade - 34 indivíduos sem perdas (grupo controle e 34 com perda bilateral do primeiro molar inferior permanente (grupo com perda. Foram excluídos da amostra pacientes que haviam perdido outros dentes que não o primeiro molar inferior, casos de agenesia e pacientes com menos de 16 anos de idade. Buscou-se avaliar somente indivíduos que tivessem relatado a perda há pelo menos 5 anos. RESULTADOS: demonstraram que a perda bilateral do primeiro molar inferior permanente leva ao suave fechamento do ângulo GnSN (P=0,05, um giro anti-horário do plano oclusal (P=0,0001, uma suave diminuição da altura facial anteroinferior (P=0,05, uma acentuada inclinação lingual (P=0,04 e retrusão dos incisivos inferiores (P=0,03. Por outro lado, a perda bilateral do primeiro molar inferior permanente não foi capaz de influenciar a relação maxilomandibular no sentido anteroposterior (P=0,21, a quantidade de mento (P=0,45, a inclinação dos incisivos superiores (P=0,12 e a posição anteroposterior dos incisivos superiores (P=0,46. CONCLUSÃO: a perda bilateral dos primeiros molares inferiores é capaz de produzir alterações marcantes no posicionamento dos incisivos inferiores e no plano oclusal, além de uma suave redução vertical da faceOBJECTIVE: To evaluate cephalometric changes in patients after bilateral loss of lower first permanent molar teeth. METHODS: Sixty-eight lateral radiographs of patients from private practices were analyzed. The sample was divided into two groups matched for age and gender: 34 individuals without loss (control group and 34 presenting with bilateral loss of lower first permanent molar teeth (loss group. Patients who had lost teeth other

Minería de datos en la encuesta permanente de hogares 2009, universidad nacional del litoral, argentina

OpenAIRE

Denis Lizazo Torres; Roberto Delfor Meyer; Verena Torres Cárdenas

2011-01-01

En este trabajo se aplicó por primera vez la Minería de Datos a la información generada por la Encuesta Permanente de Hogares del año 2009, del Observatorio Social de la Universi-dad del Litoral en Santa Fe, Argentina. El objetivo fue utilizar algoritmos de clasificación que poseen enfoques descriptivos, y es una de las tareas más utilizada en Minería de Datos para obtener nuevos conocimientos sobre la familia santafecina. La base de datos fue confeccio-nada con la información en el relevamie...

Technology of forming a positive attitude to physical training students of special medical group

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Mukhamediarov N.N.

2013-04-01

Full Text Available Defined effective technology stages of forming a positive attitude towards physical education of students in special medical groups, stimulate motivation, epistemologically, informative, content-procedural, analytical and adjustment. For each stage technology offered special tools: lectures, seminars, analysis articles, mini conference on improving technique, racing games, mini-competitions, diagnostic interviews, questionnaires, analysis of log data on attendance. Selected criteria forming positive attitudes towards physical education: theoretical and practical, formed groups for research: experimental and control, analyzed results introduction of technology, efficiency of the proposed technology and means forming a positive attitude towards physical education students in special medical groups.

Evaluation of an Ongoing Diabetes Group Medical Visit in a Family Medicine Practice.

Science.gov (United States)

Cunningham, Amy T; Delgado, David J; Jackson, Joseph D; Crawford, Albert G; Jabbour, Serge; Lieberthal, Robert D; Diaz, Victor; LaNoue, Marianna

2018-01-01

Group medical visits (GMVs), which combine 1-on-1 clinical consultations and group self-management education, have emerged as a promising vehicle for supporting type 2 diabetes management in primary care. However, few evaluations exist of ongoing diabetes GMVs embedded in medical practices. This study used a quasi-experimental design to evaluate diabetes GMV at a large family medicine practice. We examined program attendance and attrition, used propensity score matching to create a matched comparison group, and compared participants and the matched group on clinical, process of care, and utilization outcomes. GMV participants (n = 230) attended an average of 1 session. Participants did not differ significantly from the matched comparison group (n = 230) on clinical, process of care or utilization outcomes. The diabetes GMV was not associated with improvements in outcomes. Further studies should examine diabetes GMV implementation challenges to enhance their effectiveness in everyday practice. © Copyright 2018 by the American Board of Family Medicine.

Health-related quality of life among long-term rectal cancer survivors with an ostomy: manifestations by sex.

Science.gov (United States)

Krouse, Robert S; Herrinton, Lisa J; Grant, Marcia; Wendel, Christopher S; Green, Sylvan B; Mohler, M Jane; Baldwin, Carol M; McMullen, Carmit K; Rawl, Susan M; Matayoshi, Eric; Coons, Stephen Joel; Hornbrook, Mark C

2009-10-01

Intestinal stomas can pose significant challenges for long-term (> or = 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL). This was a matched cross-sectional study of long-term RC survivors conducted in three Kaiser Permanente regions. The mailed questionnaire included the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-Ostomy) and Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2). Groups surveyed were permanent ostomates (cases) and those who did not require an ostomy (controls). RC survivors were matched on sex, age, and time since diagnosis. Comparisons between groups used regression analysis with adjustment for age, comorbidity score, history of radiation therapy, income, and work status. Response rate was 54% (491 of 909). Cases and controls had similar demographic characteristics. On the basis of the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared with controls, while only female cases reported significantly worse overall HRQOL and psychological well-being. For younger females (ostomy had a greater impact on physical well-being compared with older females. Based on the SF-36v2, statistically significant and meaningful differences between female cases and controls were observed for seven of the eight scales and on the physical and mental component summary scores. Men and women report a different profile of challenges, suggesting the need for targeted or sex-specific interventions to improve HRQOL in this population. This may include focus on physical HRQOL for female ostomy survivors younger than age 75.

Factors influencing variation in physician adenoma detection rates: a theory-based approach for performance improvement.

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Atkins, Louise; Hunkeler, Enid M; Jensen, Christopher D; Michie, Susan; Lee, Jeffrey K; Doubeni, Chyke A; Zauber, Ann G; Levin, Theodore R; Quinn, Virginia P; Corley, Douglas A

2016-03-01

Interventions to improve physician adenoma detection rates for colonoscopy have generally not been successful, and there are little data on the factors contributing to variation that may be appropriate targets for intervention. We sought to identify factors that may influence variation in detection rates by using theory-based tools for understanding behavior. We separately studied gastroenterologists and endoscopy nurses at 3 Kaiser Permanente Northern California medical centers to identify potentially modifiable factors relevant to physician adenoma detection rate variability by using structured group interviews (focus groups) and theory-based tools for understanding behavior and eliciting behavior change: the Capability, Opportunity, and Motivation behavior model; the Theoretical Domains Framework; and the Behavior Change Wheel. Nine factors potentially associated with adenoma detection rate variability were identified, including 6 related to capability (uncertainty about which types of polyps to remove, style of endoscopy team leadership, compromised ability to focus during an examination due to distractions, examination technique during withdrawal, difficulty detecting certain types of adenomas, and examiner fatigue and pain), 2 related to opportunity (perceived pressure due to the number of examinations expected per shift and social pressure to finish examinations before scheduled breaks or the end of a shift), and 1 related to motivation (valuing a meticulous examination as the top priority). Examples of potential intervention strategies are provided. By using theory-based tools, this study identified several novel and potentially modifiable factors relating to capability, opportunity, and motivation that may contribute to adenoma detection rate variability and be appropriate targets for future intervention trials. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Percepção da educação permanente, continuada e em serviço para enfermeiros de um hospital de ensino La percepción de la educación permanente, continuada y en servicio para el enfermero del hospital de enseñanza The perception of permanent, continuous, in service education for nurses in a school hospital

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Amarílis Schiavon Paschoal

2007-09-01

Full Text Available Este estudo tem como objetivo discutir a concepção de educação permanente, continuada e em serviço junto a enfermeiros de um hospital de ensino. É uma pesquisa de natureza qualitativa, na qual a coleta dos dados foi realizada pela técnica do grupo focal, durante seis sessões gravadas em áudio e vídeo. Participaram deste estudo nove enfermeiros de um hospital de ensino. Para analisar os dados, utilizou-se a técnica do discurso do sujeito coletivo, que consiste na organização e tabulação de dados qualitativos de natureza verbal obtidos por meio de depoimentos, da qual resultou um único discurso. A pesquisa demonstrou que os enfermeiros diferenciaram os termos educação permanente, continuada e em serviço, construindo conceitos próprios, ressaltando a importância da diferenciação para definir o tipo de ação a ser tomada diante da necessidade educativa apresentada.Este estudio tiene como objetivo la discusión de la concepción de los términos de la educación permanente, continuada y en servicio con enfermeros del hospital de enseñanza. Es una investigación de naturaleza cualitativa, en que fueron recogidos los datos a través de la técnica del grupo focal, durante seis sesiones grabadas en audio y video. Participaron de este estudio nueve enfermeros de un hospital de enseñanza. Para analizar los datos fue utilizada la técnica del discurso del sujeto colectivo, que consiste en la organización y tabulación de datos cualitativos de naturaleza verbal obtenidos por medio de deposiciones, que resultó de un único discurso. La investigación demostró que los enfermeros diferenciaron los términos educación permanente, continuada y en servicio, construyendo conceptos propios, resaltando la importancia de la diferenciación para definir el tipo de acción a ser tomada delante de la necesidad educativa representada.This study is aimed at discussing the conception of permanent, continuous, in service education among nurses

Facebook Groups as a Powerful and Dynamic Tool in Medical Education: Mixed-Method Study

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Schmidbauer, Moritz; Gradel, Maximilian; Ferch, Sabine; Antón, Sofía; Hoppe, Boj; Pander, Tanja; von der Borch, Philip; Pinilla, Severin; Fischer, Martin; Dimitriadis, Konstantinos

2017-01-01

Background Social networking sites, in particular Facebook, are not only predominant in students’ social life but are to varying degrees interwoven with the medical curriculum. Particularly, Facebook groups have been identified for their potential in higher education. However, there is a paucity of data on user types, content, and dynamics of study-related Facebook groups. Objective The aim of this study was to identify the role of study-related Facebook group use, characterize medical students that use or avoid using Facebook groups (demographics, participation pattern, and motivation), and analyze student posting behavior, covered topics, dynamics, and limitations in Facebook groups with regards to educational usage. Methods Using a multi-method approach (interviews, focus groups, and qualitative and quantitative analysis of Facebook posts), we analyzed two representative Facebook groups of medical preclinical semesters at Ludwig-Maximilians-University (LMU) Munich. Facebook primary posts and replies over one semester were extracted and evaluated by using thematic content analysis. We developed and applied a coding scheme for studying the frequency and distribution of these posts. Additionally, we interviewed students with various degrees of involvement in the groups, as well as “new minorities,” students not registered on Facebook. Results Facebook groups seem to have evolved as the main tool for medical students at LMU to complement the curriculum and to discuss study-related content. These Facebook groups are self-organizing and quickly adapt to organizational or subject-related challenges posed by the curriculum. A wide range of topics is covered, with a dominance of organization-related posts (58.35% [6916/11,853] of overall posts). By measuring reply rates and comments per category, we were able to identify learning tips and strategies, material sharing, and course content discussions as the most relevant categories. Rates of adequate replies in these

Gender differences in leadership amongst first-year medical students in the small-group setting.

Science.gov (United States)

Wayne, Nancy L; Vermillion, Michelle; Uijtdehaage, Sebastian

2010-08-01

To investigate the extent of gender bias in the volunteerism of small-group leaders amongst first-year medical students, and whether bias could be eliminated with special instructions to the students. The gender of leaders in small-group sessions in a real academic setting was monitored under two conditions: control conditions, in which basic instructions were provided to participants, and intervention conditions, in which the same basic instructions were provided plus a brief "pep talk" on the importance of experiencing a leadership role in a safe environment. During the small-group sessions, an observer noted the gender and names of group leaders for later analysis. After a class debriefing, a subset of leaders and nonleaders from both the control and intervention groups were invited to be interviewed about their perceptions of the small-group experience. Interviews were tape recorded and transcribed for analysis. In 2007-2008 and 2008-2009, disproportionately fewer women than men volunteered to become small-group leaders under control conditions. This gender bias was eliminated under intervention conditions. The interviews illustrated how a subtle change in instructions helped some female students take on a leadership role. Gender bias in leadership in the small-group setting amongst medical students-even when women make up half of the class-may persist without targeted intervention. The authors suggest that frequent and consistent intervention during medical school could be an important factor in encouraging women to identify themselves as leaders, promoting confidence to consider leadership roles in medicine.

Nuevos retos para el profesorado de secundaria obligatoria: formación permanente para la atención a la diversidad en las aulas (New challenges for teachers of compulsory secondary: lifelong learning for attention to diversity in the classrooms (Nouveaux défis pour le professorat de secondaire obligatoire :formation permanente pour l’attention à la diversité dans la salle de classe (Novos desafios para os professores do ensino médio obrigatório: formação permanente para a atenção à diversidade na sala de aula

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Mar Prats

2009-12-01

Full Text Available La llegada reciente de alumnos inmigrantes a los centros educativos en España ha enfrentado al profesorado a nuevos retos. El presente artículo pone de manifiesto cuáles son estos nuevos retos que afrontan los docentes de la etapa de Educación Secundaria Obligatoria, ESO, a partir de sus propias voces, para conocer las necesidades formativas derivadas de esta situación educativa, con el fin de hacer propuestas de formación permanente para los docentes, como apoyo institucional en la atención de la diversidad de alumnado que coexiste en las aulas. Utilizando como método el estudio de casos múltiples hemos analizado e interpretado la información que conduce a conclusiones prácticas, con muchas posibilidades de ser tenidas en cuenta para la formación permanente de los implicados.

Utilization and costs of home-based and community-based care within a social HMO: trends over an 18-year period

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Walter Leutz

2005-10-01

Full Text Available Purpose: Our objective was to describe the utilization and costs of services from 1985 to 2002 of a Social Health Maintenance Organization (SHMO demonstration project providing a benefit for home-based and community-based as well as short-term institutional (HCB care at Kaiser Permanente Northwest (KPNW, serving the Portland, Oregon area. The HCB care benefit was offered by KPNW as a supplement to Medicare's acute care medical benefits, which KPNW provides in an HMO model. KPNW receives a monthly per capita payment from Medicare to provide medical benefits, and Medicare beneficiaries who choose to join pay a supplemental premium that covers prescription drugs, HCB care benefits, and other services. A HCB care benefit of up to $12,000 per year in services was available to SHMO members meeting requirement for nursing home certification (NHC. Methods: We used aggregate data to track temporal changes in the period 1985 to 2002 on member eligibility, enrollment in HCB care plans, age, service utilization and co-payments. Trends in the overall costs and financing of the HCB care benefit were extracted from quarterly reports, management data, and finance data. Results: During the time period, 14,815 members enrolled in the SHMO and membership averaged 4,531. The proportion of SHMO members aged 85 or older grew from 12 to 25%; proportion meeting requirements for NHC rose from 4 to 27%; and proportion with HCB care plans rose from 4 to 18%. Costs for the HCB care benefit rose from $21 per SHMO member per month in 1985 to $95 in 2002. The HCB care costs were equivalent to 12% to 16% of Medicare reimbursement. The HCB program costs were covered by member premiums (which rose from $49 to $180 and co-payments from members with care plans. Over the 18-year period, spending shifted from nursing homes to a range of community services, e.g. personal care, homemaking, member reimbursement, lifeline, equipment, transportation, shift care, home nursing, adult day

Prevalence of Childhood and Adolescent Overweight and Obesity from 2003 to 2010 in an Integrated Health Care Delivery System

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Scott Gee

2013-01-01

Full Text Available An observational study of the Kaiser Permanente Northern California (KPNC BMI coding distributions was conducted to ascertain the trends in overweight and obesity prevalence among KPNC members aged 2–19 between the periods of 2003–2005 and 2009-2010. A decrease in the prevalence of overweight (−11.1% change and obesity (−3.6% change and an increase in the prevalence of healthy weight (+2.7% change were demonstrated. Children aged 2–5 had the greatest improvement in obesity prevalence (−11.5% change. Adolescents aged 12–19 were the only age group to not show a decrease in obesity prevalence. Of the racial and ethnic groups, Hispanics/Latinos had the highest prevalence of obesity across all age groups. The KPNC prevalence of overweight and obesity compares favorably to external benchmarks, although differences in methodologies limit our ability to draw conclusions. Physician counseling as well as weight management programs and sociodemographic factors may have contributed to the overall improvements in BMI in the KPNC population. Physician training, practice tools, automated BMI reminders and performance feedback improved the frequency and quality of physician counseling. BMI screening and counseling at urgent visits, in addition to well-child care visits, increased the reach and dose of physician counseling.

La Educación Permanente en Bibliotecología y Archivología: relato de una experiencia universitaria en Uruguay (1994-2001

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Edelweiss Zahn

2013-12-01

Full Text Available Se indica cómo han variado los roles de la información y la situación relativa de las unindades de información, la producción tecnológica de vías alternativas del almacenamiento documental, tales como las bilbiotecas virtuales o digitales, los archivos y museos electrónicos. El avance de la investigación y del conocimiento en cualquier disciplina, el crecimiento de expectativas y necesidades de formación y actualización por parte de los profesionales, nuevos requerimientos y desafíos en el ámbito laboral y social, y la implantación generalizada de nuevas tecnologías, se han conjugado para obligar a una reflexión profunda de las instituciones responsables de formación especializada. En las Universidades se plantean al menos tres niveles educativos: el grado, los posgrados, y la educación continua o permanente que involucre conocimientos teórico-prácticos y metodológicos, que contribuya a mejorar el desempeño y la jerarquía profesional en la línea de conocimientos "just in time", y que habilite a niveles superiores de conocimiento y a la investigación disciplinaria. Se define y caracteriza la eduación permanente como fenómeno educativo. Se relata el proceso de institucionalización de la Educación Permanente en la Universidad de la República y en la Escuela Universitaria de Bibliotecología y Ciencias Afines en particular. Se desarrollar criterios y políticas académicos, formas de financiación del programa, su evaluación y su proección a futuro. Se presentan datos estadísticos sobre cursos, profesores, y participantes en el período 1994-2001 en la EUBCA     

Utility of a dermatology interest group blog: the impact of medical student interest groups and Web 2.0 tools as educational resources.

Science.gov (United States)

Jalalat, Sheila Z; Wagner, Richard F

2014-01-01

The open access University of Texas Dermatology Interest Group blog was established in 2004 for the purposes of increasing communication and collaboration between medical students and dermatology faculty, residents, and alumni, as well as to promote educational opportunities and the missions for which the interest group was created. This blog is unique because of its longevity and continuous postings directed toward the educational and professional needs of medical students and residents. A blog user survey was performed to assess viewers' thoughts, purpose of viewing, demographic profile, subscriber status, usage of the blog and other Web 2.0 tools (forums, Facebook, blogs, Twitter, podcasts), and perceived usefulness. Sixty-one anonymous online surveys were completed during a 1-month period. Statistical analyses of the responses demonstrated that the utilization of web-based tools and the blog were valuable resources for students, especially for blog subscribers, those more involved in an interest group, and those reading the blog for a longer period of time. The usefulness and impact of this method of communication and dissemination of information in medical education may encourage other student groups, faculty advisors, and educators to implement similar educational tools at their institutions.

The medical exposures in UNSCEAR 2000 and the data of Spanish Group

International Nuclear Information System (INIS)

Vano, E.

2001-01-01

Last year 2000, UNSCEAR published the document Sources and Effects of Ionizing Radiation which is composed of two volumes. Within Volume I: Sources, the Annex D is about medical radiation exposures. The present article summarises the more relevant data presented in this Annex, pointing out the changes that have taken places since the previous UNSCEAR report of 1993. Besides, the actions and results obtained by the Spanish UNSCEAR Working Group are presented. Some of the more relevant data presented in the last UNSCEAR report are: most of the medical applications are performed in developed countries (25% of the world-wide population); the mean effective dose (in developed countries) is approximately 1 mSv/year; the mean world-wide dose is around 0.4 mSv/year and more than 90% of this dose derives from medical diagnosis. In June 1999, the Spanish Ministry of Health and Consumption (Ministerio de Sanidad y consumo) created the UNSCEAR Working Group in which the author of the present article acts as technical coordinator. The objective of the group was to systematically compile the necessary information to edit a periodic report on the estimation of doses to the population due to medical exposures, which additionally could be used by the Health Administration as a complementary element for planning the installations and in the radiation protection programmes of the patients. The final report of the Spanish group, published in February 2000, was elaborated with the data provided by nine Autonomic Communities ( the total number of Autonomic Communities is seventeen) including 44% of the Spanish population (17.4 millions of inhabitants from the nine Autonomic Communities in relation to a total population of 39.9 millions; population data in 01.01.98). The final values in the Spanish report are rather reasonable, although in few cases deviations can appear due to the scarce information available The data provided are validated in origin due to the direct participation of

Modifying the ECC-based grouping-proof RFID system to increase inpatient medication safety.

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Ko, Wen-Tsai; Chiou, Shin-Yan; Lu, Erl-Huei; Chang, Henry Ker-Chang

2014-09-01

RFID technology is increasingly used in applications that require tracking, identification, and authentication. It attaches RFID-readable tags to objects for identification and execution of specific RFID-enabled applications. Recently, research has focused on the use of grouping-proofs for preserving privacy in RFID applications, wherein a proof of two or more tags must be simultaneously scanned. In 2010, a privacy-preserving grouping proof protocol for RFID based on ECC in public-key cryptosystem was proposed but was shown to be vulnerable to tracking attacks. A proposed enhancement protocol was also shown to have defects which prevented proper execution. In 2012, Lin et al. proposed a more efficient RFID ECC-based grouping proof protocol to promote inpatient medication safety. However, we found this protocol is also vulnerable to tracking and impersonation attacks. We then propose a secure privacy-preserving RFID grouping proof protocol for inpatient medication safety and demonstrate its resistance to such attacks.

Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: a randomized controlled trial.

Science.gov (United States)

Zwikker, Hanneke E; van den Ende, Cornelia H; van Lankveld, Wim G; den Broeder, Alfons A; van den Hoogen, Frank H; van de Mosselaar, Birgit; van Dulmen, Sandra; van den Bemt, Bart J

2014-03-01

To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA). Non-adherent RA patients using disease-modifying anti-rheumatic drugs (DMARDs) were randomized to an intervention or control arm. The intervention consisted, amongst others, of two motivational interviewing-guided group sessions led by the same pharmacist. Control patients received brochures about their DMARDs. Questionnaires were completed up to 12 months follow-up. 123 patients (mean age: 60 years, female: 69%) were randomized. No differences in necessity beliefs and concern beliefs about medication and in medication non-adherence were detected between the intervention and control arm, except at 12 months' follow-up: participants in the intervention arm had less strong necessity beliefs about medication than participants in the control arm (b: -1.0 (95% CI: -2.0, -0.1)). This trial did not demonstrate superiority of our intervention over the control arm in changing beliefs about medication or in improving medication adherence over time. Absent intervention effects might have been due to, amongst others, selection bias and a suboptimal treatment integrity level. Hence, targeting beliefs about medication in clinical practice should not yet be ruled out. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Searching for the optimal renal prescription. Fresenius, Kaiser Permanente team up to offer new options in dialysis care.

Science.gov (United States)

Neumann, M E

1999-01-01

The goals are simple: Improve well-being of the dialysis patient and reduce hospitalizations. The tools are diverse: Ultrapure dialysate. On-line blood monitoring. Biocompatible membranes. No reuse. Daily, in-center dialysis and possibly nocturnal dialysis at home. Reimbursement: Full-risk capitation, With Medicare and commercial payor rates varying on a patient-by-patient basis. Create an incubator with approximately 1,000 end-stage renal disease patients, treated at both capitated payment-exclusive dialysis units and mingled in at traditional fee-for-service clinics. Establish a team of nurses and renal care staff to direct the care plan, and put the program in place. After the first year, analyze the data and see if the end--hopefully, improved outcomes and resulting reduced hospitalizations--justifies the means--the higher cost for "optimal technologies."

Physician Acceptance of a Computerized Outpatient Medication System in a Teaching Hospital Group Practice

OpenAIRE

Blish, Christi; Proctor, Rita; Fletcher, Suzanne W.; O'Malley, Michael

1983-01-01

As part of a new automated ambulatory medical record, a computerized outpatient medication system was developed for a teaching hospital general medicine group practice. Seven months after its implementation, the system was evaluated to determine physician acceptance and approval. Practice physicians were surveyed, and 94% of the respondents approved of the system. Over 90% thought that the computerized system had improved the completeness and accuracy of medication information as well as thei...

Frequency, duration and predictors of bronchiolitis episodes of care among infants ≥32 weeks gestation in a large integrated healthcare system: a retrospective cohort study

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Flaherman Valerie J

2012-06-01

Full Text Available Abstract Background Bronchiolitis is common in the first two years of life and is the most frequent cause of hospitalization in this age group. No previous studies have used an episode-of-care analysis to describe the frequency, duration, and predictors of bronchiolitis episodes of care during the first two years. Methods We conducted a retrospective cohort study of 123,264 infants ≥32 weeks gestation born at 6 Northern California Kaiser Permanente hospitals between 1996 and 2002. We used electronic medical records to concatenate hospital, emergency department and outpatient health care encounters for bronchiolitis into discrete episodes of care. We used descriptive statistics to report frequency and duration of bronchiolitis episodes and used logistic regression to assess the effect of gestational age and other clinical and demographic predictors on the outcome of bronchiolitis episodes. Results Among all infants, the rate of bronchiolitis episodes was 162 per 1000 children during the first 2 years of life; approximately 40% required >1 day of medical attention with a mean duration of 7.0 ± 5.9 days. Prematurity was associated with increased risk of bronchiolitis episodes and longer duration. Bronchiolitis episodes rates per 1000 infants were 246 for 32–33 weeks gestational age, 204 for 34–36 weeks, and 148–178 for >36 weeks. Male gender, African-American and Hispanic race/ethnicity, and parental history of asthma were associated with an increased risk of having a bronchiolitis episode and/or longer duration. Conclusions Bronchiolitis episodes of care are frequent during the first two years of life and the duration ranges from 1 to 27 days. Prematurity was associated with more frequent and longer duration of bronchiolitis episodes of care, which may reflect illness severity and/or perceived vulnerability.

Knowledge, group-based medical mistrust, future expectations, and perceived disadvantages of medical genetic testing: perspectives of Black African immigrants/refugees.

Science.gov (United States)

Buseh, A; Kelber, S; Millon-Underwood, S; Stevens, P; Townsend, L

2014-01-01

Reasons for low participation of ethnic minorities in genetic studies are multifactorial and often poorly understood. Based on published literature, participation in genetic testing is low among Black African immigrants/refugees although they are purported to bear disproportionate disease burden. Thus, research involving Black African immigrant/refugee populations that examine their perspectives on participating in genetic studies is needed. This report examines and describes the knowledge of medical genetics, group-based medical mistrust, and future expectations of genetic research and the influence of these measures on the perceived disadvantages of genetic testing among Black African immigrants/refugees. Using a cross-sectional survey design, a nonprobability sample (n = 212) of Black African immigrants/refugees was administered a questionnaire. Participants ranged in age from 18 to 61 years (mean = 38.91, SD = 9.78). The questionnaire consisted of 5 instruments: (a) sociodemographic characteristics, (b) Knowledge of Medical Genetics scale, (c) Group-Based Medical Mistrust Scale, (d) Future Expectations/Anticipated Consequences of Genetics Research scale, and (e) Perceived Disadvantages of Genetic Testing scale. Participants were concerned that genetic research may result in scientists 'playing God,' interfering with the natural order of life. In multivariate analyses, the perceived disadvantages of genetic testing increased as medical mistrust and anticipated negative impacts of genetic testing increased. Increase in genetic knowledge contributed to a decrease in perceived disadvantages. Our findings suggest that recruitment of Black African immigrants/refugees in genetic studies should address potential low knowledge of genetics, concerns about medical mistrust, the expectations/anticipated consequences of genetic research, and the perceived disadvantages of genetic testing.

Process factors facilitating and inhibiting medical ethics teaching in small groups.

Science.gov (United States)

Bentwich, Miriam Ethel; Bokek-Cohen, Ya'arit

2017-11-01

To examine process factors that either facilitate or inhibit learning medical ethics during case-based learning. A qualitative research approach using microanalysis of transcribed videotaped discussions of three consecutive small-group learning (SGL) sessions on medical ethics teaching (MET) for three groups, each with 10 students. This research effort revealed 12 themes of learning strategies, divided into 6 coping and 6 evasive strategies. Cognitive-based strategies were found to relate to Kamin's model of critical thinking in medical education, thereby supporting our distinction between the themes of coping and evasive strategies. The findings also showed that cognitive efforts as well as emotional strategies are involved in discussions of ethical dilemmas. Based on Kamin's model and the constructivist learning theory, an examination of the different themes within the two learning strategies-coping and evasive-revealed that these strategies may be understood as corresponding to process factors either facilitating or inhibiting MET in SGL, respectively. Our classification offers a more nuanced observation, specifically geared to pinpointing the desired and less desired process factors in the learning involved in MET in the SGL environment. Two key advantages of this observation are: (1) it brings to the forefront process factors that may inhibit and not merely facilitate MET in SGL and (2) it acknowledges the existence of emotional and not just cognitive process factors. Further enhancement of MET in SGL may thus be achieved based on these observations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

La cátedra abierta y permanente de Ética

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Ana María Caballero

2015-06-01

Full Text Available La Cátedra Abierta y Permanente de Ética se propuso como un espacio de discusión y reflexión ético-política para debatir las diferentes corrientes del pensamiento axiológico y político, que propicie la resignificación de las representaciones culturales y sociales de sentido que permitan desarrollar una mirada socio histórica sobre las relaciones entre educación, ética y cultura colombiana, de tal manera que los estudiantes de la Universidad Pedagógica Nacional asuman una conciencia clara de su función como actores sociales en la construcción de la sociedad civil, la democracia, la promoción y la defensa de los derechos humanos, el crecimiento económico y el desarrollo social. La formación de valores morales que fundamenten una ética cívica parte del conocimiento de la realidad nacional y global, de la autoconciencia de cada individuo que aspira a constituirse en un ser autónomo usando su pensamiento crítico y participando en la construcción de la democracia, como modelo de gobierno que garantiza las libertades individuales, propiciando espacios para la conquista de los ideales de libertad, equidad, solidaridad y tolerancia, que permitan la convivencia ciudadana y la construcción de la nacionalidad colombiana.

[The history of the Kaiser Wilhelm Society during the Third Reich. Interim reports of the president's commission of the Max Planck Society].

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Weber, M M

2002-11-01

In 1997 the Max Planck Society set up a presidential commission to do research on the historical development of its precursor organization, the Kaiser Wilhelm Society (KWG), during the Third Reich. This paper presents some of the important results given in the interim reports of this commission that are relevant to psychiatry. It focuses on brain research, anthropology, psychiatric genetics, and the role of the well-known biochemist Adolf Butenandt. In general, the interim reports reflect the numerous links between the biomedical research of the KWG and the institutions of the National Socialist (Nazi) state. However, they do not yet allow a final historical assessment as to the complex situation of this field of research during National Socialism.

A CORRELATION BETWEEN ABO BLOOD GROUPS AND BODY MASS INDEX AMONG MEDICAL STUDENTS

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Sarbjit Singh

2017-11-01

Full Text Available BACKGROUND ABO blood groups are associated with some important chronic diseases, obesity being the major risk factor is rising rapidly globally. The present study seeks to determine if there is any association between ABO blood groups and body mass index. MATERIALS AND METHODS The present study involve 200 medical students, 102 boys and 98 girls in the age group of 18-23 years in the Government Medical College, Amritsar. Weight, height for BMI and blood groups were determined in order to find any association between ABO blood group and BMI. RESULTS Overweight and obesity was found more prevalent in boys than girls, 22.5% students were overweight and 15.5% were obese. The prevalence of overweight was (24.52% boys and 20.40% girls and prevalence of obesity was (25.49% boys and 5.10% girls. Blood group B was reported the most common blood groups (37.5% followed by blood group O (32.0%, while blood groups A and AB were found 19.5% and 11% of participants, respectively. The prevalence of overweight (BMI 25-29.9 among participants based on blood group O, A, AB and B was 29.69%, 25.64%, 18.18%, 16.00%, while obesity (BMI >30 among participants based on blood groups B, O, A and AB was 24.00%, 10.94%, 10.26% and 9.09%. CONCLUSION Prevalence of overweight and obesity was more in blood group O and B respectively and was more in males than females

Effectiveness of a group-based intervention to change medication beliefs and improve medication adherence in patients with rheumatoid arthritis: a randomized controlled trial.

NARCIS (Netherlands)

Zwikker, H.E.; Ende, C.H. van den; Lankveld, W.G. van; Broeder, A.A. den; Hoogen, F.H. van den; Mosselaar, B. van de; Dulmen, S. van; Bemt, B.J. van den

2014-01-01

Objective: To assess the effect of a group-based intervention on the balance between necessity beliefs and concern beliefs about medication and on medication non-adherence in patients with rheumatoid arthritis (RA). Methods: Non-adherent RA patients using disease-modifying anti-rheumatic drugs

A Validation of the Group-Based Medical Mistrust Scale in Formerly Incarcerated Black and Latino Men.

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Valera, Pamela; Boyas, Javier F; Bernal, Camila; Chiongbian, Victoria Briones; Chang, Yvonne; Shelton, Rachel C

2016-05-04

While there is a growing body of literature on medical mistrust and its relevance to public health, research on formerly incarcerated Black and Latino men and their perception of mistrust toward medical providers and medical institutions remains scant. Very little is known about whether formerly incarcerated Black and Latino men mistrust medical and clinical providers given their previous experiences with the criminal justice system. It is important to determine whether medical mistrust play a key role in the health and health behaviors of released Black and Latino men. The purpose of this study is to validate and assess the psychometric properties of the Group-Based Medical Mistrust Scale for use among formerly incarcerated Black and Latino men in New York City. The findings of the exploratory and confirmatory factor analyses state that a two-factor structure fit the data best. Two dimensions emerged as important subscales: discrimination and suspicion. The current findings suggest the two-factor Group-Based Medical Mistrust Scale is a valid and reliable assessment tool to discern medical mistrust levels among formerly incarcerated Black and Latino men. © The Author(s) 2016.

COMPETENCIAS EMPRENDEDORAS DEL ALUMNADO DE EDUCACIÓN PERMANENTE DE ADULTOS EN ANDALUCÍA. PERCEPCIÓN DEL PROFESORADO

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José Ma. Fernández Batanero

2017-01-01

Full Text Available En el presente trabajo analizamos la percepción que tiene el profesorado de Educación Permanente de Personas Adultas en Andalucía (España acerca del grado de presencia de competencias emprendedoras en su alumnado. Para dar respuesta al objetivo planteado adoptamos un diseño de investigación de tipo descriptivo, donde el enfoque de recolección y análisis de datos se ha definido como mixto, en el que se integran técnicas cualitativas (entrevistas en profundidad y cuantitativas (cuestionario. Para la validación del cuestionario, se utilizó la técnica de juicio de expertos, seleccionados mediante el procedimiento de «Coeficiente de competencia experta» o «Coeficiente K». El análisis de la fiabilidad del cuestionario a través de la prueba de Cronbach fue de 0,957. El cuestionario ha sido respondido por 549 profesores y profesoras de Centros de Educación Permanente de Andalucía y se han realizado 23 entrevistas en profundidad a informantes claves (directores de centros y coordinadores de sección. Los resultados muestran con claridad la percepción, tanto del profesorado como de aquellos que ejercen el ejercicio de la dirección, que el alumnado de estos centros educativos no están lo suficientemente preparados para iniciar por su cuenta un proyecto empresarial, a pesar de cursar contenidos curriculares de cultura emprendedora. Consideran que aún no poseen las competencias emprendedoras necesarias para crear y gestionar eficazmente un proyecto empresarial, constituyendo la falta de creatividad uno de los mayores obstáculos para dicho fin. Así mismo, se desprende del estudio la escasa incidencia que ejercen los programas de cultura emprendedora que se desarrollan en este tipo de centros.

The Diabetes Telephone Study: Design and challenges of a pragmatic cluster randomized trial to improve diabetic peripheral neuropathy treatment.

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Adams, Alyce S; Bayliss, Elizabeth A; Schmittdiel, Julie A; Altschuler, Andrea; Dyer, Wendy; Neugebauer, Romain; Jaffe, Marc; Young, Joseph D; Kim, Eileen; Grant, Richard W

2016-06-01

Challenges to effective pharmacologic management of symptomatic diabetic peripheral neuropathy include the limited effectiveness of available medicines, frequent side effects, and the need for ongoing symptom assessment and treatment titration for maximal effectiveness. We present here the rationale and implementation challenges of the Diabetes Telephone Study, a randomized trial designed to improve medication treatment, titration, and quality of life among patients with symptomatic diabetic peripheral neuropathy. We implemented a pragmatic cluster randomized controlled trial to test the effectiveness of an automated interactive voice response tool designed to provide physicians with real-time patient-reported data about responses to newly prescribed diabetic peripheral neuropathy medicines. A total of 1834 primary care physicians treating patients in the diabetes registry at Kaiser Permanente Northern California were randomized into the intervention or control arm. In September 2014, we began identification and recruitment of patients assigned to physicians in the intervention group who receive three brief interactive calls every 2 months after a medication is prescribed to alleviate diabetic peripheral neuropathy symptoms. These calls provide patients with the opportunity to report on symptoms, side effects, self-titration of medication dose and overall satisfaction with treatment. We plan to compare changes in self-reported quality of life between the intervention group and patients in the control group who receive three non-interactive automated educational phone calls. Successful implementation of this clinical trial required robust stakeholder engagement to help tailor the intervention and to address pragmatic concerns such as provider time constraints. As of 27 October 2015, we had screened 2078 patients, 1447 of whom were eligible for participation. We consented and enrolled 1206 or 83% of those eligible. Among those enrolled, 53% are women and the mean age

Medical group affiliations: interorganizational relationships and organizational performance.

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Rotarius, Timothy; Fottler, Myron D; Blair, John D

2003-01-01

The hyperturbulent health care environment is causing health care organizations to create interorganizational relationships (IORs). This article reports on a study of 686 medical groups that assessed how 11 types of IORs affected 7 dimensions of organizational performance. Organizational performance was ascertained through self-reported questions about performance relative to local market competitors. Respondents believed that, to varying degrees, all IORs lead to a competitive advantage over local competitors in all seven performance categories. There was no consistent pattern for either loose or tight linkages to be associated with superior performance. Consequently, loose linkages may be preferable to tighter linkages (i.e., membership in a fully integrated delivery system) that require higher levels of resource commitment.

State-level medical and absenteeism cost of asthma in the United States.

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Nurmagambetov, Tursynbek; Khavjou, Olga; Murphy, Louise; Orenstein, Diane

2017-05-01

For medically treated asthma, we estimated prevalence, medical and absenteeism costs, and projected medical costs from 2015 to 2020 for the entire population and separately for children in the 50 US states and District of Columbia (DC) using the most recently available data. We used multiple data sources, including the Medical Expenditure Panel Survey, U.S. Census Bureau, Kaiser Family Foundation, Medical Statistical Information System, and Current Population Survey. We used a two-part regression model to estimate annual medical costs of asthma and a negative binomial model to estimate annual school and work days missed due to asthma. Per capita medical costs of asthma ranged from $1,860 (Mississippi) to $2,514 (Michigan). Total medical costs of asthma ranged from $60.7 million (Wyoming) to $3.4 billion (California). Medicaid costs ranged from $4.1 million (Wyoming) to $566.8 million (California), Medicare from $5.9 million (DC) to $446.6 million (California), and costs paid by private insurers ranged from $27.2 million (DC) to $1.4 billion (California). Total annual school and work days lost due to asthma ranged from 22.4 thousand (Wyoming) to 1.5 million days (California) and absenteeism costs ranged from $4.4 million (Wyoming) to $345 million (California). Projected increase in medical costs from 2015 to 2020 ranged from 9% (DC) to 34% (Arizona). Medical and absenteeism costs of asthma represent a significant economic burden for states and these costs are expected to rise. Our study results emphasize the urgency for strategies to strengthen state level efforts to prevent and control asthma attacks.

SUITABILITY OF MEDICATIONS USED BY THE ELDERLY PARTICIPANTS OF A SOCIAL GROUP, ACCORDING TO THE BEERS CRITERIA

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Geysa Donária de Miranda Mascarenhas

2014-09-01

Full Text Available The dynamic process defined as aging progressively reduces the functional capacity of the elderly and added to the lifestyle, they can to testify to the high number of pathologies. Thus, pharmacotherapy for this age group requires special care, keeping in view its peculiarities. Given this need, a group of researchers has developed criteria that allowed the identification of inappropriate medications. Thus, the aim of this study was to investigate the suitability of medications used by the elderly participants of a social group, in Vitória da Conquista, BA, according to the Beers criteria. This research was an exploratory descriptive study and data collection conducted through semi - structured interviews. It was asked to bring all the elderly who were using medications and / or prescriptions. It was found that 12.7% of the drugs used by the elderly appeared in the list of inappropriate medicines and 42% of respondents make use of polypharmacy. Among the most prescribed inappropriate medications, there is acetylsalicylic acid, diclofenac, diazepam, piroxicam, ibuprofen and amitriptyline. The class of inappropriate drugs most used by seniors was anti - inflammatory drugs. Given this, all health professionals need to put into practice the criteria for selecting medications this age group as the reality of existing drugs in Brazil.

Suitability of medications used by the elderly participants of a social group, according to the Beers criteria

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Geysa Donária de Miranda Mascarenhas

2014-07-01

Full Text Available The dynamic process defined as aging progressively reduces the functional capacity of the elderly and added to the lifestyle, they can to testify to the high number of pathologies. Thus, pharmacotherapy for this age group requires special care, keeping in view its peculiarities. Given this need, a group of researchers has developed criteria that allowed the identification of inappropriate medications. Thus, the aim of this study was to investigate the suitability of medications used by the elderly participants of a social group, in Vitória da Conquista, BA, according to the Beers criteria. This research was an exploratory descriptive study and data collection conducted through semi - structured interviews. It was asked to bring all the elderly who were using medications and / or prescriptions. It was found that 12.7% of the drugs used by the elderly appeared in the list of inappropriate medicines and 42% of respondents make use of polypharmacy. Among the most prescribed inappropriate medications, there is acetylsalicylic acid, diclofenac, diazepam, piroxicam, ibuprofen and amitriptyline. The class of inappropriate drugs most used by seniors was anti - inflammatory drugs. Given this, all health professionals need to put into practice the criteria for selecting medications this age group as the reality of existing drugs in Brazil.

The efficacy of psycho-educational group program on medication adherence and global functioning of patients with bipolar disorder type I.

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Bahredar, Mohammad Jafar; Asgharnejad Farid, Ali Asghar; Ghanizadeh, Ahmad; Birashk, Behrooz

2014-01-01

Psycho-education is now considered as part of the integrated treatment for bipolar disorder. This study aimed to determine the efficacy of group psycho-education on medication adherence and global functioning of patients with bipolar disorder type I. 45 patients with bipolar disorder type I were allocated one of the three groups of psycho-education plus pharmacotherapy, pharmacotherapy and placebo plus pharmacotherapy. A psycho-educational program was conducted for the psycho-educational group during 9 weekly sessions. Medication adherence and global functioning of all the three groups were evaluated before the intervention, three months and six months after the intervention using Medication Adherence Rating Scale (MARS) and Global Assessment of Functioning (GAF). ANOVA was performed to examine the data. In the first and second assessments, the mean score of medication adherence and gobal functioning for patients in the psycho-educational group was significantly higher than that in the control and placebo groups (P=0.001). Medication adherence score of the psycho-educational group was increased from 6.27(0.88) to 7.92(1.38). while the mean score of the psycho-educational group increased from 56.6 (3.58) to 64.17 (2.12):, the global functioning reduced from 56.27(3.17) to 54.17(5.08) in the control group and from 56.67 (3.58) to 56 (4.36) in the placebo group. Psycho-educational program plus pharmacotherapy was effective in improvement medication adherence and global functioning of bipolar patients.

Racial/ethnic and socioeconomic differences in short-term breast cancer survival among women in an integrated health system.

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Keegan, Theresa H M; Kurian, Allison W; Gali, Kathleen; Tao, Li; Lichtensztajn, Daphne Y; Hershman, Dawn L; Habel, Laurel A; Caan, Bette J; Gomez, Scarlett L

2015-05-01

We examined the combined influence of race/ethnicity and neighborhood socioeconomic status (SES) on short-term survival among women with uniform access to health care and treatment. Using electronic medical records data from Kaiser Permanente Northern California linked to data from the California Cancer Registry, we included 6262 women newly diagnosed with invasive breast cancer. We analyzed survival using multivariable Cox proportional hazards regression with follow-up through 2010. After consideration of tumor stage, subtype, comorbidity, and type of treatment received, non-Hispanic White women living in low-SES neighborhoods (hazard ratio [HR] = 1.28; 95% confidence interval [CI] = 1.07, 1.52) and African Americans regardless of neighborhood SES (high SES: HR = 1.44; 95% CI = 1.01, 2.07; low SES: HR = 1.88; 95% CI = 1.42, 2.50) had worse overall survival than did non-Hispanic White women living in high-SES neighborhoods. Results were similar for breast cancer-specific survival, except that African Americans and non-Hispanic Whites living in high-SES neighborhoods had similar survival. Strategies to address the underlying factors that may influence treatment intensity and adherence, such as comorbidities and logistical barriers, should be targeted at low-SES non-Hispanic White and all African American patients.

Patient attitudes about the clinical use of placebo: qualitative perspectives from a telephone survey.

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Ortiz, Robin; Chandros Hull, Sara; Colloca, Luana

2016-04-04

To examine qualitative responses regarding the use of placebo treatments in medical care in a sample of US patients.Survey studies suggest a deliberate clinical use of placebos by physicians, and prior research has found that although most US patients find placebo use acceptable, the rationale for these beliefs is largely unknown. Members of the Outpatient Clinic at the Kaiser Permanente Northern California interviewed research participants who had been seen for a chronic health problem at least once in the prior 6 months. 853 women (61%) and men, white (58%) and non-white participants aged 18-75 years. Qualitative responses on perceptions of placebo use from one-time telephone surveys were analysed for common themes and associations with demographic variables. Prior results indicated that a majority of respondents felt it acceptable for doctors to recommend placebo treatments. Our study found that a lack of harm (n=291, 46.1%) and potential benefit (n=250, 39.6%) were the most common themes to justify acceptability of placebo use. Responses citing potential benefit were associated with higher education (r=0.787; pright to know and power of the mind. Older age was associated with likelihood to cite overall physician, as opposed to treatment, related themes (r=0.753; prights-and-licensing/

Clinical pharmacy cardiac risk service for managing patients with coronary artery disease in a health maintenance organization.

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Sandhoff, Brian G; Nies, Leslie K; Olson, Kari L; Nash, James D; Rasmussen, Jon R; Merenich, John A

2007-01-01

A clinical pharmacy service for managing the treatment of coronary artery disease in a health maintenance organization is described. Despite the proven benefits of aggressive risk factor modification for patients with coronary artery disease (CAD), there remains a treatment gap between consensus- and evidence-based recommendations and their application in patient care. In 1998, Kaiser Permanente of Colorado developed the Clinical Pharmacy Cardiac Risk Service (CPCRS) to focus on the long-term management of patients with CAD to improve clinical outcomes. The primary goals of the CPCRS are to increase the number of CAD patients on lipid-lowering therapy, manage medications shown to decrease the risk of future CAD-related events, assist in the monitoring and control of other diseases that increase cardiovascular risk, provide patient education and recommendations for nonpharmacologic therapy, and act as a CAD information resource for physicians and other health care providers. Using an electronic medical record and tracking database, the service works in close collaboration with primary care physicians, cardiologists, cardiac rehabilitation nurses, and other health care providers to reduce cardiac risk in the CAD population. Particular attention is given to dyslipidemia, blood pressure, diabetes mellitus, and tobacco cessation. Treatment with evidence-based regimens is initiated and adjusted as necessary. Over 11,000 patients are currently being followed by the CPCRS. A clinical pharmacy service in a large health maintenance organization provides cardiac risk reduction for patients with CAD and helps close treatment gaps that may exist for these patients.

Rectal Cancer Survivors' Participation in Productive Activities.

Science.gov (United States)

Hornbrook, Mark C; Grant, Marcia; Wendel, Christopher; Bulkley, Joanna E; Mcmullen, Carmit K; Altschuler, Andrea; Temple, Larissa Kf; Herrinton, Lisa J; Krouse, Robert S

2017-01-01

Rectal cancer and its treatment impair survivors' productivity. To assess determinants of market and nonmarket employment, job search, volunteering, and homemaking among survivors five years or longer after diagnosis. We mailed questionnaires to 1063 survivors who were members of Kaiser Permanente (Northern California, Northwest) during 2010 and 2011. Productive activities, functional health status, and bowel management at the time of the survey. Response rate was 60.5% (577/953). Higher comorbidity burdens were associated with lower productivity for men and women rectal cancer survivors. Productive survivors were younger and had lower disease stage and age at diagnosis, higher household income and educational attainment, and fewer comorbidity burdens and workplace adjustments than did nonproductive survivors (p < 0.05 each; 2-sided). Productive rectal cancer survivors were evenly split by sex. Staying productive is associated with better mental health for rectal cancer survivors. Rectal cancer survivors with multiple chronic conditions, higher disease stage, lower productive activities, and older age need better access to medical care and closer monitoring of the quality of their care, including self-care. To capture the full extent of the involvement of survivors in all types of productive activities, research should routinely include measures of employment, searching for employment, homemaking, and volunteering. Counting market and nonmarket productive activities is innovative and recognizes the continuum of contributions survivors make to families and society. Health care systems should routinely monitor rectal cancer survivors' medical care access, comorbidities, health-related quality of life, and productive activities.

Caries dental aguda del primer molar permanente en niños de 12 años

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Daniel Enrique Reyes Romagosa

Full Text Available Introducción: el primer molar permanente es considerado la llave de la oclusión dentaria, la presencia de caries en éste es elevada, lo que dificulta el logro de las metas trazadas por organizaciones de salud a nivel mundial en este grupo de edad. Objetivo: determinar el comportamiento de la caries dental aguda en primer molar permanente en una población de 12 años de edad atendida en la Clínica Estomatológica Santa Cruz de la Parroquia Goaigoaza. Métodos: se realizó un estudio descriptivo transversal en la Clínica Estomatológica Santa Cruz. Parroquia Goaigoaza, municipio Puerto Cabello, estado Carabobo, en el período comprendido entre abril del 2009 a abril 2010. Se seleccionaron 97 pacientes de 12 años de edad los que constituyeron el universo y la muestra. Acudieron a la consulta por dolor debido a la presencia de caries dental aguda. Se registraron las variables: edad, sexo, grado clínico de la caries dental, estímulos externos que provocaron dolor, la cara dental y la arcada dentaria más afectadas. La información fue recogida mediante interrogatorio y examen clínico. Resultados: el sexo masculino representó el 63,9 %. La caries dental de 3er grado estuvo presente en un 68 %. Los estímulos externos que provocaron dolor fueron: el frío presente en 75,2 % y los alimentos dulces en 69,1 % en ambos sexos. El primer molar inferior derecho resultó más afectado (46,4 % que el izquierdo (36,1 %, así como la arcada dentaria inferior (25,8 % y la cara oclusal (64,9 %. Conclusiones: predominaron el sexo masculino y la caries dental aguda de 3er grado. El frío y los alimentos dulces fueron los estímulos externos más frecuentes. Los más afectados resultaron el primer molar inferior derecho, la cara oclusal y la arcada dentaria inferior.

Las Lesson Study en Andalucía: un modelo de formación permanente

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Rosa M.ª Caparrós Vida

2015-01-01

Full Text Available El presente artículo ofrece los resultados de un estudio de casos desarrollado en el marco de un proyecto de investigación I+D de la Universidad de Málaga a través de una de las modalidades de formación permanente ofertadas por un Centro de Formación del Profesorado, bajo la demanda de un grupo de docentes de una escuela de la comarca de la Axarquía en Málaga. Las Lesson Study se convierten en el eje del estudio de los procesos de comprensión y reconstrucción del conocimiento práctico de una maestra de 1º de primaria sobre la enseñanza y el aprendizaje de la lectura y escritura, encontrando evidencias significativas sobre cómo esta estrategia metodológica y de investigación contribuye a la reconstrucción del mismo.

HPV Testing Among Providers

Centers for Disease Control (CDC) Podcasts

2009-10-15

Dr. Walter Kinney, a gynecologic oncologist with The Permanente Medical Group in Sacramento, California, talks about Pap and human papillomavirus (HPV) cotesting in women aged 30 and over.  Created: 10/15/2009 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Cancer Prevention and Control (DCPC).   Date Released: 6/9/2010.

Permanent education in health. An instrument to enhance interpersonal relations in nursing work La educación permanente en salud. Instrumento potenciador de las relaciones interpersonales del trabajo en enfermería Educação permanente em saúde. Instrumento potencializador das relações interpessoais no trabalho da enfermagem

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Juliane Portella Ribeiro

2012-08-01

Full Text Available This is a reflexive study about the need to adopt Permanent Education in Health, as an instrument capable of transforming interpersonal relations in nursing work, as it values and respect collective construction with a view to the qualification of care. Privileging specialization programs only, with a focus on work techniques, on educative processes, as a training strategy for health services, ends up reinforcing the fragmentation of care, teams and the work process. In conclusion, Permanent Education in Health serves not only as teaching and learning practice to update and transform practices, but also influences team relations, transforming joint action processes and, at the same time, implying each subject-worker involved in health practices.Se trata de un estudio reflexivo sobre la necesidad de adoptar la Educación Permanente en Salud, como un instrumento capaz de transformar las relaciones interpersonales en el trabajo de la enfermería, ya que valora y respeta la construcción colectiva para la calificación de la atención. Privilegiar sólo la especialización con direccionalidad en la técnica del trabajo en los procesos educativos, como estrategia de capacitación para los servicios de salud, acaba por reforzar la fragmentación del cuidado, de los equipos y del proceso de trabajo. Se concluye que la Educación Permanente en Salud, además de servir como práctica de enseñanza y aprendizaje para la actualización y transformación de las prácticas, actúa en las relaciones del equipo, transformando los procesos de acción conjunta y, al mismo tiempo, implicando cada sujeto-trabajador involucrado en las prácticas de salud.Se trata de um estudo reflexivo sobre a necessidade de adotar a Educação Permanente em Saúde, como um instrumento capaz de transformar as relações interpessoais no trabalho da enfermaria, já que, valoriza e respeita a construção coletiva, para a qualificação do atendimento. Privilegiar só a especializa

EL DESARROLLO PROFESIONAL MEDIANTE LA FORMACION PERMANENTE DE LOS PROFESORES CUBANOS DE MATEMÁTICA Y CIENCIAS PARA TRABAJAR EN PAISES DE HABLA INGLESA

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Noelio Vázquez Vargas

2014-12-01

Full Text Available Este artículo trata sobre el desarrollo profesional. Se presenta un estudio histórico sobre la enseñanza del inglés con fines específicos (IFE durante la formación permanente de los profesores cubanos de Matemática y Ciencias, además, se presentan las competencias básicas de los profesores de estas asignaturas, teniendo en cuenta el criterio de diferentes autores.

Does the diagnosis of breast or ovarian cancer trigger referral to genetic counseling?

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Powell, C Bethan; Littell, Ramey; Hoodfar, Elizabeth; Sinclair, Fiona; Pressman, Alice

2013-03-01

Kaiser Permanente Northern California is a large integrated health care delivery system in the United States that has guidelines for referring women with newly diagnosed BRCA1-and BRCA2-associated cancers for genetic counseling. This study assesses adherence to genetic counseling referral guidelines within this health system. Chart review was performed to identify patients with cancer who met the following pathology-based Kaiser Permanente Northern California guidelines for referral for genetic counseling: invasive breast cancer, younger than age 40; nonmucinous epithelial ovarian, fallopian tube, or peritoneal cancer, younger than age 60; women with synchronous or metachronous primary cancers of the breast and ovaries; and male breast cancer. We assessed compliance with referral guidelines. An electronic notice was sent to the managing physician of patients with newly diagnosed cancer to assess the feasibility of this intervention. A total of 340 patients were identified with breast cancer at younger than age 40 or with ovarian, peritoneal, or tubal cancer between January and June, 2008. Upon chart review, 105 of these patients met pathology-based criteria for referral to genetic counseling, of whom 47 (45%) were referred within the 2-year study period. Of the 67 subjects with breast cancer, 40 subjects (60%) were referred. In contrast, only 7 (21%) of 33 patients with ovarian cancer were referred (P < 0.001). A pilot study was performed to test the feasibility of notifying managing oncologists with an electronic letter alerting them of eligibility for genetic referral of patients with new diagnosis (n = 21). In the 3 to 6 months after this notification, 12 of these 21 patients were referred for counseling including 5 of 7 patients with a diagnosis of ovarian cancer. There is a missed opportunity for referring patients to genetic counseling, especially among patients with ovarian cancer. A pilot study suggests that alerting treating physicians is a feasible

Peer-Assisted History-Taking Groups: A Subjective Assessment of their Impact Upon Medical Students' Interview Skills

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Keifenheim, Katharina Eva

2017-08-01

Full Text Available Background and Objectives: Among the clinical skills needed by all physicians, history taking is one of the most important. The teaching model for peer-assisted history-taking groups investigated in the present study consists of small-group courses in which students practice conducting medical interviews with real patients. The purpose of this pilot study was to investigate the expectations, experiences, and subjective learning progress of participants in peer-assisted history-taking groups.Methods: The 42 medical student participants completed a 4-month, peer-assisted, elective history-taking course, which both began and ended with a subjective assessment of their interview skills by way of a pseudonymized questionnaire. Measures comprised the students’ self-assessment of their interview skills, their expectations of, and their experiences with the course and especially with the peer tutors. Results: Medical students’ most important motivations in attending peer-assisted history-taking groups were becoming able to complete a structured medical interview, to mitigate difficult interviewing situations, and to address patients’ emotional demands appropriately. By the end of the course, students’ self-assessment of both their interview skills and management of emotional issues improved significantly. Students especially benefitted from individual feedback regarding interview style and relationship formation, as well as generally accepted and had their expectations met by peer tutors. Conclusions: To meet the important learning objectives of history-taking and management of emotional issues, as well as self-reflection and reflection of student–patient interactions, students in the field greatly appreciate practicing medical interviewing in small, peer-assisted groups with real patients. At the same time, peer tutors are experienced to be helpful and supportive and can help students to overcome inhibitions in making contact with patients.

Fórum Permanente da Agenda 21 Paraná: seus vínculos com o processo de mobilização social

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Myrian Del Vecchio De Lima

2016-12-01

Full Text Available Este artigo utiliza a construção dos vínculos entre públicos envolvidos, proposta por Márcio Simeone Henriques (2004, para analisar a ocorrência de um processo de mobilização social, conforme entendimento teórico do sociólogo Bernardo Toro. O trabalho realiza esta proposta especificamente em relação às ações desenvolvidas pelo Fórum Permanente da Agenda 21 no Paraná. O objetivo é observar, por meio dos critérios dos vínculos, as ações de caráter mobilizador com relação a questões socioambientais empreendidas por esse coletivo, a partir do entendimento dos dois autores citados. Para tanto, o texto reflete sobre a compreensão do conceito central em questão, a mobilização social, e o papel da comunicação nesse processo. Após uma breve apresentação do Fórum Permanente da Agenda 21, verifica-se por meio de análise de conteúdo se há, no interior deste coletivo, vínculos que permitam atos de comunicação propícios à mobilização social em torno das diretrizes socioambientais propostas pela Agenda para orientar as políticas públicas.DOI: http://dx.doi.org/10.21882/ruc.v4i7.655 Recebido: 19/09/2016 Publicado: 07/12/2016

Política de Educação Permanente em Saúde: análise de sua implementação

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Katerine Gonçalves Moraes

2015-12-01

Full Text Available Introdução: A política nacional de educação permanente em saúde define novas diretrizes para a gestão democrática na área da educação na saúde, tais como: a gestão participativa, o protagonismo dos trabalhadores e usuários e o fortalecimento do controle social. Objetivo: Analisar o processo de implementação da Política de Educação Permanente em Saúde no Distrito Federal, Brasil. Métodos: Estudo de caso utilizando a teoria da política pública foi realizado no Distrito Federal, envolvendo 24 participantes chave responsáveis pela gestão e implementação dessa política. Resultados: Os achados apontam para um modelo centralizado de gestão com pouca participação de outros segmentos da sociedade civil, obstáculos de financiamento devido a questões burocráticas e desvalorização dos espaços de execução da política. Conclusão: Pode-se concluir que as mudanças políticas e de gestão não têm sido realizadas com a amplitude necessária para a construção coletiva do conhecimento nos serviços de saúde.

The historical development of modern virus research in Germany, especially in the Kaiser-Wilhelm-/Max-Planck-Society, 1936--1954.

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Butenandt, A

1977-01-01

This is lecture on the historical development of modern virus research in Germany to introduce a symposium dedicated to Prof. Werner Schäfer, Tübingen, on the occasion of his 65th birthday. The author was set the task of relating from his memories the beginning of modern virus research in Germany. This research has, since 1936, essentially taken place in the Kaiser-Wilhelm/Max-Planck-Society and in 1954 led to the founding of the Max-Planck-Institute for Virus Research in Tübingen, an institute which to the present day owes its scientific reputation in considerable part to the activity of Werner Schäfer. Since the author personally experienced and participated in the Institute's development from 1936-1954, his remarks are predominantly influenced by personal recollections, which have been sharpended by a renewed study of old records in the 'Library and Archive of the History of the Max-Planck-Gesellschaft', Berlin-Dahlem.

Hacia un espacio europeo de aprendizaje para toda la vida. Evolución y desarrollo de la Educación Permanente en la Unión Europea.

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Fernando López Noguero

2008-01-01

Full Text Available En sus inicios, la Unión Europea (UE concedió una mínima importancia a la educación en el marco de los derechos y las políticas sociales europeas, aumentando su peso paulatinamente, como comprobaremos en la propia evolución de la Educación Permanente en la UE, desarrollo que hemos dividido en cuatro etapas fundamentales. Así, desde la proclamación del Año Europeo de la Educación y la Formación Permanentes en 1996, en el que se fomentó en el seno de la UE el concepto de aprendizaje durante toda la vida, la Educación Permanente ha cambiado radicalmente en Europa hacia una nueva realidad que se ha dado en llamar “Espacio Europeo de Aprendizaje para toda la vida”, que analizamos en profundidad a través del análisis de la legislación y programas educativos existentes en la UE. ------------------------------------------------------------------------ In its early years, the European Union (EU granted a minimal importance to education in the framework of rights and social policies in Europe, increasing its weight gradually, as we Hill check on the evolution of Continuing Education in EU development which we have divided into tour Basic stages. So we will check how, since the proclamation of the European Year of Education and Training Standing in 1996, which fostered within the EU the concept of lifelong learning, Continuing Education has changed dramatically in Europe towards a new reality that has been termed a “European Area Learning for Life” which analyzed in depth through the analysis of legislation and educational programs existing in the EU.

2014 Hypertension Guideline: Recommendation for a Change in Goal Systolic Blood Pressure

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Handler, Joel

2015-01-01

The 2014 Kaiser Permanente Care Management Institute National Hypertension Guideline was developed to assist primary care physicians and other health care professionals in the outpatient treatment of uncomplicated hypertension in adult men and nonpregnant women aged 18 years and older. The new guideline reflects general acceptance, with minor modifications, of the “Evidence-Based Guideline” report by the panel members appointed to the National Heart, Lung, and Blood Institute 8th Joint National Committee. A major practice change is the recommendation for goal systolic blood pressure less than 150 mmHg in patients aged 60 years and older who are treated for hypertension in the absence of diabetes or chronic kidney disease. This article describes the reasons for, evidence for, and consequences of the change, and is followed by the National Guidelines handout. PMID:26057683

Sustaining engagement and partnership: model of enhancing cultural capital among nonaffiliated IRB members.

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Hung, Yvonne; Ayala, Armida; Morales, Francisco; Frierman-Hunt, Gina; Moreno, Alva; Nwachuku, Ijeoma

2013-07-01

Although federal regulations require the presence of at least one nonaffiliated member on the roster of an institutional review board (IRB), little research exists about how to foster their participation and satisfaction. Guided by principles of justice and diversity, the Kaiser Permanente Southern California IRB adapted the sociological concept of "cultural capital" to develop training and support with its nonaffiliated IRB members. Using in-depth qualitative interviews with four past and current nonaffiliated IRB members, we describe how our initial and ongoing activities enhanced their ability to analyze, communicate, and complete the ethical review of research. This case study is situated in the gaps of existing research about nonaffiliated IRB members by providing insights into how to sustain their engagement while protecting the rights of research volunteers, particularly from vulnerable communities.

How groups co-ordinate their concepts and terminology: implications for medical informatics.

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Garrod, S

1998-11-01

Conceptual and terminological systems are established and maintained by the communities who use them. This paper reports experiments which investigate the role of communication and interaction in the process. The experiments show that isolated pairs of communicators and virtual communities of interacting pairs naturally converge on their own conceptual and terminological systems when confronted with a common task. The results also indicate that the system converged on is optimal for that particular group engaged in that particular task. These findings are discussed in relation to the increasing use of tightly coordinated medical teams and its implications for getting them to adopt standardized medical terminologies.

Educação permanente: instrumento de trabalho do enfermeiro na instituição de longa permanência

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Silva, Bárbara Tarouco da; Barlem, Edison Luiz Devos; Lunardi, Valeria Lerch; Santos, Silvana Sidney Costa

2008-01-01

A questão educacional na enfermagem é ampla, podendo referir-se à educação formal em cursos técnicos, de graduação e de pós-graduação, ou à educação em saúde voltada aos treinamentos em serviço. Ante a problemática do envelhecimento populacional, as características da sociedade moderna e o uso crescente de Instituições de Longa Permanência (ILPs) como residência dos idosos, a proposta deste texto reflexivo é enfatizar a relevância e necessidade da educação permanente para os trabalhadores que...

Evaluación de la formación permanente del profesorado en la República Dominicana : el caso del Infocam

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Ayala de la Cruz, María Esperanza

2016-01-01

El presente estudio estuvo orientado a describir y valorar la calidad del sistema de formación, relacionándolo con la aplicación de las políticas educativas y de formación permanente o continua del profesorado en la República Dominicana. Su conexión con las necesidades e intereses de los docentes, su incidencia en el desarrollo personal, profesional, y de desempeño. Teniendo como intención estratégica generar y aportar líneas para avanzar hacia un sistema de evaluación de la formación...

Spanish adaptation of The Penn State College of Medicine Scale to assess professionalism in medical students.

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Bustamante, Eliseo; Sanabria, Álvaro

2014-01-01

Professionalism is a subject of interest in medical schools around the world. The use of a questionnaire could be useful to assess professionalism in Colombia. To adapt The Penn State University College of Medicine Professionalism Questionnaire as a culturally valid instrument in the Spanish language. We followed recommendations from the IQOLA project and used forward and back translation with four independent translations, as well as a pilot evaluation and an evaluation of psychometric features with 250 students. We evaluated item-scale correlations and internal consistency with Chronbach's alpha test and conducted a principal components factor analysis. Global Cronbach's alpha was 0.86, the Kaiser-Meyer-Olkin measure of sampling adequacy was 0.83, and Bartlett's test of sphericity had a p >0.00001. We found six factors that explained 93% of the total variance and four new factors emerged in the factor analysis, while eight items had high uniqueness. The Penn State University College of Medicine Scale measures professionalism attitudes in medical students with good reliability. However, the structure of the scale demonstrated differences when used in the Latin American medical student population.

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: A qualitative study of Kaiser Permanente

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E.T. Otte-Trojel (Eva Terese); T.G. Rundall (Thomas); A.A. de Bont (Antoinette); J.J. van de Klundert (Joris); M.E. Reed (Mary E.)

2015-01-01

textabstractBackground: Patient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain

Simulation Suggests that medical group mergers won't undermine the potential utility of health information exchanges.

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Rudin, Robert S; Schneider, Eric C; Volk, Lynn A; Szolovits, Peter; Salzberg, Claudia A; Simon, Steven R; Bates, David W

2012-03-01

Federal and state agencies are investing substantial resources in the creation of community health information exchanges, which are consortia that enable independent health care organizations to exchange clinical data. However, under pressure to form accountable care organizations, medical groups may merge and support private health information exchanges. Such activity could reduce the potential utility of community exchanges-that is, the exchanges' capacity to share patient data across hospitals and physician practices that are independent. Simulations of care transitions based on data from ten Massachusetts communities suggest that there would have to be many such mergers to undermine the potential utility of health information exchanges. At the same time, because hospitals and the largest medical groups account for only 10-20 percent of care transitions in a community, information exchanges will still need to recruit a large proportion of the medical groups in a given community for the exchanges to maintain their usefulness in fostering information exchange across independent providers.

Job sharing as an employment alternative in group medical practice.

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Vanek, E P; Vanek, J A

2001-01-01

Although physicians discuss quality-of-life and employment issues with their patients, they often fail to consider flexible scheduling and reduced employment options to lessen their own job stress. We examined one of these options by surveying two community-based, private practice groups with a combined 13-year experience with job sharing. We found that a majority of respondents rated job sharing as successful, and most wanted it to continue. Job sharers derived considerable personal benefit from the arrangement and had significantly more positive attitudes toward work than full-time physicians. Job sharing appeared to have little impact on practice parameters. Dependability, flexibility and willingness to cooperate were the most important attributes in choosing a job-sharing partner. Job sharing is an employment alternative worth exploring to retain physicians in medical group practice.

Suspended sediment entrainment estimation in unsteady turbulent flows by means of a stochastic meted; Computo de la incorporacion de sedimento en suspension en flujos turbulentos no permanentes utilizando un enfoque estocastico

Energy Technology Data Exchange (ETDEWEB)

Rodriguez, Jose Fernando; Garcia, Marcelo Horacio [Universidad de Illinois (United States); Admiraal, David Mark [Universidad de Nebraska en Lincoln (United States)

2001-06-01

bibliografia, pero todas ellas han sido derivadas para condiciones de flujo permanente y uniforme. La bondad de estas relaciones para predecir tasas de incorporacion en flujos no permanentes no ha sido demostrada y tampoco se ha intentado desarrollar una formulacion general que sea aplicable tanto en condiciones permanentes como no permanentes. El enfoque tradicional relacionada la incorporacion de sedimento con el esfuerzo de corte asociado con la friccion de grano en una forma deterministica, proveyendo solo una relacion entre valores medios. Una alternativa es considerar el esfuerzo de corte y la incorporacion como magnitudes estocasticas turbulentas y expresarlas en terminos de sus funciones de densidad de probabilidad (PDF). De esta manera se pueden obtener estadisticos de la incorporacion a partir de las PDF del esfuerzo de corte tanto en situaciones de flujos permanentes como no permanentes, dado que el efecto de la impermanencia esta implicito en el PDF. Esta nueva metodologia fue usada para estimar la incorporacion de sedimento debido al paso de embarcaciones en los rios Mississippi e Illinois. Al usar una expansion en cumulantes de bajo orden para describir la PDF del esfuerzo de corte y una version generalizada de la relacion de incorporacion de Garcia y Parker, se obtuvo una expresion para el promedio de la incorporacion, en funcion del promedio, varianza, asimetria y kurtosis del esfuerzo de corte. Los resultados se comparan satisfactoriamente con valores mencionados en la literatura.

Demonstration of shield-type longwall supports at York Canyon Mine of Kaiser Steel Corporation. Final technical report A

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Lawrence, R.G.; King, R.

1980-04-01

This report represents work on a program that was originated by the USBM of the Department of the Interior and was transferred to the Department of Energy on October 1, 1977. A demonstration with the Government funded Hemscheidt 320 HSL caliper type shield supports was conducted at three longwall panels of Kaiser Steel Corporation's York Canyon Mine. The purpose of this longwall demonstration was to provide the US coal industry with information on all aspects of shield longwall mining in high seams. The demonstration provided a working model for the coal industry and during the project, 350 people from the industry, schools, and government agencies visited the demonstration. They were provided with a first hand knowledge of a working shield longwall. The demonstration showed that the control of large coal lumps may be a problem in the mining of coal seam thicker than 8 feet. Mining with shield type supports provided good working conditions and a safe working environment. The shield requires very little maintenance and has a high mechanical availability.

GENDER DIFFERENCES IN QUALITY OF LIFE AMONG LONG-TERM COLORECTAL CANCER SURVIVORS WITH OSTOMIES

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Grant, Marcia; McMullen, Carmit K.; Altschuler, Andrea; Mohler, M. Jane; Hornbrook, Mark C.; Herrinton, Lisa J.; Wendel, Christopher S.; Baldwin, Carol M.; Krouse, Robert S.

2011-01-01

Objective To describe how gender shapes the concerns and adaptations of long-term (> 5 years) colorectal cancer (CRC) survivors with ostomies. Design Qualitative study using content analysis of focus group content. Setting Member of Kaiser Permanente, residing in either Oregon, Southwest Washington State, or Northern California. Sample Four female and four male focus groups selected from quantitative survey participants with health-related quality of life (HRQOL) scores in the highest or lowest quartile. Methods Eight focus groups, discussed challenges of living with an ostomy. Content was recorded, transcribed, and analyzed using directive and summative content analysis. Main Research Variables HRQOL domains of physical, psychological, social and spiritual well being. Findings All groups reported avoiding foods that cause gas or rapid transit, and discussed how limiting the amount of food eaten controlled the output. All groups discussed physical activities, getting support from friends and family, and the importance of being resilient. Both genders identified challenges with sexuality/intimacy. Coping and adjustment difficulties were discussed by women with men only discussing these issues to a small extent. Difficulties with sleep were primarily identified by Low HRQOL women. Problems with body image and depression were discussed only by Low HRQOL women. Conclusions Common issues included diet management, physical activity, social support and sexuality. Women with low HRQOL discussed problems with depression, body image, and sleep. Implications for Nursing Application of these gender-based differences can inform educational interventions for CRC survivors with ostomies. PMID:21875846

A three-dimensional `Kaiser damage-memory' effect through true-triaxial loading

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Meredith, P. G.; Browning, J.; Harland, S. R.; Healy, D.; Stuart, C.; Mitchell, T. M.

2017-12-01

Microcrack damage leading to failure in rocks evolves in response to differential loading. The vast majority of experimental studies investigate damage evolution, the `Kaiser damage-memory' effect, and rock failure using conventional triaxial stress states (σ1 > σ2 = σ3). Such stress states develop a crack population that displays cylindrical transverse isotropy. However, in nature the stress state is in general truly triaxial (σ1 > σ2 > σ3) and experiments that utilise such loading conditions can generate crack populations that display planar transverse isotropy which in turn influences properties such as permeability and strength. We investigate the evolution of crack damage under both conventional and true triaxial stress conditions using results from measurements made on cubic samples of sandstone deformed in three orthogonal directions with independently controlled stress paths. We have measured, simultaneously with stress and strain, the changes in ultrasonic compressional and shear wave velocities in the three principal directions, together with the bulk acoustic emission (AE) output. Changes in acoustic wave velocities are associated with both elastic closure and opening of pre-existing cracks, and the inelastic formation of new cracks. By contrast, AE is only associated with the inelastic growth of new crack damage and as such, we use the onset of AE to determine the initiation of new crack damage. By mapping these damage onsets under both conventional triaxial and true triaxial sequential cyclic loading, we have shown that `damage envelopes' evolve dynamically and can be pushed closer to the failure envelope. Whether a stress state has been `visited' before is key to determining and understanding damage states. Crack damage populations can be generated with multiple orientations depending on the arrangement of loading directions and hence principal stress directions. The sequential cyclic loading tests show that further damage in any one population

Is a reduction in distance to nearest supermarket associated with BMI change among type 2 diabetes patients?

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Zhang, Y Tara; Laraia, Barbara A; Mujahid, Mahasin S; Blanchard, Samuel D; Warton, E Margaret; Moffet, Howard H; Karter, Andrew J

2016-07-01

We examined whether residing within 2 miles of a new supermarket opening was longitudinally associated with a change in body mass index (BMI). We identified 12 new supermarkets that opened between 2009 and 2010 in 8 neighborhoods. Using the Kaiser Permanente Northern California Diabetes Registry, we identified members with type 2 diabetes residing continuously in any of these neighborhoods 12 months prior to the first supermarket opening until 10 months following the opening of the last supermarket. Exposure was defined as a reduction (yes/no) in travel distance to the nearest supermarket as a result of a new supermarket opening. First difference regression models were used to estimate the impact of reduced supermarket distance on BMI, adjusting for longitudinal changes in patient and neighborhood characteristics. Among patients in the exposed group, new supermarket openings reduced travel distance to the nearest supermarket by 0.7 miles on average. However, reduced distance to nearest supermarket was not associated with BMI changes. Overall, we found no evidence that reduced supermarket distance was associated with reduced levels of obesity for residents with type 2 diabetes. Published by Elsevier Ltd.

Overview of the consortium of hospitals advancing research on tobacco (chart

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Riley William T

2012-08-01

Full Text Available Abstract Background The Consortium of Hospitals Advancing Research on Tobacco (CHART is a network of six projects and a research coordinating unit funded by the National Heart, Lung, and Blood Institute, the National Cancer Institute, the National Institute on Drug Abuse, and the National Institutes of Health (NIH Office of Behavioral and Social Science Research. The CHART projects will assess the effectiveness and cost-effectiveness of smoking cessation interventions initiated during hospitalization and continued post-discharge. Methods/design Along with a seventh project funded previously under the NIH Challenge grants, the CHART projects will assess smoking cessation strategies delivered to approximately 10,000 hospitalized smokers across a geographically diverse group of nearly 20 private, public, academic, and community hospitals. The CHART research coordinating unit at Kaiser Permanente Center for Health Research provides organizational and data coordination support, facilitating the development of common measures for combining data from multiple CHART projects. Discussion The targeted enrollment in CHART, if achieved, will represent the largest, most diverse pooled dataset of hospitalized smokers receiving smoking cessation assistance, and is designed to contribute to the dissemination and implementation of smoking cessation interventions provided by hospital systems.

Simulation Suggests That Medical Group Mergers Won’t Undermine The Potential Utility Of Health Information Exchanges

Science.gov (United States)

Schneider, Eric C.; Volk, Lynn A.; Szolovits, Peter; Salzberg, Claudia A.; Simon, Steven R.; Bates, David W.

2013-01-01

Substantial resources are being invested in health information exchanges (HIE), community-based consortia that enable independent health-care organizations to exchange clinical data. However, under pressure to form accountable care organizations, medical groups may merge and support private HIE, reducing the potential utility of community HIEs. Simulations of “care transitions” based on data from 10 Massachusetts communities suggest that mergers would have to be considerable to substantially reduce the potential utility of an HIE. Nonetheless, simulations also suggest that HIEs will need to recruit a large proportion of the medical groups in a community, as hospitals and the largest groups account for only 10 to 20% of care transitions in communities. PMID:22392665

Evaluation of Small-Group Teaching in Human Gross Anatomy in a Caribbean Medical School

Science.gov (United States)

Chan, Lap Ki; Ganguly, Pallab K.

2008-01-01

Although there are a number of medical schools in the Caribbean islands, very few reports have come out so far in the literature regarding the efficacy of small-group teaching in them. The introduction of small-group teaching in the gross anatomy laboratory one and a half years ago at St. Matthew's University (SMU) on Grand Cayman appears to have…

Biopoder e UPPs: alteridade na experiência do policiamento permanente em comunidades cariocas

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Thiago Benedito Livramento Melicio

2012-12-01

Full Text Available O artigo visa refletir sobre a experiência do efetivo policial permanente em dois conjuntos de comunidades cariocas, inserido no escopo das Unidades de Polícia Pacificadora (UPP. Foram realizados dois estudos exploratórios, em agosto e dezembro de 2010. Na esteira do conceito foucaultiano de biopoder, discute-se a UPP como rede de relações de poder que a compõe e a legitima, pensando-se o local em que se instala, a política de Estado a que responde, os atores com que opera e as produções históricas das relações entre Estado e territórios populares. O campo de análise constitui-se, assim, nas práticas e saberes localizados no cotidiano e nos efeitos produzidos com a presença do policial na paisagem da favela. Se novas regras são trazidas com as UPPs, novas identificações são mobilizadas e as modulações de conjunto abrem lacunas, o governo de si não se produz sozinho, mas combina-se com diversidades na gestão da vida.

ANÁLISE DA CORRELAÇÃO ENTRE AS VARIÁVEIS DE DENSIFICAÇÃO DO COMPACTADOR GIRATÓRIO SUPERPAVE E A RESISTÊNCIA À DEFORMAÇÃO PERMANENTE EM MISTURAS ASFÁLTICAS CONVENCIONAIS E COM UTILIZAÇÃO DE RESÍDUOS

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Felipe Coutinho Onofre

2011-09-01

Full Text Available

Quando se comparam as metodologias de dosagem Superpave e Marshall de misturas asfálticas, uma das vantagens da primeira é a obtenção do gráfico de compactação. Tem sido verificado para misturas densas e contínuas do tipo Concreto Asfáltico (CA que determinadas áreas observadas nesse gráfico podem diferenciar estas misturas quanto à trabalhabilidade e à resistência à deformação permanente. No presente estudo, os parâmetros Compaction Densification Index (CDI e Traffic Densification Index (TDI foram utilizados como indicadores da compactabilidade. Desenvolveu-se um estudo de correlação entre estas variáveis e a resistência à deformação permanente de misturas asfálticas. Foram avaliadas três misturas asfálticas contendo: (i apenas agregados graníticos, (ii 50% de agregados graníticos e 50% de escória de aciaria e (iii 50% de agregados graníticos e 50% de Resíduo de Construção e Demolição (RCD. As variáveis escolhidas para determinação da resistência à deformação permanente foram o ensaio uniaxial de carga repetida (amostras compactadas para dois percentuais de Volume de vazios e o ensaio com um simulador de tráfego do tipo LCPC. Foi utilizado também o Processamento Digital de Imagens (PDI para a determinação da esfericidade dos agregados estudados, propriedade que influencia na resistência à deformação permanente. Os resultados indicam que as variáveis CDI e TDI podem ser usadas como parâmetros de estudo para prever a resistência à deformação permanente, mesmo para misturas com utilização de resíduos. A caracterização pela técnica do PDI mostrou que o agregado de origem granítica possui uma forma menos próxima a uma esfera em relação aos res

Educação Permanente em Saúde e Manoel de Barros: uma Aproximação Desformadora

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Eluana Borges Leitão de Figueiredo

Full Text Available RESUMO Trata-se de uma reflexão que promove diálogo entre pressupostos da Educação Permanente em Saúde (EPS e proposições desformadoras do poeta Manoel de Barros, com o objetivo de contribuir para a transvisão da formação e do trabalho em saúde. Optou-se por desvelar tal aproximação com base nos versos do poema “As lições de RQ”, que funcionaram como plataforma para os saltos reflexivos. A discussão encontrou respaldo principal em Paulo Freire e Adolfo Sanchez Vázquez, uma vez que caminhou na perspectiva de uma práxis revolucionária, transformadora e libertadora.

Ações de educação permanente dos enfermeiros facilitadores de um núcleo de educação em enfermagem

OpenAIRE

Lavich, Claudia Rosane Perico; Gomes Terra, Marlene; Lemos Mello, Amanda; Raddatz, Michele; Arnemann, Cristiane Trivisiol

2017-01-01

Objetivo: Identificar ações desenvolvidas por enfermeiros facilitadores de um Núcleo de Educação Permanente de um Hospital de Ensino.Método: Estudo de caso único com abordagem qualitativa, realizado com oito enfermeiros de um hospital no Estado do Rio Grande do Sul. A produção dos dados foi por meio de análise documental, observação sistemática e grupo focal, realizada de abril a setembro de 2013.Resultados: O estudo aponta para as seguintes categorias: estratégias potentes para promover açõe...

The regulatory framework of special medical group students' physical education: identifying the problem.

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Mazur Valerij Anatol'evich

2011-09-01

Full Text Available The question of regulatory framework for special medical group students' physical education, and their physical condition in particular is elaborated. It is found that in the current program the identified question is missing, although the assessment of individual performance standards for the physical condition of the students was envisaged in the programs of 1977 and 1982. The need for such an assessment is indicated by the large number of Ukrainian and foreign pediatricians and specialists in therapeutic physical culture. At the same time the standards for assessing these indicators are not developed. It complicates the formation of positive motivation of students to regular classes, and does not promote their self-confidence, capabilities and effectiveness of monitoring the effectiveness of exercise in various forms. The findings suggest the need to define the optimal composition of the bulk of tests and functional tests to assess the physical condition of special medical group students with various diseases and to develop appropriate indicators for their evaluation standards.

Genital herpes and its treatment in relation to preterm delivery.

Science.gov (United States)

Li, De-Kun; Raebel, Marsha A; Cheetham, T Craig; Hansen, Craig; Avalos, Lyndsay; Chen, Hong; Davis, Robert

2014-12-01

To examine the risks of genital herpes and antiherpes treatment during pregnancy in relation to preterm delivery (PTD), we conducted a multicenter, member-based cohort study within 4 Kaiser Permanente regions: northern and southern California, Colorado, and Georgia. The study included 662,913 mother-newborn pairs from 1997 to 2010. Pregnant women were classified into 3 groups based on genital herpes diagnosis and treatment: genital herpes without treatment, genital herpes with antiherpes treatment, and no herpes diagnosis or treatment (unexposed controls). After controlling for potential confounders, we found that compared with being unexposed, having untreated genital herpes during first or second trimester was associated with more than double the risk of PTD (odds ratio (OR) = 2.23, 95% confidence interval (CI): 1.80, 2.76). The association was stronger for PTD due to premature rupture of membrane (OR = 3.57, 95% CI: 2.53, 5.06) and for early PTD (≤35 weeks gestation) (OR = 2.87, 95% CI: 2.22, 3.71). In contrast, undergoing antiherpes treatment during pregnancy was associated with a lower risk of PTD compared with not being treated, and the PTD risk was similar to that observed in the unexposed controls (OR = 1.11, 95% CI: 0.89, 1.38). The present study revealed increased risk of PTD associated with genital herpes infection if left untreated and a potential benefit of antiherpes medications in mitigating the effect of genital herpes infection on the risk of PTD. © The Author 2014. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Medical care of hepatitis B among Asian American populations: perspectives from three provider groups.

Science.gov (United States)

Hwang, Jessica P; Roundtree, Aimee K; Engebretson, Joan C; Suarez-Almazor, Maria E

2010-03-01

Physicians can play a significant role in helping to decrease the hepatitis B virus (HBV) burden among Asian Americans. Few studies have described knowledge and practice patterns in the medical community among different provider types regarding HBV and liver cancer. Our study explores the HBV beliefs, attitudes and practice patterns of medical providers serving Asian American communities. We conducted three focus groups with primary care providers, liver specialists, and other providers predominantly serving Asian American community. We asked about practices and barriers to appropriate medical care and outreach. We moderated three focus groups with 23 participants, 18 of whom completed and returned demographic surveys. Twelve were of Asian ethnicity and 13 spoke English as a second language. Only eight screened at least half of their patients, most (72%) using the hepatitis B surface antigen test. We used grounded theory methods to analyze focus group transcripts. Participants frequently discussed cultural and financial barriers to hepatitis care. They admitted reluctance to screen for HBV because patients might be unwilling or unable to afford treatment. Cultural differences were discussed most by primary care providers; best methods of outreach were discussed most by liver specialists; and alternative medicine was discussed most by acupuncturists and other providers. More resources are needed to lower financial barriers complicating HBV care and encourage providing guideline-recommended screenings. Other providers can help promote HBV screening and increase community and cultural awareness.

[Medical terminology and lay users. A quali-quantitative survey of a group of young motivated graduates].

Science.gov (United States)

Conti, A A

2013-01-01

Medical terms occupy growing spaces in dictionaries and the media daily propose a great number of medical words. Nevertheless scientific data regarding the actual degree of comprehension of medical terminology on the part of lay users are scanty. Aim of this study was the evaluation, in a group of young motivated graduates, of the degree of understanding of a set of medical terms normally adopted by physicians in specialistic language, and also used when speaking with patients. Nine medical terms used by physicians in daily practice were selected (“aphasia”, “edema”, “erythema”, “fibrillation”, “fibroma”, “jaundice”, “paraplegia”, “polypus”, “sclerosis”) and they were administered in paper form to eighteen young graduates, non-health operators who were asked to furnish one definition for each of the terms. A subsequent structured oral discussion integrated the recorded written findings. Erythema and fibrillation were the most well-known and understood terms. Among the selected medical terms, the more difficult ones to understand were sclerosis and jaundice. Interesting features emerged from the characterization of the site attributed to some of the investigated terms, in particular edema was mainly perceived as the pulmonary one, fibroma was more often interpreted as a benign tumor localized in the uterus and polypus was more frequently associated with its collocation in the nose. The participants involved in this quali-quantitative survey demonstrated a general good knowledge and comprehension of the medical terms proposed. Some limits in knowledge documented in this group, however, indicate that the use of medical terminology needs more clarification within the doctor-patient context. Such clarification appears even more mandatory in subjects with low scholastic-education levels.

Personal reminiscences of the Kaiser Wilhelm Institute, Berlin, 1937/38 and of the nuclear project in Canada, 1944/56

International Nuclear Information System (INIS)

Cook, L.G.

1989-01-01

Part 1 of this talk deals with reminiscences from the Kaiser Wilhelm Institute in Berlin during the period 1937-1938. Topics include the course of experimental events and the continuing search for interpretations that would stand up, the guiding influence of the work of Irene Curie and Pvale Savic on the experimental work of Hahn and Strassmann, the influence and effects of Nazi political pressures within the Institute, the shadows of war, and how uranium fission finally got itself discovered. Part 2 gives reminiscences from the Nuclear Project in Canada from 1944 to 1956 as an extension of the pre-war work in Paris - both in concept and in personnel - created by British effort, the powerful changing US influences, the shift to British direction and a goal, the world's first high power heavy water moderated reactor for the production of massive quantities of synthetic radioactive materials, extraction processes including those for plutonium, the shift to Canadian direction and goals, a heavy water moderated electricity production system, and a postscript

Inmunización y militarización del cuerpo social en Colombia: el Estado en emergencia permanente

Directory of Open Access Journals (Sweden)

Juan Pablo Aranguren Romero

2015-12-01

Full Text Available En este artículo analizo cómo las estrategias de guerra contrainsurgente emprendidas en Colombia durante las décadas de los sesenta y los setenta recrean un dispositivo inmunitario en donde la nación es entendida como un cuerpo social amenazado e infectado por ideologías comunistas y en donde su seguridad y protección contra los actos violentos, suponen la administración de la violencia. Sostengo que este dispositivo inmunitario, opera bajo una lógica autodestructiva y una noción de amenaza deslocalizada que incentivó la militarización de la sociedad, la gestión del miedo y el sostenimiento de un Estado en emergencia permanente. Hechos que, a su vez, permitieron la apelación a la excepcionalidad constitucional como forma de gobierno normalizada.

The Use of the Delphi and Other Consensus Group Methods in Medical Education Research: A Review.

Science.gov (United States)

Humphrey-Murto, Susan; Varpio, Lara; Wood, Timothy J; Gonsalves, Carol; Ufholz, Lee-Anne; Mascioli, Kelly; Wang, Carol; Foth, Thomas

2017-10-01

Consensus group methods, such as the Delphi method and nominal group technique (NGT), are used to synthesize expert opinions when evidence is lacking. Despite their extensive use, these methods are inconsistently applied. Their use in medical education research has not been well studied. The authors set out to describe the use of consensus methods in medical education research and to assess the reporting quality of these methods and results. Using scoping review methods, the authors searched the Medline, Embase, PsycInfo, PubMed, Scopus, and ERIC databases for 2009-2016. Full-text articles that focused on medical education and the keywords Delphi, RAND, NGT, or other consensus group methods were included. A standardized extraction form was used to collect article demographic data and features reflecting methodological rigor. Of the articles reviewed, 257 met the inclusion criteria. The Modified Delphi (105/257; 40.8%), Delphi (91/257; 35.4%), and NGT (23/257; 8.9%) methods were most often used. The most common study purpose was curriculum development or reform (68/257; 26.5%), assessment tool development (55/257; 21.4%), and defining competencies (43/257; 16.7%). The reporting quality varied, with 70.0% (180/257) of articles reporting a literature review, 27.2% (70/257) reporting what background information was provided to participants, 66.1% (170/257) describing the number of participants, 40.1% (103/257) reporting if private decisions were collected, 37.7% (97/257) reporting if formal feedback of group ratings was shared, and 43.2% (111/257) defining consensus a priori. Consensus methods are poorly standardized and inconsistently used in medical education research. Improved criteria for reporting are needed.

The mediating sex-specific effect of psychological distress on the relationship between adverse childhood experiences and current smoking among adults.

Science.gov (United States)

Strine, Tara W; Edwards, Valerie J; Dube, Shanta R; Wagenfeld, Morton; Dhingra, Satvinder; Prehn, Angela Witt; Rasmussen, Sandra; McKnight-Eily, Lela; Croft, Janet B

2012-07-13

Research suggests that ACEs have a long-term impact on the behavioral, emotional, and cognitive development of children. These disruptions can lead to adoption of unhealthy coping behaviors throughout the lifespan. The present study sought to examine psychological distress as a potential mediator of sex-specific associations between adverse childhood experiences (ACEs) and adult smoking. Data from 7,210 Kaiser-Permanente members in San Diego California collected between April and October 1997 were used. Among women, psychological distress mediated a significant portion of the association between ACEs and smoking (21% for emotional abuse, 16% for physical abuse, 15% for physical neglect, 10% for parental separation or divorce). Among men, the associations between ACEs and smoking were not significant. These findings suggest that for women, current smoking cessation strategies may benefit from understanding the potential role of childhood trauma.

Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

DEFF Research Database (Denmark)

Frølich, Anne

2012-01-01

are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system...... in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear...... which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved....

Role modelling of clinical tutors: a focus group study among medical students.

Science.gov (United States)

Burgess, Annette; Goulston, Kerry; Oates, Kim

2015-02-14

Role modelling by clinicians assists in development of medical students' professional competencies, values and attitudes. Three core characteristics of a positive role model include 1) clinical attributes, 2) teaching skills, and 3) personal qualities. This study was designed to explore medical students' perceptions of their bedside clinical tutors as role models during the first year of a medical program. The study was conducted with one cohort (n = 301) of students who had completed Year 1 of the Sydney Medical Program in 2013. A total of nine focus groups (n = 59) were conducted with medical students following completion of Year 1. Data were transcribed verbatim. Thematic analysis was used to code and categorise data into themes. Students identified both positive and negative characteristics and behaviour displayed by their clinical tutors. Characteristics and behaviour that students would like to emulate as medical practitioners in the future included: 1) Clinical attributes: a good knowledge base; articulate history taking skills; the ability to explain and demonstrate skills at the appropriate level for students; and empathy, respect and genuine compassion for patients. 2) Teaching skills: development of a rapport with students; provision of time towards the growth of students academically and professionally; provision of a positive learning environment; an understanding of the student curriculum and assessment requirements; immediate and useful feedback; and provision of patient interaction. 3) Personal qualities: respectful interprofessional staff interactions; preparedness for tutorials; demonstration of a passion for teaching; and demonstration of a passion for their career choice. Excellence in role modelling entails demonstration of excellent clinical care, teaching skills and personal characteristics. Our findings reinforce the important function of clinical bedside tutors as role models, which has implications for faculty development and

REFORMAS EDUCATIVAS Y FORMACIÓN PERMANENTE DEL PROFESORADO EN LA ÚLTIMA OBRA DE JULIA VARELA: MEMORIA Y OLVIDO

Directory of Open Access Journals (Sweden)

Alberto Luís Gómez

2009-01-01

Full Text Available En este artículo se analizan la complejidad del proceso de construcción de los Centros de Profesores y el papel desempeñado por una diversidad de instancias y personas que, desde distintos puntos de vista, defendieron su articulación dentro del más amplio campo de la formación permanente del profesorado español entre 1983 y 1990. Habiendo tomado como punto de partida de nuestras reflexiones el último libro de Julia Varela ¿Las reformas educativas a debate (1982-2006¿ defendemos tanto su interés como la asimetría existente entre la relevancia política de esta obra y su debilidad historiográfica.

Are medical treatments for individuals and groups like single-play and multiple-play gambles?

Directory of Open Access Journals (Sweden)

Michael L. DeKay

2006-11-01

Full Text Available People are often more likely to accept risky monetary gambles with positive expected values when the gambles will be played more than once. We investigated whether this distinction between single-play and multiple-play gambles extends to medical treatments for individual patients and groups of patients. Resident physicians and medical students (extit{n} = 69 and undergraduates (extit{n} = 99 ranked 9 different flu shots and a no-flu-shot option in 1 of 4 combinations of perspective (individual patient vs. group of 1000 patients and uncertainty frame (probability vs. frequency. The rank of the no-flu-shot option (a measure of preference for treatment vs. no treatment was not significantly related to perspective or participant population. The main effect of uncertainty frame and the interaction between perspective and uncertainty frame approached significance (0.1 {extgreater} extit{p} {extgreater} 0.05, with the no-flu-shot option faring particularly poorly (treatment faring particularly well when decisions about many patients were based on frequency information. Undergraduate participants believed that the no-flu-shot option would be less attractive (treatment would be more attractive in decisions about many patients, but these intuitions were inconsistent with the actual ranks. These results and those of other studies suggest that medical treatments for individuals and groups are not analogous to single-play and multiple-play monetary gambles, perhaps because many people are unwilling to aggregate treatment outcomes over patients in the same way that they would compute net gains or losses over monetary gambles.

Increasing medical student exposure to musculoskeletal medicine: the initial impact of the Orthopaedic Surgery and Sports Medicine Interest Group

Directory of Open Access Journals (Sweden)

Mickelson DT

2017-07-01

Full Text Available Dayne T Mickelson,1 Philip K Louie,2 Kenneth R Gundle,3 Alex W Farnand,4 Douglas P Hanel5 1Department of Orthopedic Surgery and Sports Medicine, Duke University, Durham, NC, USA; 2Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA; 3Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR, USA; 4Department of General Surgery, Presence Saint Joseph Hospital – Chicago, Chicago, IL, USA; 5Department of Orthopedic Surgery and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA Purpose: To investigate the impact of the Orthopaedic Surgery and Sports Medicine Interest Group (OSSMIG on medical student interest and confidence in core musculoskeletal (MSK concepts through supplemental education and experiences at a single tertiary, academic institution.Methods: Medical student OSSMIG members at various levels of training were anonymously surveyed at the beginning and end of the 2014–2015 academic year.Results: Eighteen (N=18 medical student interest group members completed the survey. Significant improvement in their level of training was observed with regard to respondents’ self-assessed competence and confidence in MSK medicine (p<0.05. Additionally, respondents’ attitudes toward exposure and support from the interest group were significantly higher than those provided by the institution (p<0.05. Members believed OSSMIG increased interest in MSK medicine, improved confidence in their ability to perform orthopedics-related physical exams, strengthened mentorship with residents and attendings, and developed a connection with the Department of Orthopedic Surgery and its residents (median “Strongly Agree”, interquartile range one and two scale items.Conclusion: Since its inception 8 years ago, OSSMIG has been well received and has positively impacted University of Washington School of Medicine students through various interventions

Comparative Effectiveness of Three Prophylactic Strategies to Prevent Clinical Macular Edema after Phacoemulsification Surgery.

Science.gov (United States)

Shorstein, Neal H; Liu, Liyan; Waxman, Michael D; Herrinton, Lisa J

2015-12-01

To study the relationship of chemoprophylaxis and other factors with the occurrence of acute, clinical, postoperative macular edema. Retrospective cohort study. The drug regimens consisted of postoperative topical prednisolone acetate (PA) alone or with a nonsteroidal anti-inflammatory drug (NSAID) or intraoperative subconjunctival injection of 2 mg triamcinolone acetonide (TA) alone. Patients undergoing phacoemulsification at Kaiser Permanente, Diablo Service Area, Northern California, from 2007 through 2013. We identified incident macular edema diagnoses that had been recorded 5 to 120 days after phacoemulsification with visual acuity 20/40 or worse and evidence of macular thickening by optical coherence tomography. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from logistic regression analysis, conditioned on the surgeon and adjusted for year, patient age and race, diabetic retinopathy status, other ocular comorbidities, systemic comorbidities, and posterior capsular rupture status. Incident rates of acute, clinical, postoperative macular edema. We confirmed 118 cases among 16 070 cataract surgeries (incidence, 0.73%). Compared with PA alone, the OR for the relationship of macular edema with PA+NSAID was 0.45 (95% CI, 0.21-0.95) and that for TA injection was 1.21 (95% CI, 0.48-3.06). The frequency of intraocular pressure spikes of 30 mmHg or more between postoperative days 16 and 45 was 0.6% in the topical PA group, 0.3% in the topical PA+NSAID group (P = 0.13), and 0.8% for the TA group (P = 0.52). Black race was associated with a risk of macular edema (OR, 2.86; 95% CI, 1.41-5.79). Adding a prophylactic NSAID to PA treatment was associated with a reduced risk of macular edema with visual acuity of 20/40 or worse. The risk and safety of TA injection were similar to those of PA alone. Further research is needed on the prognostic significance of postoperative macular edema, the role of prophylaxis, the risk among black people, and the

Políticas y prácticas en la formación permanente del profesorado en TIC en Cataluña

OpenAIRE

Adriana Ornellas; Joan\\u2010Anton Sánchez; Leticia Fraga Colman; Laura Domingo

2015-01-01

En este artículo presentamos los resultados que emergen de una de las dimensiones investigadas en el proyecto “Políticas y prácticas en torno a las TIC en la enseñanza obligatoria: Implicaciones para la innovación y la mejora” (Ministerio de Ciencia e Innovación. SEJ2007-­‐67562). Nos centramos aquí en uno de los factores determinantes del éxito o fracaso de las políticas destinadas a transformar las prácticas educativas a partir de la integración de las TIC: la formación inicial y permanente...

Políticas y prácticas en la formación permanente del profesorado en TIC en Cataluña

Directory of Open Access Journals (Sweden)

Adriana Ornellas

2015-01-01

Full Text Available En este artículo presentamos los resultados que emergen de una de las dimensiones investigadas en el proyecto “Políticas y prácticas en torno a las TIC en la enseñanza obligatoria: Implicaciones para la innovación y la mejora” (Ministerio de Ciencia e Innovación. SEJ2007-­‐67562. Nos centramos aquí en uno de los factores determinantes del éxito o fracaso de las políticas destinadas a transformar las prácticas educativas a partir de la integración de las TIC: la formación inicial y permanente del profesorado.

How does the culture of medical group practices influence the types of programs used to assure quality of care?

Science.gov (United States)

Kaissi, Amer; Kralewski, John; Curoe, Ann; Dowd, Bryan; Silversmith, Janet

2004-01-01

It is widely acknowledged that the culture of medical group practices greatly influences the quality of care, but little is known about how cultures are translated into specific types of programs focused on quality. This study explores this issue by assessing the influence of the organizational culture on these types of programs in medical group practices in the upper Midwest. Data were obtained from two surveys of medical group practices. The first survey was designed to assess the culture of the practice using a nine-dimension instrument developed previously. The second survey was designed to obtain organizational structure data including the programs identified by the literature as important to the quality of care in medical practices. Completed surveys were obtained from eighty-eight medical groups. The relationship of the group practice culture to structural programs focused on quality of care was analyzed using logistic regression equations. Several interesting patterns emerged. As expected, practices with a strong information culture favor electronic data systems and formal programs that provide comparative or evidence-based data to enhance their clinical practices. However, those with a quality-centered culture appear to prefer patient satisfaction surveys to assess the quality of their care, while practices that are more business-oriented rely on bureaucratic strategies such as benchmarking and physician profiling. Cultures that emphasize the autonomy of physician practice were negatively (but not at a statistically significant level) associated with all the programs studied. Practices with a highly collegial culture appear to rely on informal peer review mechanisms to assure quality rather than any of the structural programs included in this analysis. This study suggests that the types of quality programs that group practices develop differ according to their cultures. Consequently, it is important for practice administrators and medical directors to

A Survey of Parents with Children on the Autism Spectrum: Experience with Services and Treatments.

Science.gov (United States)

Becerra, Tracy A; Massolo, Maria L; Yau, Vincent M; Owen-Smith, Ashli A; Lynch, Frances L; Crawford, Phillip M; Pearson, Kathryn A; Pomichowski, Magdalena E; Quinn, Virginia P; Yoshida, Cathleen K; Croen, Lisa A

2017-01-01

Autism spectrum disorders (ASD) are lifelong neurodevelopmental disorders, and little is known about how parents address the health and psychosocial consequences of ASD. Few studies have examined use of various treatments and services in a large, diverse sample of children with ASD and their families. This paper presents methods to create an autism research resource across multiple large health delivery systems and describes services and treatments used by children with ASD and their families. Four study sites conducted a Web survey of parents of children and adolescents with ASD who were members of Kaiser Permanente. We tabulated data distributions of survey responses and calculated χ 2 statistics for differences between responders and nonresponders. The children of the 1155 respondents were racially and ethnically diverse (55% white, 6% black, 5% Asian, 9% multiracial, 24% Hispanic) and representative of the total population invited to participate with respect to child sex (83% male), child age (57% Education Programs (85%), family physician visits (78%), and occupational and speech therapy (55% and 60%, respectively). Home-based programs frequently included implementation of social skills training (44%) and behavior management (42%). Prescription medication use was high (48%). Caregivers reported disruption of personal and family routines because of problem behaviors. These survey data help to elucidate parents' experiences with health services for their children with ASD and serve as a potential resource for future research.

Predictors of Bowel Function in Long-term Rectal Cancer Survivors with Anastomosis.

Science.gov (United States)

Alavi, Mubarika; Wendel, Christopher S; Krouse, Robert S; Temple, Larissa; Hornbrook, Mark C; Bulkley, Joanna E; McMullen, Carmit K; Grant, Marcia; Herrinton, Lisa J

2017-11-01

Bowel function in long-term rectal cancer survivors with anastomosis has not been characterized adequately. We hypothesized that bowel function is associated with patient, disease, and treatment characteristics. The cohort study included Kaiser Permanente members who were long-term (≥5 years) rectal cancer survivors with anastomosis. Bowel function was scored using the self-administered, 14-item Memorial Sloan-Kettering Cancer Center Bowel Function Index. Patient, cancer, and treatment variables were collected from the electronic medical chart. We used multiple regression to assess the relationship of patient- and treatment-related variables with the bowel function score. The study included 381 anastomosis patients surveyed an average 12 years after their rectal cancer surgeries. The total bowel function score averaged 53 (standard deviation, 9; range, 31-70, higher scores represent better function). Independent factors associated with worse total bowel function score included receipt of radiation therapy (yes vs. no: 5.3-unit decrement, p 6 cm: 3.2-unit decrement, p decrement, p decrement, p model explained 20% of the variation in the total bowel function score. Low tumor location, radiation therapy, temporary ostomy during initial treatment, and history of smoking were linked with decreased long-term bowel function following an anastomosis. These results should improve decision-making about surgical options.

The human factor: the critical importance of effective teamwork and communication in providing safe care.

Science.gov (United States)

Leonard, M; Graham, S; Bonacum, D

2004-10-01

Effective communication and teamwork is essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm. The complexity of medical care, coupled with the inherent limitations of human performance, make it critically important that clinicians have standardised communication tools, create an environment in which individuals can speak up and express concerns, and share common "critical language" to alert team members to unsafe situations. All too frequently, effective communication is situation or personality dependent. Other high reliability domains, such as commercial aviation, have shown that the adoption of standardised tools and behaviours is a very effective strategy in enhancing teamwork and reducing risk. We describe our ongoing patient safety implementation using this approach within Kaiser Permanente, a non-profit American healthcare system providing care for 8.3 million patients. We describe specific clinical experience in the application of surgical briefings, properties of high reliability perinatal care, the value of critical event training and simulation, and benefits of a standardised communication process in the care of patients transferred from hospitals to skilled nursing facilities. Additionally, lessons learned as to effective techniques in achieving cultural change, evidence of improving the quality of the work environment, practice transfer strategies, critical success factors, and the evolving methods of demonstrating the benefit of such work are described.

TENDENCIATEMPORALDE LAINCAPACIDAD LABORAL PERMANENTE EN ESPAÑA (1992-2010

Directory of Open Access Journals (Sweden)

Xavier Duran

2012-01-01

Full Text Available Fundamentos: La incapacidad permanente (IP es un problema de salud laboral en el que intervienen factores laborales, sanitarios o legales, los cuales han variado en España a lo largo de los últimos años. El objetivo del presente estudio es describir la tendencia temporal de la IP en España desde 1992 a 2010 por gravedad de la incapacidad y diferentes variables sociodemográficas y de afiliación a la seguridad social. Métodos: A partir de los datos de la Seguridad Social sobre afiliación y altas de IP en España se describió la tendencia temporal de la incidencia anual de la IP en el periodo comprendido entre 1992 y 2010. Para valorar las tendencias se estimó el porcentaje de cambio anual (PCA y el intervalo de confianza al 95% mediante un modelo de regresión binomial negativa. Resultados: La tendencia de la incidencia de IP se subdividió en tres periodos. El primero (1992 a 1997 presentó una incidencia aproximadamente constante de 75 casos por 10.000 trabajadores (PCA1= -0,1; IC 95%:-1,6 a 1,4. Seguidamente las tasas descendieron durante un período de tres años (PCA2:-12,1%; IC 95%:-13,9 a -10,4, situándose alrededor de 50 nuevos casos por 10.000 trabajadores en el año 2000. A partir de este año la incidencia de IP se mantuvo aproximadamente constante hasta el año 2010 (PCA3=0,4; IC 95%:-0,2 a 1,0. Conclusiones: Apesar del incremento de trabajadores afiliados a la seguridad social en el periodo estudiado, la incidencia de IP se mantiene bastante estable, con un descenso entre 1997 y 2000 que se podría atribuir a las medidas de evaluación y seguimiento de las IP adoptados en 1995.

Self-Management Support to People with Type 2 Diabetes - A comparative study of Kaiser Permanente and the Danish Healthcare System

DEFF Research Database (Denmark)

Schiøtz, Michaela Louise; Strandberg-Larsen, Martin; Frølich, Anne

2012-01-01

En væsentlig del af kronikeromsorgen i et sundhedsvæsen er også at understøtte egenomsorgen. Egenomsorg omfatter fx, at patienten kender til, hvad der kan optimere behandlingsindsatsen, herunder ændring af livsstil, kendskab til sundhedsvæsenets tilbud, og at deltage aktivt i at koordinere og sik...

[The PROPRESE trial: results of a new health care organizational model in primary care for patients with chronic coronary heart disease based on a multifactorial intervention].

Science.gov (United States)

Ruescas-Escolano, Esther; Orozco-Beltran, Domingo; Gaubert-Tortosa, María; Navarro-Palazón, Ana; Cordero-Fort, Alberto; Navarro-Pérez, Jorge; Carratalá-Munuera, Concepción; Pertusa-Martínez, Salvador; Soler-Bahilo, Enrique; Brotons-Muntó, Francisco; Bort-Cubero, Jose; Núñez-Martínez, Miguel A; Bertomeu-Martínez, Vicente; López-Pineda, Adriana; Gil-Guillén, Vicente F

2014-06-01

Comparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care. In this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed. The characteristics of patients were: age (68.4±11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes. Copyright © 2014 Elsevier España, S.L. All rights reserved.

An Overview of medical solution business of Hitachi group

International Nuclear Information System (INIS)

Ninomiya, Ken; Tao, Ryuji; Umegaki, Kikuo; Hashizume, Akihide; Watanabe, Shigeru

2006-01-01

Hitachi is promoting the medicare business in the medical fields of imaging diagnosis, external diagnosis, medical information, treatment support and medical service with the concept that advancement of medical technology is essential for health and this paper describes its major details including research/development. In imaging diagnosis, Hitachi has apparatuses for MRI, X-ray radiography, X-CT, ultrasonography and PET, which are being subject to continuous technological improvement for patients (the principle, Patient Friendly). Clinical laboratory test equipments are in external diagnosis, where ''LABOSPECT series'', a support system for clinical chemistry, has been recently marketed. Medical information involves the total health-care system of people to connect the medical facilities (e.g., POMR, problem oriented medical record) and national medical institutions (e.g., IHE-J, integrating the healthcare enterprise-Japan). One of topics of Hitachi's res/dev is the molecular imaging like PET equipped with high magnetic field MRI and semi-conductor detector and, the other, targeting therapy with proton accelerator already operating in Tsukuba University and to be operated in The University of Texas. Hitachi is working for turning the dream of healthy and safe society into reality through technology. (T.I.)

Medical Managment of the Acute Radiation Syndrome: Recommendations of the Strategic National Stockpile Radiation Working Group

National Research Council Canada - National Science Library

Waselenka, Jamie K; MacVittie, Thomas J; Blakely, William F; Pesik, Nicki; Wiley, Albert L; Dickerson, William E; Tsu, Horace; Confer, Dennis L; Coleman, Norman; Seed, Thomas

2004-01-01

.... This consensus document was developed by the Strategic National Stockpile Radiation Working Group to provide a framework for physicians in internal medicine and the medical subspecialties to evaluate...

Recognition of patients with medically unexplained physical symptoms by family physicians: results of a focus group study

NARCIS (Netherlands)

Boeft, M. den; Huisman, D.; Wouden, J.C. van der; Numans, M.E.; Horst, H.E. van der; Lucassen, P.L.B.J.; Olde Hartman, T.C.

2016-01-01

BACKGROUND: Patients with medically unexplained physical symptoms (MUPS) form a heterogeneous group and frequently attend their family physician (FP). Little is known about how FPs recognize MUPS in their patients. We conducted a focus group study to explore how FPs recognize MUPS and whether they

Basic steps in establishing effective small group teaching sessions in medical schools.

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Meo, Sultan Ayoub

2013-07-01

Small-group teaching and learning has achieved an admirable position in medical education and has become more popular as a means of encouraging the students in their studies and enhance the process of deep learning. The main characteristics of small group teaching are active involvement of the learners in entire learning cycle and well defined task orientation with achievable specific aims and objectives in a given time period. The essential components in the development of an ideal small group teaching and learning sessions are preliminary considerations at departmental and institutional level including educational strategies, group composition, physical environment, existing resources, diagnosis of the needs, formulation of the objectives and suitable teaching outline. Small group teaching increases the student interest, teamwork ability, retention of knowledge and skills, enhance transfer of concepts to innovative issues, and improve the self-directed learning. It develops self-motivation, investigating the issues, allows the student to test their thinking and higher-order activities. It also facilitates an adult style of learning, acceptance of personal responsibility for own progress. Moreover, it enhances student-faculty and peer-peer interaction, improves communication skills and provides opportunity to share the responsibility and clarify the points of bafflement.

The role of medical group practice administrators in the adoption and implementation of Medicare's physician quality reporting system.

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Coulam, Robert; Kralewski, John; Dowd, Bryan; Gans, David

2016-01-01

Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators. To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States. We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators. Responses were organized and analyzed using the innovation decision framework of Van de Ven and colleagues. Administrators conducted due diligence on PQRS, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators' recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations. Virtually, all who attempted it agreed that PQRS was straightforward to implement. However, the complexities of Medicare's PQRS reports impeded use of the data by administrators to support quality management. Group practice administrators are playing a prominent role in activities related to the quality of patient care--they are not limited to the business side of the practice. Especially, as PQRS becomes more nearly universal after 2014, Medicare should take account of the role that administrators play, by more actively engaging administrators in shaping these programs and making it easier for administrators to use the results. More research is needed on the rapidly evolving role of nonphysician administration in medical group practices. Practice administrators have a larger role than commonly understood in how quality reporting initiatives are adopted and used and are in an exceptional position to influence the more appropriate use of these resources if

Evolution of Facebook groups: Informal e-learning among medical laboratory scientists in Nigeria

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Jarret Cassaniti

2014-09-01

Full Text Available Most people think of online courses when they talk about e-learning, but aspects of social media can also be considered e-learning. In 2011 the Knowledge for Health Project (K4Health began work with local partners to implement an e-learning and professional development policy for Medical Laboratory Scientists based on the needs identified by United States Agency for International Development (USAID/Nigeria. Six e-learning courses were developed and promoted through several channels including social media. A Facebook Group was created to share information about accessing and navigating the courses and attracted 8,500 members in 18 months. As the Group grew, the topics discussed evolved to include trade union news, employment opportunities and technical resources. Another Facebook Group provided insights that Facebook Groups could be used to facilitate interactions focused on continuing professional development. The findings show that Facebook Groups accommodate an informal learning style, allowing individuals to learn through peer support in flexible ways. It has also shown that the use of Facebook Groups is associated with high levels of engagement with e-learning courses.

Changes in School Food Preparation Methods Result in Healthier Cafeteria Lunches in Elementary Schools.

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Behrens, Timothy K; Liebert, Mina L; Peterson, Hannah J; Howard Smith, Jennifer; Sutliffe, Jay T; Day, Aubrey; Mack, Jodi

2018-05-01

The purpose of this study is to examine the impact of a districtwide food best practices and preparation changes in elementary schools lunches, implemented as part of the LiveWell@School childhood obesity program, funded by LiveWell Colorado/Kaiser Permanente Community Health Initiative. Longitudinal study examining how school changes in best practices for food preparation impacted the types of side items offered from 2009 to 2015 in elementary school cafeterias in a high-need school district in southern Colorado. Specifically, this study examined changes in side items (fruits, vegetables, potatoes, breads, and desserts). In Phase 1 (2009-2010), baseline data were collected. During Phase 2 (2010-2011), breaded and processed foods (e.g., frozen nuggets, pre-packaged pizza) were removed and school chefs were trained on scratch cooking methods. Phase 3 (2011-2012) saw an increased use of fresh/frozen fruits and vegetables after a new commodity order. During Phase 4 (2013-2015), chef consulting and training took place. The frequency of side offerings was tracked across phases. Analyses were completed in Fall 2016. Because of limited sample sizes, data from Phases 2 to 4 (intervention phases) were combined for potatoes and desserts. Descriptive statistics were calculated. After adjusting for length of time for each phase, Pearson chi-square tests were conducted to examine changes in offerings of side items by phase. Fresh fruit offerings increased and canned fruit decreased in Phases 1-4 (p=0.001). A significant difference was observed for vegetables (p=0.001), with raw and steamed vegetables increasing and canned vegetables decreasing from Phase 1 to 4. Fresh potatoes (low in sodium) increased and fried potatoes (high in sodium) decreased from Phase 1 to Phases 2-4 (p=0.001). Breads were eliminated entirely in Phase 2, and dessert changes were not significant (p=0.927). This approach to promoting healthier lunch sides is a promising paradigm for improving elementary

Medical mission to dominican republic: one dermatology group?s experiences.

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Ahmed, Atif; Peine, Steven

2013-01-01

The intents of this article are to share our experiences during a medical mission in the Dominican Republic and to provide the reader with a cross-sectional view of conditions seen and an overview of interesting and challenging cases encountered. We also discuss treatments and techniques used and share lessons learned. 2013.

Estrategias del Teatro del Oprimido para la formación permanente del profesorado

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Tomás Motos-Teruel

2012-01-01

Full Text Available Este artículo relata una experiencia y su valoración de formación permanente del profesorado basada en el aprendizaje vivencial utilizando como estrategia metodológica el Teatro del Oprimido (TO para estimular y favorecer la reflexión sobre la práctica educativa. Sus objetivos básicos fueron dar a conocer la formulación teórica y la metodología del TO y hacer la transferencia de las estrategias metodológicas vivenciadas a la práctica docente. El estudio se ha planteado desde una óptica cualitativa con el estudio de caso único. Y como resultados más destacables hay que reseñar el interés y la percepción de la utilidad personal y profesional del TO como instrumento de reflexión sobre la acción y generador de clima positivo. El Teatro del Oprimido es una formulación teórica y un método estético cuya teoría y praxis están inspiradas en la Pedagogía del Oprimido de Paulo Freire, utiliza las técnicas dramáticas como un instrumento eficaz para la comprensión y la búsqueda de alternativas a problemas sociales, interpersonales e individuales.

EDUCAÇÃO PERMANENTE EM ENFERMAGEM E A INTERFACE COM A OUVIDORIA HOSPITALAR

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Raquel Costa Rodrigues de Souza

2010-01-01

Full Text Available Se trata de un estudio descriptivo-exploratorio, con enfoque cualitativo, cuyo objetivo fue investigar las demandas de los usuarios del servicio de Defensoría del Pueblo relacionadas con la asistencia de enfermería y discutir su contribución para la educación permanente. La investigación se desarrolló en hospital público federal, con notoriedad en realización de procedimientos diagnósticos y terapéuticos de alta complejidad en Ortopedia. La recolección de datos se basó en la técnica de análisis documental, incluyendo la gestión de informaciones y materiales, de las demandas de los usuarios que figuran en los registros de la Oficina de Defensoría del Pueblo, relativos al año 2009, (total de 3.895 declaraciones. Hemos clasificado las declaraciones recibidas- en este estudio- según la naturaleza de la comunicación: elogio, pedido de información, queja, sugerencia y denuncia. Hemos considerado la importancia del Servicio de Defensoría del Pueblo para mejorar la actuación de enfermería, teniendo en cuenta las contribuciones extraídas del contexto de las demandas y que la relación interdisciplinar permite percibir y evaluar las necesidades evidenciadas.

Estimating morbidity rates from electronic medical records in general practice: evaluation of a grouping system.

NARCIS (Netherlands)

Biermans, M.C.J.; Verheij, R.A.; Bakker, D.H. de; Zielhuis, G.A.; Vries Robbé, P.F. de

2008-01-01

Objectives: In this study, we evaluated the internal validity of EPICON, an application for grouping ICPCcoded diagnoses from electronic medical records into episodes of care. These episodes are used to estimate morbidity rates in general practice. Methods: Morbidity rates based on EPICON were

The Effect of Student Working Group Establishment on Teaching General Embryology Course to Medical Students

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Mozafar Khazaei

2012-11-01

Full Text Available Introduction: Quantitative and qualitative enhancement of educational activities is an essential issue. Learners’ cooperation in the teaching process in order to increase teaching effectiveness and promotion is considered significant. The aim of the present study was to determine the effect of establishment of student working group on the teaching general embryology course to medical students.Methods: Ten students (1% of medical embryology course were selected to analyze the topics to be taught before each session according to lesson plan, and observe the whole teaching process during lesson presentation. Then, having asked the other students’ viewpoints and discussing with one another, they provided the teacher with a written report on the strengths and weaknesses of the teaching and its problems. The teacher analyzed the problems proposed by the working group to improve teaching process in the next session. At the end of the semester, a questionnaire was administered to all the participants. Data were analyzed using descriptive statistics.Results: The mean of students’ scores was 74.26%. The most important findings obtained in this study included positive role of film projection in teaching the materials (95.34%, significance of presentation of various pictures from different books (88.4%, changing students’ attitude toward application of embryology in different diseases (86%, and repetition of previous session’s pictures (83.75%. The weak points mentioned, however, were physical problems of the classroom and deficiency of audio visual equipment.Conclusion: Student working group has a positive impact on the teaching medical general embryology.

Use of Electronic Health Records and Administrative Data for Public Health Surveillance of Eye Health and Vision-Related Conditions

Science.gov (United States)

Elliott, Amanda; Davidson, Arthur; Lum, Flora; Chiang, Michael; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E.; Chou, Chiu-Fang

2014-01-01

Purpose To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Methods We describe three currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Results Each of the three sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Conclusions Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. PMID:23158225

The mediating sex-specific effect of psychological distress on the relationship between adverse childhood experiences and current smoking among adults

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Strine Tara W

2012-07-01

Full Text Available Abstract Background Research suggests that ACEs have a long-term impact on the behavioral, emotional, and cognitive development of children. These disruptions can lead to adoption of unhealthy coping behaviors throughout the lifespan. The present study sought to examine psychological distress as a potential mediator of sex-specific associations between adverse childhood experiences (ACEs and adult smoking. Method Data from 7,210 Kaiser-Permanente members in San Diego California collected between April and October 1997 were used. Results Among women, psychological distress mediated a significant portion of the association between ACEs and smoking (21% for emotional abuse, 16% for physical abuse, 15% for physical neglect, 10% for parental separation or divorce. Among men, the associations between ACEs and smoking were not significant. Conclusions These findings suggest that for women, current smoking cessation strategies may benefit from understanding the potential role of childhood trauma.

Outcomes in Treatment for Intradural Spinal Cord Ependymomas

International Nuclear Information System (INIS)

Volpp, P. Brian; Han, Khanh; Kagan, A. Robert; Tome, Michael

2007-01-01

Purpose: Spinal cord ependymomas are rare tumors, accounting for <2% of all primary central nervous system tumors. This study assessed the treatment outcomes for patients diagnosed with spinal cord ependymomas within the Southern California Kaiser Permanente system. Methods and Materials: We studied 23 patients treated with surgery with or without external beam radiotherapy (EBRT). The local and distant control rates and overall survival rates were determined. Results: The overall local control, overall recurrence, and 9-year overall survival rate was 96%, 17.4%, and 63.9%, respectively. Conclusions: The results of our study indicate that en bloc gross total resection should be the initial treatment, with radiotherapy reserved primarily for postoperative cases with unfavorable characteristics such as residual tumor, anaplastic histologic features, or piecemeal resection. Excellent local control and overall survival rates can be achieved using modern microsurgical techniques, with or without local radiotherapy

Utilization and perceived problems of online medical resources and search tools among different groups of European physicians.

Science.gov (United States)

Kritz, Marlene; Gschwandtner, Manfred; Stefanov, Veronika; Hanbury, Allan; Samwald, Matthias

2013-06-26

There is a large body of research suggesting that medical professionals have unmet information needs during their daily routines. To investigate which online resources and tools different groups of European physicians use to gather medical information and to identify barriers that prevent the successful retrieval of medical information from the Internet. A detailed Web-based questionnaire was sent out to approximately 15,000 physicians across Europe and disseminated through partner websites. 500 European physicians of different levels of academic qualification and medical specialization were included in the analysis. Self-reported frequency of use of different types of online resources, perceived importance of search tools, and perceived search barriers were measured. Comparisons were made across different levels of qualification (qualified physicians vs physicians in training, medical specialists without professorships vs medical professors) and specialization (general practitioners vs specialists). Most participants were Internet-savvy, came from Austria (43%, 190/440) and Switzerland (31%, 137/440), were above 50 years old (56%, 239/430), stated high levels of medical work experience, had regular patient contact and were employed in nonacademic health care settings (41%, 177/432). All groups reported frequent use of general search engines and cited "restricted accessibility to good quality information" as a dominant barrier to finding medical information on the Internet. Physicians in training reported the most frequent use of Wikipedia (56%, 31/55). Specialists were more likely than general practitioners to use medical research databases (68%, 185/274 vs 27%, 24/88; χ²₂=44.905, Presources on the Internet and frequent reliance on general search engines and social media among physicians require further attention. Possible solutions may be increased governmental support for the development and popularization of user-tailored medical search tools and open

Primary Care DirectConnect: How the Marriage of Call Center Technology and the EMR Brought Dramatic Results—A Service Quality Improvement Study

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Bowman, Brent; Smith, Scott

2010-01-01

Of the key Health Plan patient satisfaction measures used in Kaiser Permanente Colorado, ease of contacting the physician's office with a medical question was consistently rated as the lowest quarterly patient satisfaction measure. Furthermore, medical office staff had become dissatisfied with their inability to contact patients who had previously left messages. In addition to the shear volume of messages, the return calls were often unanswered, leading to subsequent attempts to reach patients, creating additional work for medical office staff. DirectConnect—the project name for a system and set of processes focused on improving patient satisfaction with the ability to contact Primary Care delivery teams by telephone—focuses on isolating medical advice calls from the other types of calls handled by the centralized Call Center. The system identifies the patient using his/her unique electronic medical record number, then automatically routes medical advice calls directly to the appropriate Primary Care Physician (PCP) or staff. The clinician may then evaluate and respond to the patient's need quickly, thus managing more of their panel's requests in real time. How is DirectConnect different from simply having the patient contact their PCP's office directly? The primary difference is “one-number” convenience that allows all patients to dial one number to access their PCP's team. In addition, calls are routed to various staff as available to reduce long telephone queues and wait times. The DirectConnect system has resulted in statistically significant improvement in key service quality measures. Patient satisfaction improved from a pre-implementation nine quarter mean of 55.9% to a post-implementation 12 quarter mean of 70.2%. Fourteen percent to 17% of all Primary Care calls are now handled by the patient's home medical office team, creating a 54% improvement in the centralized Call Center's speed of answering calls in the first quarter post implementation�

Medical malpractice reform and employer-sponsored health insurance premiums.

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Morrisey, Michael A; Kilgore, Meredith L; Nelson, Leonard Jack

2008-12-01

Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance. Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions. Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums. State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS. Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance. The findings suggest that tort reforms have not translated into insurance savings.

The good and bad of group conformity: a call for a new programme of research in medical education.

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Beran, Tanya N; Kaba, Alyshah; Caird, Jeff; McLaughlin, Kevin

2014-09-01

Given that a significant portion of medical education occurs in various social settings (small groups, large classes, clinical environments), it is critical to examine how group members interact. One type of influence on these interactions is conformity, whereby an individual changes his or her own behaviour to match incorrect responses of others in a group. Conformity to peer pressure has been replicated in experimental research conducted in many countries over the last 60 years. There is newly emerging empirical evidence of this effect in medical education, suggesting that subtle motivations and pressures within a group may prevent students from challenging or questioning information that seems incorrect. This narrative review aims to present an overview of theory and findings in research into conformity in the fields of social psychology, business, sociology and aviation theory to demonstrate its direct relevance to medical education and the health professions. We searched online databases (MEDLINE, PubMed, PsycINFO and ProQuest) from the University of Calgary catalogue. We also searched citations in articles reviewed and references provided by colleagues. We limited our narrative review to publications released between 1950 and 2012. Group conformity behaviour may be one of a number of communication challenges associated with interprofessional care, and may represent a factor contributing to the burden of adverse events. This paper calls for a new programme of research into conformity in medical education that provides systematic empirical evidence of its relevance and applications in education, health care and practice. This review reveals decades of anecdotal and empirical evidence that conformity is a pervasive phenomenon across disciplines. Further research is needed to elucidate which situations pose the greatest risk for the occurrence of conformity, how to manage it in practice and its implications for patient safety. © 2014 John Wiley & Sons Ltd.

Defectos del esmalte, caries en dentición primaria, fuentes de fluoruro y su relación con caries en dientes permanentes Enamel defects, caries in primary dentition and fluoride sources: relationship with caries in permanent teeth

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Ana Alicia Vallejos-Sánchez

2007-06-01

Full Text Available Objetivo: Explorar la relación entre la presencia de defectos del esmalte (DE, la experiencia de caries en la dentición temporal, y la exposición a diversas fuentes de fluoruros, con la presencia de caries en la dentición permanente de niños con dentición mixta. Material y métodos: Se realizó un estudio transversal en 713 sujetos de 6-9 años de edad de 4 escuelas de Campeche, México, mediante un cuestionario dirigido a las madres, y un examen clínico bucal a los niños. La variable dependiente fue la prevalencia de caries en la dentición permanente. Resultados: El promedio de dientes temporales cariados, extraídos y obturados (ceod y dientes permanentes cariados, perdidos y obturados (CPOD fue de 2,48 (2,82 (ceod > 0 = 58,9% y 0,40 (0,98 (CPOD > 0 = 18,2%, respectivamente. El índice SiC (índice de caries significativa, calculado en la dentición temporal fue de 5,85 para los niños de 6 años de edad. En el análisis de regresión logística multivariado permanecieron significativas, después de ajustar por variables de exposición a fluoruros, la mayor edad (odds ratio [OR] = 2,99, el ceod > 0 (OR = 5,46, la menor escolaridad de la madre (OR = 1,57 y una interacción entre sexo y defectos del esmalte. Conclusiones: Las caries en la dentición temporal y permanente fueron relativamente menores que las observaciones publicadas por otros estudios en México. Los resultados confirmaron que la caries en la dentición temporal se asoció fuertemente con la caries en la dentición permanente. No hubo una relación significativa entre las fuentes de fluoruro y la caries dental en la dentición permanente.Objective: To examine the relationship between the presence of enamel defects, dental caries in primary teeth, and exposure to various fluoride technologies and the presence of dental caries in permanent teeth in children with mixed dentition. Materials and methods: A cross-sectional study was conducted in 713 children aged 6-9 years old

More comprehensive discussion of CRC screening associated with higher screening.

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Mosen, David M; Feldstein, Adrianne C; Perrin, Nancy A; Rosales, A Gabriella; Smith, David H; Liles, Elizabeth G; Schneider, Jennifer L; Meyers, Ronald E; Elston-Lafata, Jennifer

2013-04-01

Examine association of comprehensiveness of colorectal cancer (CRC) screening discussion by primary care physicians (PCPs) with completion of CRC screening. Observational study in Kaiser Permanente Northwest, a group-model health maintenance organization. A total of 883 participants overdue for CRC screening received an automated telephone call (ATC) between April and June 2009 encouraging CRC screening. Between January and March 2010, participants completed a survey on PCPs' discussion of CRC screening and patient beliefs regarding screening. receipt of CRC screening (assessed by electronic medical record [EMR], 9 months after ATC). Primary independent variable: comprehensiveness of CRC screening discussion by PCPs (7-item scale). Secondary independent variables: perceived benefits of screening (4-item scale assessing respondents' agreement with benefits of timely screening) and primary care utilization (EMR; 9 months after ATC). The independent association of variables with CRC screening was assessed with logistic regression. Average scores for comprehensiveness of CRC discussion and perceived benefits were 0.4 (range 0-1) and 4.0 (range 1-5), respectively. A total of 28.2% (n = 249) completed screening, 84% of whom had survey assessments after their screening date. Of screeners, 95.2% completed the fecal immunochemical test. More comprehensive discussion of CRC screening was associated with increased screening (odds ratio [OR] = 1.51, 95% confidence interval [CI] = 1.03-2.21). Higher perceived benefits (OR = 1.46, 95% CI = 1.13-1.90) and 1 or more PCP visits (OR = 5.82, 95% CI = 3.87-8.74) were also associated with increased screening. More comprehensive discussion of CRC screening was independently associated with increased CRC screening. Primary care utilization was even more strongly associated with CRC screening, irrespective of discussion of CRC screening.

Chemotherapy and low-dose radiotherapy in the treatment of HIV-infected patients with carcinoma of the anal canal

International Nuclear Information System (INIS)

Peddada, Anuj V.; Smith, Damon E.; Rao, Aroor R.; Frost, Daniel B.; Kagan, A. Robert

1997-01-01

Purpose: To determine the efficacy and tolerance of a standardized protocol of chemotherapy and low-dose radiotherapy in the treatment of anal cancer in human immunodeficiency virus (HIV)-infected patients. Methods and Materials: Between 1987 and 1995, eight HIV-positive patients with squamous cell carcinoma of the anal canal, four of whom had acquired immunodeficiency syndrome (AIDS), received therapy at the Kaiser Permanente Medical Center. All patients were treated using a combined modality approach consisting of lowdose radiotherapy (30 Gy in 15 fractions delivered 5 days/week), and chemotherapy [1000 mg/m 2 of 5-fluorouracil (5-FU) delivered on days 1-4 and 29-32 as a continuous infusion over 96 h, and 10 mg/m 2 of mitomycin C delivered as a bolus injection on day 1]. Patients have been followed from 4 to 81 months (mean 41, median 38). Results: All eight patients completed the therapy with minor variations to the protocol, and all have attained a clinical complete response. Four patients are alive and free of disease, and four died as a result of complications of AIDS, but remained free of anal carcinoma. There were no mortalities from the protocol and the morbidity was acceptable. Only one patient each was noted to have Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Grade 4 hematologic and gastrointestinal acute toxicity, and no Grade 4 skin toxicity was noted. Conclusion: This combined therapy is effective for HIV-infected patients and appears to be tolerable with acceptable toxicities. It is best applied to patients who are HIV positive, or who have AIDS without concurrent major opportunistic infections. This approach is reasonable and affords patients a reasonably good chance at sphincter preservation by avoiding abdominoperineal resection. The optimal therapy for HIV-positive patients with advanced AIDS remains less well defined

Frequency of different blood groups and its association with BMI and blood pressure among the female medical students of Faisalabad.

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Jawed, Shireen; Zia, Sadaf; Tariq, Sundus

2017-08-01

To determine the frequency of different blood groups among female medical students and to find the association of blood groups and body mass index with blood pressure. This cross-sectional study was performed at the University Medical and Dental College, Faisalabad, Pakistan, from March to April 2016, and comprised female medical students. Participants were divided into groups on the basis of their ABO blood groups and on body mass index criteria. Blood groups were determined by simple conventional slide method. Blood pressure was estimated by manual auscultatory technique with a mercury sphygmomanometer. Data was analysed usingSPSS20. There were 145 students with an overall mean age of18.4±0.75 years (range: 17-23 years). Blood group B was the predominant group 65(44.8%). Besides, 130(89.6%) subjects were rhesus positive and 23(53%) subjects of blood group O were pre-hypertensive. Multiple regression analysis indicated significant positive association of blood group O with both systolic and diastolic blood pressure (p=0.002, 0.001). However, subsequent logistic regression showed significant association only with diastolic blood pressure (p=0.001). Relative risk of pre-hypertension for obese (p=0.001) was greater than non-obese subjects. Body mass index was significantly associated with both systolic and diastolic blood pressure (p=0.004, 0.042). Blood group B was the most common blood group. Blood group O was associated with diastolic pre-hypertension, while body mass index was associated with both systolic and diastolic pre-hypertension.

Pedagogical Conditions of Shaping Motor Competence in Physical Education of Students of Special Medical Groups

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В. М. Корягін

2016-09-01

Full Text Available Study objective. To define the pedagogical conditions of shaping motor competence in students of special medical groups during physical education at higher educational institutions. Study methods: theoretical analysis, systematization, comparison of different views on the issue under study, methodological and special literature collation, general scientific methods of theoretical level: analogy, analysis, synthesis, abstraction, induction. Study results. The study addresses the issues of indicating the pedagogical conditions necessary for the effective shaping of the motor competence in students of special medical groups during their physical education at higher educational institutions. The data analysis and collation of the data collected from the scientific, methodological and special literature helped outline and organize their index, which is a pre-requisite for ensuring the process effectiveness. We recommend using the study results as a major foundation for re-organization of the scientific and methodological aspects of physical education of students with health problems to ensure their motor competence effectively shaped.

Medical Students' Empathy for Vulnerable Groups: Results From a Survey and Reflective Writing Assignment.

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Wellbery, Caroline; Saunders, Pamela A; Kureshi, Sarah; Visconti, Adam

2017-12-01

As medical education curricula increasingly acknowledge the contributions of the social determinants of health to individual health, new methods of engaging students in the care of vulnerable groups are needed. Empathy is one way to connect students with patients, but little is known about how to nurture students' empathy on behalf of populations. This study examined the relationship between individual and social empathy as groundwork for cultivating students' empathy for vulnerable groups. In 2014-2015, first-year medical students completed the Social Empathy Index at the start and end of a two-semester population health course, and they completed a reflective writing assignment exploring the challenges of caring for vulnerable patients. Pre- and posttest mean survey scores were compared, and reflective writing assignments were analyzed for themes concerning social empathy. Data from 130 students were analyzed. Scores for the contextual understanding of systemic barriers domain increased significantly. There was a trend toward increased cumulative social empathy scores that did not reach statistical significance. Students' essays revealed three themes relating to individual empathy as the foundation for social empathy; civic and moral obligations; and the role of institutional practices in caring for vulnerable groups. This study extends understanding of empathy beyond care for the individual to include care for vulnerable groups. Thus, social empathy may function as a valuable concept in developing curricula to support students' commitment to care for the underserved. Educators first need to address the many barriers students cited that impede both individual and social empathy.

Métodos para determinação de parâmetros de máquinas síncronas de ímãs permanentes

OpenAIRE

Guilherme Homrich

2016-01-01

A teoria de duplo eixo é geralmente utilizada para modelar e caracterizar máquinas síncronas de polos salientes. O conhecimento das indutâncias de eixo direto e eixo em quadratura são fundamentais para o desenvolvimento destes modelos e para o projeto de controladores destas máquinas. No entanto, métodos tradicionais para determinação destas indutâncias através de ensaios tornam-se impraticáveis em máquinas síncronas de ímãs permanentes pela impossibilidade de controlar a corrente de campo. R...

Macro and Micro-Nutrients Intake, Food Groups Consumption and Dietary Habits among Female Students in Isfahan University of Medical Sciences

OpenAIRE

Azadbakht, L; Esmaillzadeh, A

2012-01-01

Background Improving the dietary intake among different groups and population is important for improving the health status. This study determines the nutrients and food group intake as well as dietary habits among female students in Isfahan University of Medical Sciences. Methods Two hundreds and eighty nine healthy female youths who were randomly selected among students of Isfahan University of Medical Sciences in Isfahan, Iran were enrolled. A validated semi quantitative food frequency ques...

An equivalence study of interview platform: Does videoconference technology impact medical school acceptance rates of different groups?

Science.gov (United States)

Ballejos, Marlene P; Oglesbee, Scott; Hettema, Jennifer; Sapien, Robert

2018-02-14

Web-based interviewing may be an effective element of a medical school's larger approach to promotion of holistic review, as recommended by the Association of American Medical Colleges, by facilitating the feasibility of including rural and community physicians in the interview process. Only 10% of medical schools offer videoconference interviews to applicants and little is known about the impact of this interview modality on the admissions process. This study investigated the impact of overall acceptance rates using videoconference interviews and face-to-face interviews in the medical school selection process using an equivalence trial design. The University of New Mexico School of Medicine integrated a videoconferencing interview option for community and rural physician interviewers in a pseudo-random fashion during the 2014-2016 admissions cycles. Logistic regression was conducted to examine whether videoconference interviews impacted acceptance rates or the characteristics of accepted students. Demographic, admissions and diversity factors were analyzed that included applicant age, MCAT score, cumulative GPA, gender, underrepresented in medicine, socioeconomic status and geographic residency. Data from 752 interviews were analyzed. Adjusted rates of acceptance for face-to-face (37.0%; 95% CI 28.2, 46.7%) and videoconference (36.1%; 95% CI 17.8, 59.5%) interviews were within an a priori ± 5% margin of equivalence. Both interview conditions yielded highly diverse groups of admitted students. Having a higher medical college admission test score, grade point average, and self-identifying as disadvantaged increased odds of admission in both interview modalities. Integration of the videoconference interview did not impact the overall acceptance of a highly diverse and qualified group of applicants, and allowed rural and community physicians to participate in the medical school interview process as well as allowed campus faculty and medical student committee members

Measurement invariance of the strength of motivation for medical school: a multi-group confirmatory factor analysis.

Science.gov (United States)

An, M; Kusurkar, R A; Li, L; Xiao, Y; Zheng, C; Hu, J; Chen, M

2017-07-11

The Strength of Motivation for Medical School-Revised (SMMS-R) questionnaire measures students' motivation for studying medicine. It includes three subscales: 'willingness to sacrifice', 'readiness to start', and 'persistence'. Measurement invariance is a prerequisite for group comparisons. The objectives of this study were to verify the factorial structure of the SMMS-R questionnaire and to investigate it's measurement invariance. A total of 989 medical students were approached, 930 cases were kept for data analysis. Factorial structure of and measurement invariance of the SMMS-R were tested using single and multiple group confirmatory factor analyses with Mplus. Trational Cronbach's α along with McDonald's ω and glb were used to measure internal consistency for each subscale. Internal consistency for subscales and the full instrument were within the acceptable range. A 3-factor structure of the Chinese version of the SMMS-R was supported. Full configural, metric and partial scalar invariance were obtained. The SMMS-R showed measurement invariance across gender and two independent samples. So it can be used for group and cross-cultural comparisons.

Group dynamics and social interaction in a South Asian online learning forum for faculty development of medical teachers.

Science.gov (United States)

Anshu; Sharma, M; Burdick, W P; Singh, T

2010-04-01

Group dynamics of online medical faculty development programs have not been analyzed and reported in literature. Knowledge of the types of content of posted messages will help to understand group dynamics and promote participation in an asynchronous learning environment. This paper assesses group dynamics and social interactivity in an online learning environment for medical teachers in the South Asian context. Participants of a medical education fellowship program conducted by the Foundation for Advancement of International Medical Education and Research (FAIMER) Regional Institute at Christian Medical College, Ludhiana (CMCL) in India interact on a listserv called the Mentoring-Learning Web (ML-Web). Monthly topics for online discussion are chosen by fellows through a standard tool called "multi-voting". Fellows volunteer to moderate sessions and direct the pace of the discussion. We analyzed the content and process of the discussion of one particular month. The emails were categorized as those that reflected cognitive presence (dealing with construction and exploration of knowledge), teacher presence (dealing with instructional material and learning resources), and social presence, or were administrative in nature. Social emails were further classified as: affective, cohesive and interactive. Social emails constituted one-third of the total emails. Another one-quarter of the emails dealt with sharing of resources and teacher presence, while cognitive emails comprised 36.2% of the total. More than half of the social emails were affective, while a little less than one-third were cohesive. Social posts are an inevitable part of online learning. These posts promote bonding between learners and contribute to better interaction and collaboration in online learning. Moderators should be aware of their presence and use them as tools to promote interactivity.

Risk perception about medication sharing among patients: a focus group qualitative study on borrowing and lending of prescription analgesics

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Markotic F

2017-02-01

Full Text Available Filipa Markotic,1 Davorka Vrdoljak,2 Marijana Puljiz,3 Livia Puljak,4 1Centre for Clinical Pharmacology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina; 2Department of Family Medicine, University of Split School of Medicine, Split, 3Family Medicine Clinic, Health Centre Imotski, Kamenmost, 4Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia Background: One form of self-medication is sharing of medications, defined as borrowing or lending medications in situations where the receiver of these drugs is not the individual to whom the medications were allocated. Objective: To explore experiences and opinions of patients about sharing prescription analgesics, reasons for sharing prescription analgesics, the way in which patients choose to share those medications, their awareness of risk regarding sharing prescription analgesics, and how they estimated the potential risk.Methods: This qualitative study was conducted by focus group discussions with 40 participants led by a moderator trained in focus group methodology using a semi-structured moderator guide. Adults aged ≥18 years who had received a prescription for an analgesic at least once in a lifetime were included. Six separate focus groups were conducted to discuss participants’ perception of risks associated with sharing of prescription analgesics among patients. Additionally, participants filled out two questionnaires on demographic data, their own behavior regarding sharing analgesics, and their attitudes about risks associated with sharing prescription analgesics.Results: In a questionnaire, 55% of the participants indicated that they personally shared prescription analgesics, while subsequently in the focus group discussions, 76% confessed to such behavior. Participants recognized certain risks related to sharing of prescription analgesics, mentioned a number of reasons for engaging in such behavior, and indicated certain positive

The quality of life of medical students studying in New Zealand: a comparison with nonmedical students and a general population reference group.

Science.gov (United States)

Henning, Marcus A; Krägeloh, Christian U; Hawken, Susan J; Zhao, Yipin; Doherty, Iain

2012-01-01

Quality of life is an essential component of learning and has strong links with the practice and study of medicine. There is burgeoning evidence in the research literature to suggest that medical students are experiencing health-related problems such as anxiety, depression, and burnout. The aim of the study was to investigate medical students' perceptions concerning their quality of life. Two hundred seventy-four medical students studying in their early clinical years (response rate = 80%) participated in the present study. Medical students were asked to fill in the abbreviated version of the World Health Organization Quality of Life questionnaire to elicit information about their quality of life perceptions in relation to their physical health, psychological health, social relationships, and environment. Subsequently, their responses were compared with two nonmedical students groups studying at a different university in the same city and an Australian general population norm. The findings were compared using independent group's t tests, confidence intervals, and Cohen's d. The main finding of the study indicated that medical students had similar quality of life perceptions to nonmedical students except in relation to the environment domain. Furthermore, the medical student group scored lower than the general population reference group on the physical health, psychological health, and environment quality of life domains. The results suggest that all university students are expressing concerns related to quality of life, and thus their health might be at risk. The findings in this study provided no evidence to support the notion that medical students experience lower levels of quality of life compared to other university students. When compared to the general population, all student groups examined in this study appeared to be experiencing lower levels of quality of life. This has implications for pastoral support, educationalists, student support personnel, and the

Value of pharmacist medication interviews on optimizing the electronic medication reconciliation process.

Science.gov (United States)

Lee, Audrey; Varma, Arjun; Boro, Maureen; Korman, Nancy

2014-06-01

Few studies have explored the impact of using different methods for obtaining accurate medication histories on medication safety. This study was conducted to compare the accuracy and clinical impact of pharmacist medication histories obtained by electronic medical record review (EMRR) alone with those obtained by direct interviews combined with EMRR. This 18-week prospective study included patients who were admitted to the Inpatient Medicine Service at the study institution and who had a pharmacist-conducted medication reconciliation EMRR within 48 hours of hospital admission. A chart review was performed to collect data to determine whether differences existed in the number of discrepancies, recommendations, and medication errors between the EMRR alone group compared to the EMRR combined with the patient interview group. Five hundred thirteen discrepancies were identified with the EMRR group compared to 986 from the combined EMRR and patient interview group (P < .001). Significantly more recommendations were made in the combination interview group compared to the EMRR alone group (260 vs 97; P < .001). Fewer medication errors were identified for the EMRR alone group compared to the combination interview group (55 vs 134; P < .001). The most common errors were omitted medications followed by extra dose/failure to discontinue therapy and wrong dose/frequency errors. Pharmacist-conducted admission medication interviews combined with EMRR can potentially identify harmful medication discrepancies and prevent medication errors.

Preserving third year medical students' empathy and enhancing self-reflection using small group "virtual hangout" technology.

Science.gov (United States)

Duke, Pamela; Grosseman, Suely; Novack, Dennis H; Rosenzweig, Steven

2015-01-01

Medical student professionalism education is challenging in scope, purpose, and delivery, particularly in the clinical years when students in large universities are dispersed across multiple clinical sites. We initiated a faculty-facilitated, peer small group course for our third year students, creating virtual classrooms using social networking and online learning management system technologies. The course emphasized narrative self-reflection, group inquiry, and peer support. We conducted this study to analyze the effects of a professionalism course on third year medical students' empathy and self-reflection (two elements of professionalism) and their perceptions about the course. Students completed the Groningen Reflection Ability Scale (GRAS) and the Jefferson Scale of Empathy (JSE) before and after the course and provided anonymous online feedback. The results of the JSE before and after the course demonstrated preservation of empathy rather than its decline. In addition, there was a statistically significant increase in GRAS scores (p < 0.001), suggesting that the sharing of personal narratives may foster reflective ability and reflective practice among third year students. This study supports previous findings showing that students benefit from peer groups and discussion in a safe environment, which may include the use of a virtual group video platform.

Construção de descritores para o processo de educação permanente em atenção básica Building descriptors for the permanent basic care education process

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Rosita Saupe

2007-11-01

Full Text Available Educação permanente e atenção básica fazem parte do sistema de saúde brasileiro desde suas origens. Recentemente estas políticas públicas foram atualizadas, gerando um movimento inovador de construção de conhecimento visando apoiar sua implementação e consolidação. Este estudo, através de uma metodologia quantitativa, procurou evidenciar os principais descritores que devem orientar os processos de educação permanente em atenção básica. O método é originário da Universidade da Carolina do Norte. É desenvolvido em duas etapas. Os dados apresentados neste artigo dizem respeito à primeira etapa, que inclui as seguintes fases: elaboração de um diagrama com todos os componentes a serem avaliados; sua análise por um grupo de especialistas, indicando o que deve ser mantido, retirado ou incluído; avaliação por juízes, utilizando escala Likert de 1 a 5; verificação da concordância entre os juízes. O diagrama foi decomposto em quatro dimensões, procurando responder as seguintes questões: para quem? - audiências ou população alvo; o quê? - módulos de conteúdos e experiências de aprendizagem; para quê? - competências a serem desenvolvidas; e como? - metodologia a ser priorizada. Os resultados evidenciaram a procedência dos descritores propostos e avaliados, constituindo em material que pode contribuir para a tomada de decisão sobre educação permanente em atenção básica.Permanent education and basic care have been part of the Brazilian health system from the beginning. These public policies were recently updated, leading to an innovative knowledge construction movement to support their implementation and consolidation. This study, which used a quantitative approach, attempted to single-out the main descriptors that must guide the permanent basic care education processes. The method originated at the University of North Carolina and is carried out in two stages. The data shown in this article concern the

Exploratory study of the characteristics of feedback in the reflective dialogue group given to medical students in a clinical clerkship

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Chin-Chen Wen

2015-02-01

Full Text Available Purpose: Structured narrative reflective writing combined with guided feedback is an efficient teaching method for enhancing medical students’ reflective capacity. However, what kinds of feedback offered and reflection presented in a reflective group remain unclear. The aim of this study was to investigate the characteristics of feedback in a reflective dialogue group. Methods: Fifth-year medical students on a monthly interval rotation at the pediatric department of a medical center in eastern Taiwan during the 2012 academic year completed their reflective writing regarding patient and family psychosocial issues, and were subsequently debriefed in a 2-h group discussion session to receive feedback from a clinical tutor and peers. Content analysis was conducted to explore the characteristics of feedback and reflection presented in the reflective dialogue. The evaluative questionnaire regarding the benefits of reflection with others was administrated following the group session. Results: Forty students participated in five reflective groups and 108 psychosocial issues were discussed and identified. The tutor played an initiating role in the group discussion by providing six equal feedback types involving exploring new knowledge, initiating advanced discussion, highlighting the issues, and encouraging the students. The students provided eight types of feedback that involved a substantial deep discussion on psychosocial issues and action plans based on the complex interactive ecological network of clinical encounters. Each student attained 1.25 times the depth or breadth of reflection after receiving feedback and experienced the benefits of reflection with others. Conclusion: Through structured narrative reflective writing combined with pluralistic group discussion with a tutor and peers, the medical students had time to think deeply and broadly about psychosocial issues among patients and their family members. Facilitative feedback providing new

The next organizational challenge: finding and addressing diagnostic error.

Science.gov (United States)

Graber, Mark L; Trowbridge, Robert; Myers, Jennifer S; Umscheid, Craig A; Strull, William; Kanter, Michael H

2014-03-01

Although health care organizations (HCOs) are intensely focused on improving the safety of health care, efforts to date have almost exclusively targeted treatment-related issues. The literature confirms that the approaches HCOs use to identify adverse medical events are not effective in finding diagnostic errors, so the initial challenge is to identify cases of diagnostic error. WHY HEALTH CARE ORGANIZATIONS NEED TO GET INVOLVED: HCOs are preoccupied with many quality- and safety-related operational and clinical issues, including performance measures. The case for paying attention to diagnostic errors, however, is based on the following four points: (1) diagnostic errors are common and harmful, (2) high-quality health care requires high-quality diagnosis, (3) diagnostic errors are costly, and (4) HCOs are well positioned to lead the way in reducing diagnostic error. FINDING DIAGNOSTIC ERRORS: Current approaches to identifying diagnostic errors, such as occurrence screens, incident reports, autopsy, and peer review, were not designed to detect diagnostic issues (or problems of omission in general) and/or rely on voluntary reporting. The realization that the existing tools are inadequate has spurred efforts to identify novel tools that could be used to discover diagnostic errors or breakdowns in the diagnostic process that are associated with errors. New approaches--Maine Medical Center's case-finding of diagnostic errors by facilitating direct reports from physicians and Kaiser Permanente's electronic health record--based reports that detect process breakdowns in the followup of abnormal findings--are described in case studies. By raising awareness and implementing targeted programs that address diagnostic error, HCOs may begin to play an important role in addressing the problem of diagnostic error.

Safety of Quadrivalent Meningococcal Conjugate Vaccine in Children 2-10 Years.

Science.gov (United States)

Tartof, Sara Yee; Sy, Lina S; Ackerson, Bradley K; Hechter, Rulin C; Haag, Mendel; Slezak, Jeffrey M; Luo, Yi; Fischetti, Christine A; Takhar, Harp S; Miao, Yan; Solano, Zendi; Jacobsen, Steven J; Tseng, Hung-Fu

2017-11-01

Quadrivalent meningococcal conjugate vaccine is recommended for children, adolescents and adults at increased risk of meningococcal disease. In 2011, MenACWY-CRM (Menveo, GSK, Siena, Italy) was approved for children 2-10 years of age in the United States. Although no safety concerns arose from clinical trials, it remains important to monitor its safety in routine clinical settings. Kaiser Permanente Southern California members 2-10 years old who received MenACWY-CRM between September 2011 and September 2014 were included. Electronic health records were searched using a validated algorithm to identify 26 prespecified events of interests (EOIs) and serious medically attended events (SMAEs) from inpatient or emergency settings up to 1 year after MenACWY-CRM vaccination. SMAEs were categorized by International Classification of Diseases, 9th revision diagnostic categories. All events were reviewed to confirm the diagnosis and symptom onset date. The study was descriptive (NCT01452438); no statistical tests were performed. Among 387 vaccinated children, 327 with ≥6 months membership before vaccination were analyzed. Among EOIs, 9 asthma cases and 1 myasthenia gravis case underwent chart review which confirmed 1 incident asthma case occurring 237 days after concomitant vaccination with MenACWY-CRM and typhoid vaccine. Thirty-one children experienced SMAEs, most commonly because of unrelated injury and poisoning. The remaining events occurred sporadically after vaccination and most were unlikely related to vaccination based on medical record review. One incident EOI of asthma late in the 1-year observation period and sporadic distribution of SMAEs were observed. These data do not suggest safety concerns associated with MenACWY-CRM vaccination in children 2-10 years old.

La aspiración de Brasil al asiento permanente en el Consejo de Seguridad de la Organización de las Naciones Unidas: un breve panorama

OpenAIRE

Renata de Melo Rosa; Ana Carolina Gomes Lira Linhares

2009-01-01

Este artículo analiza la posición de Brasil frente a la aspiración de un asiento permanente al Consejo de Seguridad de las Naciones Unidas. Los esfuerzos entabulados por Brasil en el escenario internacional, los discursos del primer rango del gobierno, así como un protagonismo más acelerado frente a los vecinos latino-americanos confirman esta aspiración. Pero, Brasil aún enfrenta serios problemas internos de seguridad nacional y tendrá que enfrentar otros compañeros regionales también, aspir...

Quality Indicators for the Management of Diabetes Mellitus for Vulnerable Older Persons

National Research Council Canada - National Science Library

Shekelle, Paul

2004-01-01

.... Direct medical expenditures on diabetic care were estimated at $44 million. At Northern California Kaiser, a matched cohort analysis indicated that the annual excess expenditures for diabetic patients totaled $3,500 per person...

Estudo comparativo entre ensino presencial e a distância para educação permanente de profissionais auxiliares e técnicos de enfermagem

OpenAIRE

Silva, Adriane das Neves

2014-01-01

As mudanças ocorridas no mundo do trabalho têm exigido do profissional atualização constante de saberes que possibilitem o desenvolvimento de atitude crítico-reflexiva. Este estudo buscou analisar a aplicabilidade das tecnologias da informação e da comunicação na Educação Permanente dos profissionais auxiliares e técnicos de Enfermagem em um hospital público municipal. É um estudo do tipo ensaio clínico, que lançou mão de técnicas quantitativas e qualitativas através de um experimento que oco...

Cohesion assessment of student groups from the faculty of dentistry at Burdenko Voronezh State Medical University

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Pashkov A. N.

2017-10-01

Full Text Available the article presents data on the study of the cohesion of 115 students from the faculty of dentistry at Burdenko Voronezh State Medical University. The study revealed that students have high and medium favorable psychological climate. 99 of them have the average level of group cohesion, and 16 revealed a low level of this indicator. To improve the educational process and interpersonal relations, these results must be taken into account when forming groups.

Understanding Medical Students' Experience with Stress and Its Related Constructs: A Focus Group Study from Singapore.

Science.gov (United States)

Farquhar, Julia; Lie, Desiree; Chan, Angelique; Ow, Mandy; Vidyarthi, Arpana

2018-02-01

In order to protect medical students from burnout and its untoward psychiatric effects, it is imperative to understand their stress, burnout, coping, and resilience experiences. This study aimed to derive collective definitions from the medical student perspective, to identify common themes of students' experiences, and to distinguish pre-clinical and clinical year students' experiences relating to these four constructs. The authors conducted focus groups of medical students in Singapore across 4 years using a semi-structured question guide. Participants shared their understanding, experiences, and the relationships between stress, burnout, coping, and resilience. Coders independently evaluated construct definitions and derived common themes through an iterative process, and compared transcripts of pre-clinical and clinical year students to determine differences in experience over time. Nine focus groups (54 students, 28 females, mean age 24.3) were conducted. Students identified common definitions for each construct. Nine themes emerged within three domains: (1) relating constructs to personal experience, (2) interrelating stress, burnout, coping, and resilience, and (3) understanding the necessity of stress. Compared to clinical students, pre-clinical students reported theory-based rather than reality-based experiences and exam-induced stress, defined constructs using present rather than future situations, and described constructs as independent rather than interrelated. This sample of medical students in Singapore shares a common understanding of stress, burnout, coping, and resilience, but experiences these uniquely. They perceive a positive role for stress. These findings build upon prior literature, suggesting an interrelationship between stress and its related constructs and adding the novel perspective of students from an Asian country.

Necesidades y motivaciones de los estudiantes de educación permanente en España. El caso del Centro de Educación Permanente Valle del Guadiato en Córdoba

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Beatriz del V. Medina F

2013-05-01

Full Text Available El objetivo de la investigación en la que está basado el artículo fue identificar las necesidades y las motivaciones de los estudiantes del Centro de Educación Permanente (CEPER Valle del Guadiato de Córdoba, España. Se parte de diferentes teorías para su fundamentación, como las aportadas por Maslow (2005, McClelland (1989, García Aretio (1988, Paz (1984, Palladino (1981, entre otros. Se utilizó la metodología comparada cuyas unidades de comparación se corresponden con las unidades espaciales, que en este estudio son los municipios: Belmez, Espiel, Fuente Obejuna, Peñarroya-Pueblonuevo, Villanueva del Rey y Villaviciosa de Córdoba. Para la recogida de datos se utiliza el estudio documental, el cuestionario escrito y la observación cualitativa. El universo poblacional del CEPER Valle del Guadiato lo conformaron 606 personas adultas del período escolar 2011-2012 (592 estudiantes, 14 maestros, siendo la muestra de 265 personas (251 estudiantes, 14 maestros. Entre las principales conclusiones destacan que las necesidades sociales, laborales y personales de los estudiantes del Centro objeto de estudio se derivan básicamente del deseo de aprender, del deseo de superación personal, y del interés por el tema. Las motivaciones giran en torno a la oportunidad de ocupar sus tiempos libres, a la posibilidad de tener mejores oportunidades de encontrar trabajo, y al apoyo de la familia.

Necesidades y motivaciones de los estudiantes de educación permanente en España. El caso del Centro de Educación Permanente Valle del Guadiato en Córdoba

Directory of Open Access Journals (Sweden)

Beatriz del V. Medina F

2013-01-01

Full Text Available El objetivo de la investigación en la que está basado el artículo fue identifi-car las necesidades y las motivaciones de los estudiantes del Centro de Educación Permanente (CEPER Valle del Guadiato de Córdoba, España. Se parte de dife-rentes teorías para su fundamentación, como las aportadas por Maslow (2005,McClelland (1989, García Aretio (1988, Paz (1984, Palladino (1981, entre otros. Se utilizó la metodología comparada cuyas unidades de comparación se co-rresponden con las unidades espaciales, que en este estudio son los municipios: Belmez, Espiel, Fuente Obejuna, Peñarroya-Pueblo nuevo, Villanueva del Rey y Villaviciosa de Córdoba. Para la recogida de datos se utiliza el estudio documental, el cuestionario escrito y la observación cualitativa. El universo poblacional del “CEPER Valle del Guadiato” lo conformaron 606 personas adultas del período escolar 2011-2012 (592 estudiantes, 14 maestros, siendo la muestra de 265 personas (251 estudiantes, 14 maestros. Entre las principales conclusiones destacan que las necesidades sociales, laborales y personales de los estudiantes del Centro objeto de estudio se derivan básicamente del deseo de aprender, del deseo de superación personal, y del interés por el tema. Las motivaciones giran en torno a la oportunidad de ocupar sus tiempos libres, a la posibilidad de tener mejores oportunidades de encontrar trabajo, y al apoyo de la familia.

Association between clinical parameters and the presence of active caries lesions in first permanent molars Associação entre parâmetros clínicos e a presença de lesões ativas de cárie em primeiros molares permanentes

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Juliana Maria Quaglio

2006-12-01

Full Text Available The aim of the present study was to evaluate the association between clinical parameters and the presence of active caries lesions on the occlusal surface of first permanent molars. Forty eight children (5.8-13.8 years-old with at least one first permanent molar present were selected. The clinical parameters evaluated were gender, age, DMF-T and dmf-t, presence of active white spots in other teeth, general plaque index, tooth's dental arch (upper or lower, tooth's side (right or left, presence of visible plaque and eruption degree of the first permanent molars. The first permanent molars were evaluated through visual inspection by two examiners in order to assess the presence of active or inactive caries lesions on the occlusal surface. Univariate and multivariate analyses for determination of the association between clinical parameters and the presence of active caries lesions in these teeth were performed. The presence of active white spots in other teeth was associated with the presence of active caries lesions in the first permanent molars, in both univariate and multivariate analyses (Odds ratio = 8.8 and 1.9, respectively. The presence of abundant visible plaque on the occlusal surface of the first permanent molars (Odds ratio = 3.5 in the univariate analysis, and 3.9 in the multivariate one also presented a significant association. In conclusion, the presence of active white spots in other teeth and the presence of considerable visible plaque were associated with the presence of active caries lesions on the occlusal surfaces of first permanent molars.O objetivo do presente trabalho foi avaliar a associação entre parâmetros clínicos e presença de lesões ativas de cárie sobre a superfície oclusal de primeiros molares permanentes. Quarenta e oito crianças (5,8-13,8 anos com pelo menos um primeiro molar permanente foram selecionadas. Os parâmetros clínicos avaliados foram sexo, idade, CPO-D e ceo-d, presença de manchas brancas

A study of the prevalence of significant increases in serum creatinine following angiotension-converting enzyme inhibitor administration.

Science.gov (United States)

Thorp, M L; Ditmer, D G; Nash, M K; Wise, R; Jaderholm, P L; Smith, J D; Chan, W

2005-05-01

Angiontension-converting enzyme inhibitors (ACEIs) are beneficial in the treatment of diabetic and nondiabetic kidney disease, coronary artery disease and congestive heart failure. One adverse effect of ACEIs use is a rise in serum creatinine and potential renal failure. This paper attempts to quantify this risk and assess the need for pre- and post-ACEI serum creatinine measurements. A computerized search of Kaiser Permanente Northwest's electronic medical record was conducted to find patients over the age of 40 years taking lisinopril between July 1, 2000 and June 30, 2002. Patient demographic information and presence in diabetes and coronary artery disease registries was collected. A subsequent search for pre- and postlisinopril serum creatinine levels within 6 months of initial lisinopril prescription was conducted. Patients with prelisinopril creatinine 2.5 mg/dl underwent chart review to discern adverse events associated with the rise in serum creatinine. A total of 18,977 patients were prescribed lisinopril between July 1, 2000 and June 30, 2002. In all 13 166 patients had a pre- and postlisinopril creatinine checked. In all, 31 patients had a rise in creatinine from 2.5 mg/dl (0.2%). Possible contributors to rise in creatinine included congestive heart failure, dehydration and infection. No patients developed end-stage renal disease, although three died. In conclusion, end-stage renal disease is an unlikely outcome among patients prescribed lisinopril and is most likely associated with other events.

Obesity during childhood and adolescence increases susceptibility to multiple sclerosis after accounting for established genetic and environmental risk factors

Science.gov (United States)

Gianfrancesco, Milena A.; Acuna, Brigid; Shen, Ling; Briggs, Farren B.S.; Quach, Hong; Bellesis, Kalliope H.; Bernstein, Allan; Hedstrom, Anna K.; Kockum, Ingrid; Alfredsson, Lars; Olsson, Tomas; Schaefer, Catherine; Barcellos, Lisa F.

2014-01-01

Objective To investigate the association between obesity and multiple sclerosis (MS) while accounting for established genetic and environmental risk factors. Methods Participants included members of Kaiser Permanente Medical Care Plan, Northern California Region (KPNC) (1,235 MS cases and 697 controls). Logistic regression models were used to estimate odds ratios (ORs) with 95% confidence intervals (95% CI). Body mass index (BMI) or body size was the primary predictor of each model. Both incident and prevalent MS cases were studied. Results In analyses stratified by gender, being overweight at age 10 and 20 were associated with MS in females (prisk of MS for females with a BMI ≥ 30 kg/m2 was observed (OR = 2.15, 95% CI 1.18, 3.92). Significant associations between BMI in 20’s and MS in males were not observed. Multivariate modeling demonstrated that significant associations between BMI or body size with MS in females persisted after adjusting for history of infectious mononucleosis and genetic risk factors, including HLA-DRB1*15:01 and established non-HLA risk alleles. Interpretation Results show that childhood and adolescence obesity confer increased risk of MS in females beyond established heritable and environmental risk factors. Strong evidence for a dose-effect of BMI in 20’s and MS was observed. The magnitude of BMI association with MS is as large as other known MS risk factors. PMID:25263833

Reliability and validity of a survey to measure bowel function and quality of life in long-term rectal cancer survivors.

Science.gov (United States)

Wendel, Christopher S; Grant, Marcia; Herrinton, Lisa; Temple, Larissa K F; Hornbrook, Mark C; McMullen, Carmit K; Bulkley, Joanna E; Altschuler, Andrea; Krouse, Robert S

2014-12-01

Examination of reliability and validity of a specialized health-related quality of life questionnaire for rectal cancer (RC) survivors (≥5 years post-diagnosis). We mailed 1,063 Kaiser Permanente (KP) RC survivors (313 ostomy and 750 anastomosis) a questionnaire containing the Modified City of Hope Quality of Life-Ostomy (mCOH-QOL-O), SF-12v2, Duke-UNC Functional Social Support Questionnaire (FSSQ), and Memorial Sloan-Kettering Cancer Center Bowel Function Index (BFI). We adapted certain BFI items for use by subjects with intestinal ostomies. We evaluated reliability for all instruments with inter-item correlations and Cronbach's alpha. We assessed construct validity only for the BFI in the ostomy group, because such use has not been reported. The overall response rate was 60.5 % (577 respondents/953 eligible). Compared with non-responders, participants were on average 2 years younger and more likely non-Hispanic white, resided in educationally non-deprived areas, and had KP membership through a group. The mCOH-QOL-O, SF-12, and FSSQ were found to be highly reliable for RC survivors. In the ostomy group, BFI Urgency/Soilage and Dietary subscales were found to be reliable, but Frequency was not. Factor analysis supported the construct of Urgency/Soilage and Dietary subscales in the ostomy group, although one item had a moderate correlation with all three factors. The BFI also demonstrated good concurrent validity with other instruments in the ostomy group. With possible exception of the BFI Frequency subscale in populations with ostomies, components of our survey can be used for the entire population of RC survivors, no matter whether they received anastomosis or ostomy.

Use of electronic health records and administrative data for public health surveillance of eye health and vision-related conditions in the United States.

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Elliott, Amanda F; Davidson, Arthur; Lum, Flora; Chiang, Michael F; Saaddine, Jinan B; Zhang, Xinzhi; Crews, John E; Chou, Chiu-Fang

2012-12-01

To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. Perspective, comparing systems. We describe 3 currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. Each of the 3 sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. Copyright © 2012 Elsevier Inc. All rights reserved.

Personal health record use and association with immunizations and well-child care visits recommendations.

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Tom, Jeffrey O; Chen, Chuhe; Zhou, Yi Yvonne

2014-01-01

To determine the association of parental use of integrated personal health records (PHRs) with children's adherence to immunization and well-child care (WCC) visit recommendations. For the immunization and WCC visit measures, we retrospectively analyzed, respectively, 766 and 639 matched pairs at Kaiser Permanente (KP) Hawaii and 2795 and 2448 pairs at KP Northwest who were ≤ 31 days old at enrollment and continuously enrolled for 2 years between January 2007 and July 2011. The independent variable (≥ 1 PHR feature used vs none) was matched using propensity scores on parental and children characteristics. The dependent variables were 2 measures from the 2010 Healthcare Effectiveness Data and Information Set: combination 2 immunization (all immunizations vs immunizations only at KP Northwest (KP Hawaii: OR 1.1, 95% CI 0.8-1.4, P > .05; KP Northwest OR 1.2, 95% CI 1.0-1.3, P immunizations in only 1 region. Copyright © 2014 Mosby, Inc. All rights reserved.

Is the modernisation of postgraduate medical training in the Netherlands successful? Views of the NVMO Special Interest Group on Postgraduate Medical Education.

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Scheele, Fedde; Van Luijk, Scheltus; Mulder, Hanneke; Baane, Coby; Rooyen, Corry Den; De Hoog, Matthijs; Fokkema, Joanne; Heineman, Erik; Sluiter, Henk

2014-02-01

Worldwide, the modernisation of medical education is leading to the design and implementation of new postgraduate curricula. In this article, the Special Interest Group for postgraduate medical education of the Netherlands Association for Medical Education (NVMO) reports on the experiences in the Netherlands. To provide insight into the shift in the aims of postgraduate training, as well as into the diffusion of distinct curricular activities, introduced during the process of modernisation. Based on three levels of training described by Frenk et al., the process of modernisation in the Netherlands is reviewed in a narrative way, using the expert views of the NVMO-SIG on PGME as a source of information. Educational science has effectively been incorporated and has until now mainly been applied on the level of informative learning to create 'medical expertise'. Implementing change on the level of formative learning for 'professional performance' has until now been a slow and arduous process, but the concept of reflection on practice has been firmly embraced. The training on the level of transformative learning is still in its early stages. The discussion about the aims of modern medical education could benefit from a more structured and transdisciplinary approach. Research is warranted on the interface between health care provision and those sciences that specialise in generic professional skills and in the societal context. Training professionals and educating 'enlightened change agents' for transformation in health care requires more governance and support from academic leaders with a broader perspective on the future of health care.

[se-atlas - the health service information platform for people with rare diseases : Supporting research on medical care institutions and support groups].

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Haase, Johanna; Wagner, Thomas O F; Storf, Holger

2017-05-01

se-atlas - the health service information platform for rare diseases - is part of the German National Action Plan for People with Rare Diseases and is funded by the German Federal Ministry of Health. The objective of se-atlas as a web-based platform is to illustrate those medical care institutions that are linked to rare diseases, in a transparent and user-friendly way. The website provides an overview of medical care institutions and support groups focusing on rare diseases in Germany. The primary target groups of se-atlas are affected patients, their relatives and physicians but can also include non-medical professionals and the general public. In order to make it easier to look up medical care institutions or support groups and optimize the search results displayed, various strategies are being developed and evaluated. Hence, the allocation of diseases to appropriate medical care institutions and support groups is currently a main focus. Since its launch in 2015, se-atlas has grown continuously and now incorporates five times more entries than were included 20 months prior. Among this data are the current rare diseases centres in Germany, which play a major role in providing patient-centred healthcare by acting as primary contact points for people with rare diseases. Further expansion and maintenance of the data base raises several organisational and software-related challenges. For one, the data should be completed by adding more high-quality information, while not neglecting the existing entries and maintaining their high level of quality in the long term.

["Vocational perspective"--short-term efficacy of a group treatment for patients with extensive work-related problems during medical rehabilitation].

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Bönisch, A; Dorn, M; Ehlebracht-König, I

2012-01-01

To analyze the short-term efficacy of the Vocational Perspective programme for patients identified as having extensive work-related problems during rheumatology or orthopaedic inpatient rehabilitation. The primary objectives of the programme on patient level are to convey information about the legal provisions regarding earning incapacity and occupational reintegration, to suggest strategies for dealing with one's own occupational situation, and to strengthen the motivation to stay employed. The programme is explicitly designed for patients who wish to retire or have applied for a pension. On the systemic level, the main goals are to facilitate doctor-patient communication and to increase rehabilitation teams' awareness of occupational problems. In a controlled quasi-experimental design, 359 subjects were consecutively assigned to either the control group (CG, n=177) or the intervention group (IG, n=182). The control group received standard care only, whereas the intervention group additionally participated in the 5-part Vocational Perspective programme. Evaluation criteria were assessed by questionnaire at the beginning (t1) and at end of rehabilitation (t2). Survey participation was 92.2% at t2. The socio-medically relevant knowledge status was objectively documented using a specially designed knowledge questionnaire. Aspects of treatment satisfaction were evaluated using individual items, and the subjective prognosis of gainful employment was assessed using the Subjective Prognosis of Gainful Employment (SPE) scale. Facilitation of communication between doctor and patient was operationalized at patient level in terms of patient satisfaction with medical care, and increased awareness of the rehabilitation team was operationalized in terms of the rate of recommendations to apply for vocational reintegration (LTA) services at discharge. Emotional and functional parameters were exploratively analyzed (anxiety and depression using the IRES 3.1 scales, and

Principles of developing a well-rounded program of physical rehabilitation for female students in the special medical group with consideration of physical activity impairment

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N. R. Golod

2015-05-01

Full Text Available Purpose : to highlight the main provisions of a comprehensive physical rehabilitation program for students of special medical group based on violations of the motor capacity. Material : testing 24 students of special medical group and the same number of their healthy peers on standardized tests of physical qualities. To reflect the movement disorders applied functional movement screen. Results : a program of rehabilitation of the students included: lifestyle modification; morning hygienic gymnastics; kinesitherapy (using yoga fitness, functional training; aerobic exercise (swimming, Nordic Walking, jogging, aerobics wellness; massage. First presented a unified approach to working with students of special medical groups - selection based on load capacity motor disorders according to the results of tests of functional movement screen. The complexity of the impact of the program involves the impact on the physical, social and mental health components. Conclusions : the author's program of physical rehabilitation of students of special medical group is complex.

Salary survey of the Medical Library Group of Southern California and Arizona.

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Smith, J L; Connolly, B F; Davis, M; Graham, E; Wheeler, S

1984-01-01

The 1982 salary survey of the Medical Library Group of Southern California and Arizona (MLGSCA) indicates that 211 health sciences librarians in Southern California and Arizona earned a mean annual salary of $20,910 for 1982. Data analysis shows a positive correlation between salary and educational level. Other factors found to affect salary were job history, number of positions held, MLA certification, and professional responsibility. Age, gender, and MLA certification did not have a consistent positive correlation with salary. Results indicate that the salaries of hospital librarians are, on the average, roughly comparable to those of academic librarians in Southern California and Arizona. PMID:6743878

Writing for publication in medical education: the benefits of a faculty development workshop and peer writing group.

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Steinert, Yvonne; McLeod, Peter J; Liben, Stephen; Snell, Linda

2008-01-01

Although educational innovations in medical education are increasing in number, many educators do not submit their ideas for publication. The goal of this initiative was to assist faculty members write about their educational innovations. Twenty-four faculty members participated in this intervention, which consisted of a half-day workshop, three peer writing groups, and independent study. We assessed the impact of this intervention through post-workshop evaluations, a one-year follow-up questionnaire, tracking of manuscript submissions, and an analysis of curriculum vitae. The workshop evaluations and one-year follow-up demonstrated that participants valued the workshop small groups, self-instructional workbook, and peer support and feedback provided by the peer writing groups. One year later, nine participants submitted a total of 14 manuscripts, 11 of which were accepted for publication. In addition, 10 participants presented a total of 38 abstracts at educational meetings. Five years later, we reviewed the curriculum vitae of all participants who had published or presented their educational innovation. Although the total number of publications remained the same, the number of educationally-related publications and presentations at scientific meetings increased considerably. A faculty development workshop and peer writing group can facilitate writing productivity and presentations of scholarly work in medical education.

Do medical students generate sound arguments during small group discussions in problem-based learning?: an analysis of preclinical medical students' argumentation according to a framework of hypothetico-deductive reasoning.

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Ju, Hyunjung; Choi, Ikseon; Yoon, Bo Young

2017-06-01

Hypothetico-deductive reasoning (HDR) is an essential learning activity and a learning outcome in problem-based learning (PBL). It is important for medical students to engage in the HDR process through argumentation during their small group discussions in PBL. This study aimed to analyze the quality of preclinical medical students' argumentation according to each phase of HDR in PBL. Participants were 15 first-year preclinical students divided into two small groups. A set of three 2-hour discussion sessions from each of the two groups during a 1-week-long PBL unit on the cardiovascular system was audio-recorded. The arguments constructed by the students were analyzed using a coding scheme, which included four types of argumentation (Type 0: incomplete, Type 1: claim only, Type 2: claim with data, and Type 3: claim with data and warrant). The mean frequency of each type of argumentation according to each HDR phase across the two small groups was calculated. During small group discussions, Type 1 arguments were generated most often (frequency=120.5, 43%), whereas the least common were Type 3 arguments (frequency=24.5, 8.7%) among the four types of arguments. The results of this study revealed that the students predominantly made claims without proper justifications; they often omitted data for supporting their claims or did not provide warrants to connect the claims and data. The findings suggest instructional interventions to enhance the quality of medical students' arguments in PBL, including promoting students' comprehension of the structure of argumentation for HDR processes and questioning.

Many large medical groups will need to acquire new skills and tools to be ready for payment reform.

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Mechanic, Robert; Zinner, Darren E

2012-09-01

Federal and state policy makers are now experimenting with programs that hold health systems accountable for delivering care under predetermined budgets to help control health care spending. To assess how well prepared medical groups are to participate in these arrangements, we surveyed twenty-one large, multispecialty groups. We evaluated their participation in risk contracts such as capitation and the degree of operational support associated with these arrangements. On average, about 25 percent of the surveyed groups' patient care revenue stemmed from global capitation contracts and 9 percent from partial capitation or shared risk contracts. Groups with a larger share of revenue from risk contracts were more likely than others to have salaried physicians, advanced data management capabilities, preferred relationships with efficient specialists, and formal programs to coordinate care for high-risk patients. Our findings suggest that medical groups that lack risk contracting experience may need to develop new competencies and infrastructure to successfully navigate federal payment reform programs, including information systems that track performance and support clinicians in delivering good care; physician-level reward systems that are aligned with organizational goals; sound physician leadership; and an organizational commitment to supporting performance improvement. The difficulty of implementing these changes in complex health care organizations should not be underestimated.

Collaborative-Group Testing Improves Learning and Knowledge Retention of Human Physiology Topics in Second-Year Medical Students

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Vázquez-García, Mario

2018-01-01

The present study examined the relationship between second-year medical students' group performance and individual performance in a collaborative-learning environment. In recent decades, university professors in the scientific and humanistic disciplines have successfully put into practice different modalities of collaborative approaches to…

Implementing the patient-centered medical home model for chronic disease care in small medical practices: practice group characteristics and physician understanding.

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Baxter, Louisa; Nash, David B

2013-01-01

Strengthening primary care may improve health outcomes and restrain spending. The patient-centered medical home (PCMH) model is endorsed as a tool to achieve this. Early evaluations in large group practices demonstrate improvements in some health outcomes. Evidence is lacking from small medical practices that deliver the majority of primary health care. This was a national survey of 200 physicians that explored perceptions of PCMH. There was considerable interest in adoption of the model; however, providing PCMH care was seen as an extension of traditional roles that requires additional reimbursement. No differentiation was made among a variety of payment models to do this. All joint principle components of the model were identified as important: extending access and information technology were the most contentious. There was consensus that PCMH might improve the quality of primary care; however, tension between wider societal benefits and rising costs for individual practices was a challenge to implementation.

Enhancing medical students' reflectivity in mentoring groups for professional development - a qualitative analysis.

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Lutz, Gabriele; Pankoke, Nina; Goldblatt, Hadass; Hofmann, Marzellus; Zupanic, Michaela

2017-07-14

Professional competence is important in delivering high quality patient care, and it can be enhanced by reflection and reflective discourse e.g. in mentoring groups. However, students are often reluctant though to engage in this discourse. A group mentoring program involving all preclinical students as well as faculty members and co-mentoring clinical students was initiated at Witten-Herdecke University. This study explores both the attitudes of those students towards such a program and factors that might hinder or enhance how students engage in reflective discourse. A qualitative design was applied using semi-structured focus group interviews with preclinical students and semi-structured individual interviews with mentors and co-mentors. The interview data were analyzed using thematic content analysis. Students' attitudes towards reflective discourse on professional challenges were diverse. Some students valued the new program and named positive outcomes regarding several features of professional development. Enriching experiences were described. Others expressed aversive attitudes. Three reasons for these were given: unclear goals and benefits, interpersonal problems within the groups hindering development and intrapersonal issues such as insecurity and traditional views of medical education. Participants mentioned several program setup factors that could enhance how students engage in such groups: explaining the program thoroughly, setting expectations and integrating the reflective discourse in a meaningful way into the curriculum, obliging participation without coercion, developing a sense of security, trust and interest in each other within the groups, randomizing group composition and facilitating group moderators as positive peer and faculty role models and as learning group members. A well-designed and empathetic setup of group mentoring programs can help raise openness towards engaging in meaningful reflective discourse. Reflection on and communication of

A Origem Histórica do Conceito de Área de Preservação Permanente no Brasil

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Glaucus Vinicius Biasetto Ribeiro

2011-01-01

Full Text Available A nossa atualidade vem sendo marcada por uma crescente preocupação com as questões ligadas ao meio ambiente e com a preservação do nosso planeta. De uma maneira geral o aquecimento global, a influência antrópica, a degradação de ambientes naturais, os processos ecológicos, a biodiversidade, a sustentabilidade, bem como a cidadania ambiental tem se tornado temas de discussão nas diversas esferas de convívio social.Dentro da história brasileira podemos identificar uma série de regramentos de caráter ambiental considerando-se como marco a Lei 4.771 de 15 de setembro de 1965, que instituiu o novo Código Florestal Brasileiro. Ao longo do presente artigo procuraremos investigar a origem da conceituação das áreas de preservação permanentes, tema alvo de grandes discussões na atualidade, tal qual surgiu e foi inserida na legislação brasileira, procurando recuperar esse aspecto específico da história do Brasil.

Learning psychology as a challenging process towards development as well as “studies as usual”: a thematic analysis of medical students’ reflective writing

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Semb O

2014-12-01

Full Text Available Olof Semb,1 Niclas Kaiser,2 Sven-Olof Andersson,1 Elisabet Sundbom3 1Department of Clinical Sciences, Division for Professional Development, Umeå University, Umeå, Sweden; 2Department of Psychology, Umeå University, Umeå, Sweden; 3Department of Clinical Sciences, Division for Psychiatry and Medical Psychology, Umeå University, Umeå, Sweden Abstract: Reflective writing in medical training has been shown to be most effective when combined with some form of personal meeting or dialog. During a course in medical psychology for medical students, reflective texts were followed up by an individual personal talk with a teacher from the course. Thematic analysis of the texts revealed four separate sub-themes: 1 the course has enabled me and the class to develop, which is good albeit arduous; 2 understanding myself is a resource in understanding people as well as knowing psychology; 3 the course provided me with new, purely intellectual skills as well as eye-openers; and 4 the receiving teacher is an integral part of my reflective writing. The main theme, capturing the students’ writing process, concluded that students perceive the course as “Learning psychology as a challenging process towards development” as well as “studies as usual”. Ethical, psychological, and pedagogical aspects are discussed in the paper. Keywords: reflective writing, self-knowledge, individual personal talks, thematic analysis, medical education

Nutritional care of Danish medical inpatients: Effect on dietary intake and the occupational groups' perspectives of intervention

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Jensen Lillian

2004-09-01

Full Text Available Abstract Background Many patients do not eat and drink sufficiently during hospitalisation. The clinical consequences of this under nutrition include lassitude, an increased risk of complications and prolonged convalescence. The aim of the study was 1 to introduce intervention targeting nutritional care for medical inpatients, 2 to investigate the effect of this intervention, and 3 to investigate the occupational groups' attitudes towards nutritional intervention and nutritional care in general. Methods The design was to determinate the extent to which the protein and energy requirements of medical inpatients were met before and after intervention. Dietary protein and energy intakes were assessed by 72-hour weighed food records. A total number of 108 medical patients at four bed sections and occupational groups in the two intervention bed sections, Aarhus University Hospital, Denmark participated. The intervention included introduction and implementation of nursing procedures targeting nutritional care during a five-month investigation period using standard food produced at the hospital. The effect of intervention for independent groups of patients were tested by one-way analysis of variance. After the intervention occupational groups were interviewed in focus groups. Results Before the intervention hospital food on average met 72% of the patients' protein requirement and 85% of their energy requirement. After intervention hospital food satisfied 85% of the protein and 103% of the energy requirements of 14 patients in one intervention section and 56% of the protein and 76% of the energy requirement of 17 patients in the other intervention section. Hospital food satisfied 61% of the protein and 75% of the energy requirement in a total of 29 controls. From the occupational groups' point of view lack of time, lack of access to food, and lack of knowledge of nutritional care for patients were identified as barriers to better integration of

Factors influencing the development of end-of-life communication skills: A focus group study of nursing and medical students.

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Gillett, Karen; O'Neill, Bernadette; Bloomfield, Jacqueline G

2016-01-01

Poor communication between health care professionals and dying patients and their families results in complaints about end-of-life care. End-of-life communication skills should be a core part of nursing and medical education but research suggests that qualified doctors and nurses find this a challenging area of practice. The aim of this study was to explore factors influencing the development of end-of-life communication skills by nursing and medical students. A qualitative study comprising five focus groups. Second year undergraduate nursing (n=9 across 2 focus groups) and fourth year undergraduate medical students (n=10 across 3 focus groups) from a London University. Barriers and facilitators influenced nursing and medical students' experience of communication with dying patients and their families in clinical practice. Extrinsic barriers included gatekeeping by qualified staff and lack of opportunity to make sense of experiences through discussion. Intrinsic barriers included not knowing what to say, dealing with emotional responses, wasting patients' time, and concerns about their own ability to cope with distressing experiences. Facilitating factors included good role models, previous experience, and classroom input. In addition to clinical placements, formal opportunities for reflective discussion are necessary to facilitate the development of students' confidence and skills in end-of-life communication. For students and mentors to view end-of-life communication as a legitimate part of their learning it needs to be specified written practice-learning outcome. Mentors and supervisors may require training to enable them to facilitate students to develop end-of-life communication skills. Copyright © 2015 Elsevier Ltd. All rights reserved.

COMPARISON OF MEDICAL COSTS AND CARE OF APPENDECTOMY PATIENTS BETWEEN FEE-FOR-SERVICE AND SET FEE FOR DIAGNOSIS-RELATED GROUP SYSTEMS IN 20 CHINESE HOSPITALS.

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Zhang, Yin-hua; He, Guo-ping; Liu, Jing-wei

2016-09-01

The objective of this study was to compare the fee-for-service and set fee for diagnosis-related group systems with regard to quality of medical care and cost to appendectomy patients. We conducted a retrospective study of 208 inpatients (from 20 hospitals) who undergone appendectomy in Changsha, China during 2013. Data were obtained from databases of medical insurance information systems directly connected to the hospital information systems. We collected and compared patient ages, length of study, and total medical costs for impatient appendectomies between patients using fee-for-service and set fee for diagnosisrelated group systems. One hundred thirty-three patients used the fee for service system and 75 used the set fee diagnosis related group system. For those using the diagnosis-related group system, the mean length of hospitalization (6.2 days) and mean number of prescribed antimicrobials (2.4) per patient were significantly lower than those of the patients who used the fee-for-service system (7.3 days and 3.0, respectively; p = 0.018; p < 0.05) and were accompanied by lower medical costs and cost of antimicrobials (RMB 2,518 versus RMB 4,484 and RMB476 versus RMB1,108, respectively; p = 0.000, p = 0.000). There were no significant differences in post-surgical complications between the two systems. The diagnosis-related group system had significantly medical costs for appendectomy compared to the fee-for-service system, without sacrificing quality of medical care.

Design and rationale of the medical students learning weight management counseling skills (MSWeight) group randomized controlled trial.

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Ockene, Judith K; Ashe, Karen M; Hayes, Rashelle B; Churchill, Linda C; Crawford, Sybil L; Geller, Alan C; Jolicoeur, Denise; Olendzki, Barbara C; Basco, Maria Theresa; Pendharkar, Jyothi A; Ferguson, Kristi J; Guck, Thomas P; Margo, Katherine L; Okuliar, Catherine A; Shaw, Monica A; Soleymani, Taraneh; Stadler, Diane D; Warrier, Sarita S; Pbert, Lori

2018-01-01

Physicians have an important role addressing the obesity epidemic. Lack of adequate teaching to provide weight management counseling (WMC) is cited as a reason for limited treatment. National guidelines have not been translated into an evidence-supported, competency-based curriculum in medical schools. Weight Management Counseling in Medical Schools: A Randomized Controlled Trial (MSWeight) is designed to determine if a multi-modal theoretically-guided WMC educational intervention improves observed counseling skills and secondarily improve perceived skills and self-efficacy among medical students compared to traditional education (TE). Eight U.S. medical schools were pair-matched and randomized in a group randomized controlled trial to evaluate whether a multi-modal education (MME) intervention compared to traditional education (TE) improves observed WMC skills. The MME intervention includes innovative components in years 1-3: a structured web-course; a role play exercise, WebPatientEncounter, and an enhanced outpatient internal medicine or family medicine clerkship. This evidence-supported curriculum uses the 5As framework to guide treatment and incorporates patient-centered counseling to engage the patient. The primary outcome is a comparison of scores on an Objective Structured Clinical Examination (OSCE) WMC case among third year medical students. The secondary outcome compares changes in scores of medical students from their first to third year on an assessment of perceived WMC skills and self-efficacy. MSWeight is the first RCT in medical schools to evaluate whether interventions integrated into the curriculum improve medical students' WMC skills. If this educational approach for teaching WMC is effective, feasible and acceptable it can affect how medical schools integrate WMC teaching into their curriculum. Copyright © 2017 Elsevier Inc. All rights reserved.

Barriers to Medication Decision Making in Women with Lupus Nephritis: A Formative Study using Nominal Group Technique.

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Singh, Jasvinder A; Qu, Haiyan; Yazdany, Jinoos; Chatham, Winn; Dall'era, Maria; Shewchuk, Richard M

2015-09-01

To assess the perspectives of women with lupus nephritis on barriers to medication decision making. We used the nominal group technique (NGT), a structured process to elicit ideas from participants, for a formative assessment. Eight NGT meetings were conducted in English and moderated by an expert NGT researcher at 2 medical centers. Participants responded to the question: "What sorts of things make it hard for people to decide to take the medicines that doctors prescribe for treating their lupus kidney disease?" Patients nominated, discussed, and prioritized barriers to decisional processes involving medications for treating lupus nephritis. Fifty-one women with lupus nephritis with a mean age of 40.6 ± 13.3 years and disease duration of 11.8 ± 8.3 years participated in 8 NGT meetings: 26 African Americans (4 panels), 13 Hispanics (2 panels), and 12 whites (2 panels). Of the participants, 36.5% had obtained at least a college degree and 55.8% needed some help in reading health materials. Of the 248 responses generated (range 19-37 responses/panel), 100 responses (40%) were perceived by patients as having relatively greater importance than other barriers in their own decision-making processes. The most salient perceived barriers, as indicated by percent-weighted votes assigned, were known/anticipated side effects (15.6%), medication expense/ability to afford medications (8.2%), and the fear that the medication could cause other diseases (7.8%). Women with lupus nephritis identified specific barriers to decisions related to medications. Information relevant to known/anticipated medication side effects and medication cost will form the basis of a patient guide for women with systemic lupus erythematosus, currently under development.

The exploration of medical resources utilization among inguinal hernia repair in Taiwan diagnosis-related groups

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Yu-Hua Yan

2017-11-01

Full Text Available Abstract Background This study centered on differences in medical costs, using the Taiwan diagnosis-related groups (Tw-DRGs on medical resource utilization in inguinal hernia repair (IHR in hospitals with different ownership to provide suitable reference information for hospital administrators. Methods The 2010–2011 data for three hospitals under different ownership were extracted from the Taiwan National Health Insurance claims database. A retrospective method was applied to analyze the age, sex, length of stay, diagnosis and surgical procedure code, and the change in financial risk of medical costs in IHR cases after introduction of Tw-DRGs. The study calculated the cost using Tw-DRG payment principles, and compared it with estimated inpatient medical costs calculated using the fee-for-service policy. Results There were 723 IHR cases satisfying the Tw-DRGs criteria. Cost control in the medical care corporation hospital (US$764.2/case was more efficient than that in the public hospital (US$902.7/case or nonprofit proprietary hospital (US$817.1/case surveyed in this study. For IHR, anesthesiologists in the public hospital preferred to use general anesthesia (86%, while those in the two other hospitals tended to administer spinal anesthesia. We also discovered the difference in anesthesia cost was high, at US$80.2/case on average. Conclusions Because the Tw-DRG-based reimbursement system produces varying hospital costs, hospital administrators should establish a financial risk assessment system as early as possible to improve healthcare quality and financial management efficiency. This would then benefit the hospital, patient, and Bureau of National Health Insurance.

The exploration of medical resources utilization among inguinal hernia repair in Taiwan diagnosis-related groups.

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Yan, Yu-Hua; Kung, Chih-Ming; Chen, Yi

2017-11-09

This study centered on differences in medical costs, using the Taiwan diagnosis-related groups (Tw-DRGs) on medical resource utilization in inguinal hernia repair (IHR) in hospitals with different ownership to provide suitable reference information for hospital administrators. The 2010-2011 data for three hospitals under different ownership were extracted from the Taiwan National Health Insurance claims database. A retrospective method was applied to analyze the age, sex, length of stay, diagnosis and surgical procedure code, and the change in financial risk of medical costs in IHR cases after introduction of Tw-DRGs. The study calculated the cost using Tw-DRG payment principles, and compared it with estimated inpatient medical costs calculated using the fee-for-service policy. There were 723 IHR cases satisfying the Tw-DRGs criteria. Cost control in the medical care corporation hospital (US$764.2/case) was more efficient than that in the public hospital (US$902.7/case) or nonprofit proprietary hospital (US$817.1/case) surveyed in this study. For IHR, anesthesiologists in the public hospital preferred to use general anesthesia (86%), while those in the two other hospitals tended to administer spinal anesthesia. We also discovered the difference in anesthesia cost was high, at US$80.2/case on average. Because the Tw-DRG-based reimbursement system produces varying hospital costs, hospital administrators should establish a financial risk assessment system as early as possible to improve healthcare quality and financial management efficiency. This would then benefit the hospital, patient, and Bureau of National Health Insurance.

76 FR 19174 - In the Matter of Circuit Systems, Inc., Global Energy Group, Inc., Integrated Medical Resources...

Science.gov (United States)

2011-04-06

... SECURITIES AND EXCHANGE COMMISSION File No. 500-1 In the Matter of Circuit Systems, Inc., Global Energy Group, Inc., Integrated Medical Resources, Inc., iNTELEFILM Corp., and Lot$off Corp.; Order of... lack of current and accurate information concerning the securities of Circuit Systems, Inc. because it...

Medication withdrawal may be an option for a select group of patients in relapsing-remitting multiple sclerosis

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Guilherme Sciascia do Olival

2013-08-01

Full Text Available This article describes the clinical and radiological evolution of a stable group of patients with relapsing-remitting multiple sclerosis that had their disease-modifying therapy (DMT withdrawn. Forty patients, which had made continuous use of one immunomodulator and had remained free of disease for at least 5 years, had their DMT withdrawn and were observed from 13 to 86 months. Out of the followed patients, 4 (10% patients presented with new attacks. In addition to these patients, 2 (5% patients had new lesions revealed by magnetic resonance imaging that did not correspond to clinical attacks. Despite these results, the difficult decision to withdraw medication requires careful analysis. Withdrawal, however, should not be viewed as simply the suspension of treatment because these patients should be evaluated periodically, and the immunomodulators should be readily reintroduced if new attacks occur. Nonetheless, medication withdrawal is an option for a select group of patients.

Provider Factors and Patient-Reported Healthcare Discrimination in the Diabetes Study of California (DISTANCE)

Science.gov (United States)

Lyles, Courtney R.; Karter, Andrew J.; Young, Bessie A.; Spigner, Clarence; Grembowski, David; Schillinger, Dean; Adler, Nancy

2011-01-01

Objective We examined provider-level factors and reported discrimination in the healthcare setting. Methods With data from the Diabetes Study of Northern California (DISTANCE)—a race-stratified survey of diabetes patients in Kaiser Permanente Northern California—we analyzed patient-reported racial/ethnic discrimination from providers. Primary exposures were characteristics of the primary care provider (PCP, who coordinates care in this system), including specialty/type, and patient-provider relationship variables including racial concordance. Results Subjects (n=12,151) included 20% black, 20% Latino, 23% Asian, 30% white, and 6% other patients, with 2% to 8% reporting discrimination by racial/ethnic group. Patients seeing nurse practitioners as their PCP (OR=0.09; 95% CI: 0.01–0.67), those rating their provider higher on communication (OR=0.70; 95% CI: 0.66–0.74) were less likely to report discrimination, while those with more visits (OR=1.10; 95% CI: 1.03–1.18) were more likely to report discrimination. Racial concordance was not significant once adjusting for patient race/ethnicity. Conclusions Among diverse diabetes patients in managed care, provider type and communication were significantly related to patient-reported discrimination. Practice Implications Given potential negative impacts on patient satisfaction and treatment decisions, future studies should investigate which interpersonal aspects of the provider-patient relationship reduce patient perceptions of unfair treatment. PMID:21605956

Awareness and distribution of ABO, Rhesus blood groups and haemoglobin phenotypes among medical undergraduates in a Nigerian university.

Science.gov (United States)

Akingbola, T S; Yuguda, S; Akinyemi, O O; Olomu, S

2016-09-01

In the past two decades the Nigerian government and religious organisations have put more emphasis on knowing the haemoglobin electrophoresis of school children and intending couples respectively. Knowledge of the distribution of blood groups and haemoglobin electrophoretic patterns among young people is vital for the prevention of haemoglobinopathies in the population and for providing effective blood banking services. Therefore, this study was designed to assess the frequency and awareness of blood group and haemoglobinphenotypes among a new set of fourth year clinical medical and dental students of the University of Ibadan, Nigeria. Data, including socio-demographics, self- reported blood group and haemoglobin phenotypes, were obtained from 155 students using a self-administered questionnaire. The ABO, Rhesus (Rh) blood groups and haemoglobin electrophoresis were determined by the tile (slide) technique and cellulose acetate at alkaline phrespectively. Only 43.9% of the participants knew their blood groups while less than a third (29.7%) knew their haemoglobin phenotypes. knowledge of both their blood groups and haemoglobin phenotypes was documented in as low as 20.6% of the respondents. The frequency of haemoglobin AA, AS, AC and. CC were 78.0%, 16.8%, 3.9% and 1.3% respectively. Similarly, the distribution of blood groups were: 0 RhD positive - 47.8%;0 RhD negative- 1.9%;ARhD positive- 21.9%; A RhD negative - 1.3%; B RhD positive - 23.2%; B RhD negative -1.3% and AB RhD positive - 2.6%. No participant was AB RhD negative. Participants who bad previously donated blood and those who were females were more likely to know their blood groups and haemoglobin phenotypes respectively (pblood groups and haemoglobin phenotypes among the medical and dental students was poor. Documentation and routine screening for haemoglobinphenotypes as well as blood grouping, accompanied by appropriate counseling should be institutionalised in Nigeriantertiary institutions.

Deformación permanente de materiales granulares en pavimentos flexibles: estado del conocimiento Permanent strain of granular materials in flexible pavements: state of the art

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Hugo Alexánder Rondón

2009-01-01

Full Text Available Diversos estudios han sido desarrollados en el área de los pavimentos para comprender el comportamiento elastoplástico que experimentan materiales granulares bajo carga cíclica. Este es el segundo de dos artículos que presentan el estado del conocimiento de investigaciones desarrolladas en esta área. Basado en una amplia revisión bibliográfica, este artículo da cuenta de la forma como ha sido estudiado el fenómeno de deformación permanente en materiales granulares empleados para conformar capas de base y sub-base de estructuras de pavimentos flexibles. Además, se exponen y se discuten los factores que afectan la resistencia a la deformación permanente y la evolución de las ecuaciones matemáticas desarrolladas para predecir la deformación que experimentan estos materiales bajo carga cíclica. Un estado del conocimiento sobre el comportamiento resiliente de estos materiales es presentado en el primer artículo (Rondón y Reyes, 2007.Several studies have been conducted in pavement field for trying to understand the elastoplastic behavior experienced by granular materials under a cyclic load. This is the second out of two articles which show state-of-the-art of researches conducted in this field. Based on a wide literature review, this article accounts for the way how permanent strain phenomenon has been studied in granular materials used for creating base and sub-base layers of flexible pavement structures. Besides, this article displays and discusses factors which affect resistance to permanent strain and evolution of mathematical equations developed for predicting that strain experienced by these materials under a cyclic load. A state-of-the-art about resilient behavior of these materials has been presented in the first article (Rondón and Reyes, 2007.

Experiences of sickness absence, marginality and Medically Unexplained Physical Symptoms - A focus group study

DEFF Research Database (Denmark)

E.L., Werner; A, Aamland; Malterud, Kirsti

2013-01-01

PURPOSE: Medically unexplained physical symptoms (MUPS) form a major cause of sickness absence. The purpose of this study was to explore factors which may influence further marginalization among patients with MUPS on long-term sickness absence. METHODS: Two focus-group discussions were conducted...... of objective findings were perceived as an additional burden to the sickness absence itself. Factors that could counteract further marginalization were a supportive social network, positive coping strategies such as keeping to the daily schedule and physical activity, and positive attention and confidence from...

Gestão participativa na educação permanente em saúde: olhar das enfermeiras Gestión participativa en la educación permanente en salud: visión de las enfermeras Participative management in permanent health education: view of the nurses

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Adriane Calvetti de Medeiros

2010-02-01

Full Text Available Este estudo de abordagem qualitativa teve como objetivo conhecer as estratégias de gestão, com base na Educação Permanente em Saúde (EPS. Os participantes da pesquisa foram seis enfermeiras assistenciais de uma unidade de terapia intensiva de um hospital universitário do Estado do Rio Grande do Sul. Utilizou-se como instrumento de coleta de dados o Método de Círculo de Cultura de Freire. Os dados foram coletados nos meses de junho a agosto/2007. Os resultados apontam para o planejamento participativo e tomada de decisão como estratégias da EPS que promovem a autonomia, a valorização, a competência técnica e a construção do trabalho em equipe, em seu próprio percurso de aprendizagem.Este estudio de abordaje cualitativa tuvo como objetivo conocer las estrategias de gestión, con base en la Educación Permanente en Salud (EPS. Los participantes de la investigación fueron seis enfermeras asistenciales de una unidad de terapia intensiva de un hospital universitario del Estado de Rio Grande do Sul. Se utilizó como instrumento de recollección de datos el Método de Círculo de Cultura de Freire. Los dados fueran recogidos en los meses de junio a agosto/2007. Los resultados apuntan para la planificación participativo y toma de decisión como estrategias de la EPS que promueven la autonomía, la valorización, la competencia técnica y la construcción del trabajo en equipo, en su propio recorrido de aprendizajeThis study is of qualitative approach, and aimed at knowing the management strategies, on the basis of the Permanent Education in Health (PEH. The participants of the research had been six nurses of an intensive care unit from an university hospital in the State of Rio Grande do Sul, Brazil. The Method Circle of Culture of Freire was used like as instrument for collection of data. The data were collected in the period from June to august, 2007. Results point out participative planning and decision making as strategies of the

Anxiety, Culture, and Expectations: Oncologist-Perceived Factors Associated With Use of Nonrecommended Serum Tumor Marker Tests for Surveillance of Early-Stage Breast Cancer.

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Hahn, Erin E; Munoz-Plaza, Corrine; Wang, Jianjin; Garcia Delgadillo, Jazmine; Schottinger, Joanne E; Mittman, Brian S; Gould, Michael K

2017-01-01

Breast cancer offers several opportunities for reducing use of ineffective practices based on American Society of Clinical Oncology guidelines. We assessed oncologist-perceived factors associated with use of one such practice-serum tumor markers for post-treatment breast cancer surveillance-focusing on medical oncologists with high, medium, or low test use. Using a mixed-methods design, we identified patients who had been treated for early-stage breast cancer diagnosed between January 1, 2009, and December 31, 2012, within Kaiser Permanente Southern California and calculated the number of tests ordered from January 1, 2010, to December 31, 2014. We identified oncologists with high, medium, or low use and subsequently performed semistructured interviews. We used patient satisfaction data to assess association between pattern of use and satisfaction score. We identified 7,363 patients, with 40,114 tests ordered. High-use oncologists were defined as those ordering at least one test annually for 35% of patients or more, low-use oncologists as those ordering at least one test for 5% of patients or less; 42% of oncologists were high, 27% low, and 31% medium users. We interviewed 17 oncologists: six high, eight low, and three medium users. Factors associated with high use included: perceived patient anxiety, oncologist anxiety, belief that there was nothing else to offer, concern about satisfaction, patient competition, peer use, and system barriers. Factors associated with low use included: beliefs about consequences (eg, causes harms) and medical center culture (eg, collective decision to follow guidelines). We found no association between satisfaction score and pattern of use. Barriers to deimplementation are numerous and complex. Traditional strategies of practice change alone are unlikely to be effective. Multifaceted, multilevel strategies deployed to address patient-, clinician-, and system-related barriers may be required.

Impact of an automated dispensing system in outpatient pharmacies.

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Humphries, Tammy L; Delate, Thomas; Helling, Dennis K; Richardson, Bruce

2008-01-01

To evaluate the impact of an automated dispensing system (ADS) on pharmacy staff work activities and job satisfaction. Cross-sectional, retrospective study. Kaiser Permanente Colorado (KPCO) outpatient pharmacies in September 2005. Pharmacists and technicians from 18 outpatient pharmacies. All KPCO outpatient pharmacists (n = 136) and technicians (n = 160) were surveyed regarding demographics and work activities and pharmacist job satisfaction. Work activities and job satisfaction were compared between pharmacies with and without ADS. Historical prescription purchase records from ADS pharmacies were assessed for pre-ADS to post-ADS changes in productivity. Self-reported pharmacy staff work activities and pharmacist job satisfaction. Pharmacists who responded to the demographic questionnaire (n = 74) were primarily women (60%), had a bachelor's degree in pharmacy (68%), and had been in practice for 10 years or more (53%). Responding technicians (n = 72) were predominantly women (80%) with no postsecondary degree (90%) and fewer than 10 years (68%) in practice. Pharmacists in ADS pharmacies who responded to the work activities questionnaire (n = 50) reported equivalent mean hours spent in patient care activities and filling medication orders compared with non-ADS pharmacists (n = 33; P > 0.05). Similarly, technicians in ADS pharmacies who responded to the work activities questionnaire (n = 64) reported equivalent mean hours spent in filling medication orders compared with non-ADS technicians (n = 38; P > 0.05). An equivalent proportion of ADS pharmacists reported satisfaction with their current job compared with non-ADS pharmacies (P > 0.05). Mean productivity did not increase appreciably after automation (P >0.05). By itself, installing an ADS does not appear to shift pharmacist work activities from dispensing to patient counseling or to increase job satisfaction. Shifting pharmacist work activities from dispensing to counseling and monitoring drug therapy outcomes

Acute Kidney Injury and Risk of Heart Failure and Atherosclerotic Events.

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Go, Alan S; Hsu, Chi-Yuan; Yang, Jingrong; Tan, Thida C; Zheng, Sijie; Ordonez, Juan D; Liu, Kathleen D

2018-05-17

AKI in the hospital is common and is associated with excess mortality. We examined whether AKI is also independently associated with a higher risk of different cardiovascular events in the first year after discharge. We conducted a retrospective analysis of a cohort between 2006 and 2013 with follow-up through 2014, within Kaiser Permanente Northern California. We identified all adults admitted to 21 hospitals who had one or more in-hospital serum creatinine test result and survived to discharge. Occurrence of AKI was on the basis of Kidney Disease: Improving Global Outcomes diagnostic criteria. Potential confounders were identified from comprehensive inpatient and outpatient, laboratory, and pharmacy electronic medical records. During the 365 days after discharge, we ascertained occurrence of heart failure, acute coronary syndromes, peripheral artery disease, and ischemic stroke events from electronic medical records. Among a matched cohort of 146,941 hospitalized adults, 31,245 experienced AKI. At 365 days postdischarge, AKI was independently associated with higher rates of the composite outcome of hospitalization for heart failure and atherosclerotic events (adjusted hazard ratio [aHR], 1.18; 95% confidence interval [95% CI], 1.13 to 1.25) even after adjustment for demographics, comorbidities, preadmission eGFR and proteinuria, heart failure and sepsis complicating the hospitalization, intensive care unit (ICU) admission, length of stay, and predicted in-hospital mortality. This was driven by an excess risk of subsequent heart failure (aHR, 1.44; 95% CI, 1.33 to 1.56), whereas there was no significant association with follow-up atherosclerotic events (aHR, 1.05; 95% CI, 0.98 to 1.12). AKI is independently associated with a higher risk of cardiovascular events, especially heart failure, after hospital discharge. Copyright © 2018 by the American Society of Nephrology.

An Audit of the Effectiveness of Large Group Neurology Tutorials for Irish Undergraduate Medical Students

LENUS (Irish Health Repository)

Kearney, H

2016-07-01

The aim of this audit was to determine the effectiveness of large group tutorials for teaching neurology to medical students. Students were asked to complete a questionnaire rating their confidence on a ten point Likert scale in a number of domains in the undergraduate education guidelines from the Association of British Neurologists (ABN). We then arranged a series of interactive large group tutorials for the class and repeated the questionnaire one month after teaching. In the three core domains of neurological: history taking, examination and differential diagnosis, none of the students rated their confidence as nine or ten out of ten prior to teaching. This increased to 6% for history taking, 12 % in examination and 25% for differential diagnosis after eight weeks of tutorials. This audit demonstrates that in our centre, large group tutorials were an effective means of teaching, as measured by the ABN guidelines in undergraduate neurology.

Case Finding and Medical Treatment of Type 2 Diabetes among Different Ethnic Minority Groups: The HELIUS Study

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Marieke B. Snijder

2017-01-01

Full Text Available Aims. Prevention of diabetes complications depends on the level of case finding and successful treatment of diabetes, which may differ between ethnicities. Therefore, we studied the prevalence by age, awareness, treatment, and control of type 2 diabetes, among a multiethnic population. Methods. We included 4,541 Dutch, 3,032 South-Asian Surinamese, 4,109 African Surinamese, 2,323 Ghanaian, 3,591 Turkish, and 3,887 Moroccan participants (aged 18–70 y from the HELIUS study. The prevalence of diabetes was analysed by sex, ethnicity, and 10-year age groups. Ethnic differences in the prevalence, awareness, treatment, and control of diabetes were studied by logistic regression. Results. From the age of 31–40 years and older, the prevalence of diabetes was 3 to 12 times higher among ethnic minority groups than that among the Dutch host population. Awareness and medical treatment of diabetes were 2 to 5 times higher among ethnic minorities than that among Dutch. Among those medically treated, only 37–53% had HbA1c levels on target (≤7.0%; only Dutch men had HbA1c levels on target more often (67%. Conclusions. Our results suggest that the age limit for case finding among ethnic minority groups should be lower than that for the general population. Importantly, despite higher awareness and treatment among ethnic minorities, glycemic control was low, suggesting a need for increased efforts to improve the effectiveness of treatment in these groups.

Barriers to the medication error reporting process within the Irish National Ambulance Service, a focus group study.

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Byrne, Eamonn; Bury, Gerard

2018-02-08

Incident reporting is vital to identifying pre-hospital medication safety issues because literature suggests that the majority of errors pre-hospital are self-identified. In 2016, the National Ambulance Service (NAS) reported 11 medication errors to the national body with responsibility for risk management and insurance cover. The Health Information and Quality Authority in 2014 stated that reporting of clinical incidents, of which medication errors are a subset, was not felt to be representative of the actual events occurring. Even though reporting systems are in place, the levels appear to be well below what might be expected. Little data is available to explain this apparent discrepancy. To identify, investigate and document the barriers to medication error reporting within the NAS. An independent moderator led four focus groups in March of 2016. A convenience sample of 18 frontline Paramedics and Advanced Paramedics from Cork City and County discussed medication errors and the medication error reporting process. The sessions were recorded and anonymised, and the data was analysed using a process of thematic analysis. Practitioners understood the value of reporting errors. Barriers to reporting included fear of consequences and ridicule, procedural ambiguity, lack of feedback and a perceived lack of both consistency and confidentiality. The perceived consequences for making an error included professional, financial, litigious and psychological. Staff appeared willing to admit errors in a psychologically safe environment. Barriers to reporting are in line with international evidence. Time constraints prevented achievement of thematic saturation. Further study is warranted.

Macro and Micro-Nutrients Intake, Food Groups Consumption and Dietary Habits among Female Students in Isfahan University of Medical Sciences.

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Azadbakht, L; Esmaillzadeh, A

2012-04-01

Improving the dietary intake among different groups and population is important for improving the health status. This study determines the nutrients and food group intake as well as dietary habits among female students in Isfahan University of Medical Sciences. Two hundreds and eighty nine healthy female youths who were randomly selected among students of Isfahan University of Medical Sciences in Isfahan, Iran were enrolled. A validated semi quantitative food frequency questionnaire was used. Folate, iron, calcium and fiber intake were lower than the recommended dietary allowances (RDA) amounts (70, 76, 90, 56% of RDA, respectively). Forty five percent of the population consumed fast foods 2 times a week and 35% used the frying oils for cooking most of the time. Female youths had lower amount of some micronutrients. Consuming frying oils, hydrogenated vegetable oils, and fast food intake should be limited among this group.

Política de formação e educação permanente em saúde no brasil: bases legais e referências teóricas

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Renata Lúcia Gigante

Full Text Available Resumo Este artigo teve como objetivo discutir as inter-relações dos relatórios das Conferências Nacionais de Saúde com as propostas apresentadas em documentos oficiais do Sistema Único de Saúde referentes à formação e desenvolvimento de recursos humanos, buscando relacioná-los à incorporação de novos referenciais pedagógicos pautados pelas metodologias ativas de ensino-aprendizagem. O estudo aqui apresentado foi do tipo exploratório, referente à pesquisa na literatura das áreas de saúde e educação, no período de 1941 – realização da 1a Conferência Nacional de Saúde – até 2007, quando foi publicada a portaria n. 1.996 GM/MS. Essa portaria definiu novas diretrizes e estratégias para a implementação da Política Nacional de Educação Permanente em Saúde, com o objetivo de evidenciar a importância da formação de recursos humanos para a consolidação do Sistema Único de Saúde. Verificou-se que há correlação entre as reivindicações que emergem de necessidades sociais identificadas na construção do Sistema Único de Saúde e as propostas inscritas nas legislações pertinentes. Destaca-se que o sucesso de projetos de educação permanente depende de profunda imbricação entre processos educativos e de intervenção institucional, que contemplem a complexidade dos modos de fazer saúde.

Is medical students' moral orientation changeable after preclinical medical education?

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Lin, Chaou-Shune; Tsou, Kuo-Inn; Cho, Shu-Ling; Hsieh, Ming-Shium; Wu, Hsi-Chin; Lin, Chyi-Her

2012-03-01

Moral orientation can affect ethical decision-making. Very few studies have focused on whether medical education can change the moral orientation of the students. The purpose of the present study was to document the types of moral orientation exhibited by medical students, and to study if their moral orientation was changed after preclinical education. From 2007 to 2009, the Mojac scale was used to measure the moral orientation of Taiwan medical students. The students included 271 first-year and 109 third-year students. They were rated as a communitarian, dual, or libertarian group and followed for 2 years to monitor the changes in their Mojac scores. In both first and third-year students, the dual group after 2 years of preclinical medical education did not show any significant change. In the libertarian group, first and third-year students showed a statistically significant increase from a score of 99.4 and 101.3 to 103.0 and 105.7, respectively. In the communitarian group, first and third-year students showed a significant decline from 122.8 and 126.1 to 116.0 and 121.5, respectively. During the preclinical medical education years, students with communitarian orientation and libertarian orientation had changed in their moral orientation to become closer to dual orientation. These findings provide valuable hints to medical educators regarding bioethics education and the selection criteria of medical students for admission.

Review of medical discharge summaries and medical documentation in a metropolitan hospital: impact on diagnostic-related groups and Weighted Inlier Equivalent Separation.

Science.gov (United States)

Chin, N; Perera, P; Roberts, A; Nagappan, R

2013-07-01

Accurate and comprehensive clinical documentation is crucial for effective ongoing patient care, follow up and to optimise case mix-based funding. Each Diagnostic Related Group (DRG) is assigned a 'weight', leading to Weighted Inlier Equivalent Separation (WIES), a system many public and private hospitals in Australia subscribe to. To identify the top DRG in a general medical inpatient service, the completeness of medical discharge documentation, commonly missed comorbidities and system-related issues and subsequent impact on DRG and WIES allocation. One hundred and fifty completed discharge summaries were randomly selected from the top 10 medical DRG in our health service. From a detailed review of the clinical documentation, principal diagnoses, associated comorbidities and complications, where appropriate, the DRG and WIES were modified. Seventy-two (48%) of the 150 reviewed admissions resulted in a revision of DRG and WIES equivalent to an increase of AUD 142,000. Respiratory-based DRG generated the largest revision of DRG and WIES, while 'Cellulitis' DRG had the largest relative change. Twenty-seven per cent of summaries reviewed necessitated a change in coding with no subsequent change in DRG allocation or WIES. Acute renal failure, anaemia and electrolyte disturbances were the most commonly underrepresented entities in clinical discharge documentation. Seven patients had their WIES downgraded. Comprehensive documentation of principal diagnosis/diagnoses, comorbidities and their complications is imperative to optimal DRG and WIES allocation. Regular meetings between clinical and coding staff improve the quality and timeliness of medical documentation, ensure adequate communication with general practitioners and lead to appropriate funding. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

Historias de vida de mujeres afincadas de forma permanente en situación de exclusión social

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Gabriela Moriana Mateo

2016-07-01

Full Text Available Este artículo presenta parte de los resultados de un trabajo de campo etnográfico realizado en distintos centros de Servicios Sociales Especializados para mujeres de la Generalitat Valenciana. Su objetivo es conocer los tipos de violencia y los factores de exclusión social que subyacen en las historias de vida de las mujeres institucionalizadas. La metodología de investigación utilizada ha sido de índole cualitativa. Se ha realizado observación participante y entrevistas tanto informales como biográficas que, junto con documentos personales e informes sociales, han permitido elaborar 15 historias de vida. Aunque en esta aproximación tan sólo se analizan las cuatro afincadas en la situación de exclusión social de forma permanente. Respecto a los resultados, cabe señalar que en las trayectorias vitales analizadas subyacen distintos factores de exclusión social que afectan tanto a los hombres como a las mujeres, pero también importantes factores específicos de género, como la violencia contra las mujeres intrafamiliar y de género.

Las redes sociales en los procesos de adaptación a cambios permanentes de hábitat* Un estudio con habitantes de la Depresión Momposina (Norte de Colombia)

OpenAIRE

Gabriel Garrido Escudero; Camilo Madariaga

2001-01-01

En este artículo se describen las redes sociales durante los procesos de adaptación a los permanentes cambios que viven los pobladores de la Depresión Momposina en La Travesía, corregimiento de Mompox (Colombia). La información se recogió en una muestra de 262 personas, mediante la triangulación se compararon los resultados cuantitativos y los cuantitativos y se contrastó la información desde diversas estrategias para describir de mejor forma los fenómenos estudiados. Con ba...

Gender differences and similarities in medical students' experiences of mistreatment by various groups of perpetrators.

Science.gov (United States)

Siller, Heidi; Tauber, Gloria; Komlenac, Nikola; Hochleitner, Margarethe

2017-08-14

Mistreatment of medical students during medical education is a widespread concern. Studies have shown that medical students report the most mistreatment compared to students of other study programs and that the prevalence of mistreatment peaks during clinical training. For this reason, a study was conducted to assess prevalence of mistreatment among medical students committed by various groups of people. The focus was to identify whether gender was associated with the experience of mistreatment. Additionally, students' perception of university climate for reporting sexual harassment was assessed. In the study 88 medical students (45 women, 43 men) participated. A modified version of the Questionnaire on Student Abuse was used to assess students' experience of various types of mistreatment and associated distress during medical education. To explore factors that could be associated with this experience the organizational climate for reporting sexual harassment was assessed with the Psychological Climate for Sexual Harassment. The most often cited perpetrators of mistreatment were strangers (79.5%), friends (75.0%) and university staff (68.2%). Strangers mostly committed psychological mistreatment and sexual harassment, whereas friends additionally engaged in physical mistreatment of medical students. The most common form of mistreatment conducted by university staff was humiliation of students. These kinds of psychological mistreatment were reported to be distressing (43%). Gender differences were found in the prevalence of mistreatment. Women experienced more sexual harassment and humiliation than did men. On the other hand, men experienced more physical mistreatment than did women. Women reported experiencing more distress from mistreatment experiences than did men and also more often reported being mistreated by university staff than did men. Women perceived a greater risk in reporting sexual harassment to the organization than did men. Mistreatment of female and

Educação permanente: uma ferramenta para o desenvolvimento docente na graduação

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Carlos Alberto Lazarini

Full Text Available OBJETIVO: Descrever a percepção dos docentes tutores e dos docentes da Unidade de Prática Profissional (UPP da primeira série dos cursos de Medicina e Enfermagem da Famema quanto à relevância de participar do programa de Educação Permanente (EP. MÉTODOS: Estudo exploratório com questionário semiestruturado. Empregou-se a técnica de análise temática do Discurso do Sujeito Coletivo. RESULTADOS: A quase totalidade dos sujeitos considerou a atividade de EP como relevante. Os docentes da UPP apontaram ótimo espaço para aprendizagem, troca de experiências e reflexão sobre a prática. As ideias centrais dos tutores foram bom espaço de discussão e reflexão, porém um momento mal aproveitado. CONSIDERAÇÕES: Para os docentes da UPP, a proposta da EP (reflexão sobre a prática vem sendo atingida, mas não tem respondido às expectativas e ao entendimento dos tutores. Dada a importância do desenvolvimento docente para a sustentação de um currículo inovador, é necessário problematizar os sentidos implícitos nesta fala em busca de uma EP mais responsiva aos tutores

Malaria problem in Afghanistan: malaria scanning results of the Turkish medical aid group after the war.

Science.gov (United States)

Oner, Yaşar Ali; Okutan, Salih Erkan; Artinyan, Elizabeth; Kocazeybek, Bekir

2005-04-01

Malaria is a parasitic infection caused by Plasmodium species and it is especially seen in tropical and subtropical areas. We aimed to evaluate the effects of the infection in Afghanistan, which is an endemic place for malaria and had severe socio-economical lost after the war. We also compared these data with the ones that were recorded before the war. Blood samples were taken from 376 malaria suspected patients who come to the health center, established by the medical group of Istanbul Medical Faculty in 2002, Afghanistan. Blood samples were screened using the OPTIMAL Rapid Malaria Test and Giemsa staining method. In 95 (25.3%) patients diagnosis was malaria. In 65 patients (17.3%) the agent of the infection was P. falciparum and in 30 patients (8%) agents were other Plasmodium species.

Reliability and known-group validity of the Arabic version of the 8-item Morisky Medication Adherence Scale among type 2 diabetes mellitus patients.

Science.gov (United States)

Ashur, S T; Shamsuddin, K; Shah, S A; Bosseri, S; Morisky, D E

2015-12-13

No validation study has previously been made for the Arabic version of the 8-item Morisky Medication Adherence Scale (MMAS-8(©)) as a measure for medication adherence in diabetes. This study in 2013 tested the reliability and validity of the Arabic MMAS-8 for type 2 diabetes mellitus patients attending a referral centre in Tripoli, Libya. A convenience sample of 103 patients self-completed the questionnaire. Reliability was tested using Cronbach alpha, average inter-item correlation and Spearman-Brown coefficient. Known-group validity was tested by comparing MMAS-8 scores of patients grouped by glycaemic control. The Arabic version showed adequate internal consistency (α = 0.70) and moderate split-half reliability (r = 0.65). Known-group validity was supported as a significant association was found between medication adherence and glycaemic control, with a moderate effect size (ϕc = 0.34). The Arabic version displayed good psychometric properties and could support diabetes research and practice in Arab countries.

Propuesta de un plan permanente de relaciones públicas para educar adolescentes sobre los riesgos que existen en las redes sociales

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Gina Gilbert Toral

2014-06-01

redes sociales, utilizadas como un medio de comunicación altamente efectivo; hoy en día existe un notorio cambio en la manera en que los adolescentes se relacionan e interactúan entre sí, se evidencia que los niños a temprana edad adquieren dominio sobre las redes sociales y el internet en general, por lo que están expuestos a peligros de tipo psicológico, tales como: ciberbullying, sexting, grooming y morphing. Por lo antes expuesto, y con el fin de incidir de manera positiva en los adolescentes, el presente trabajo de investigación propone la creación de un plan permanente de relaciones públicas, que entre otras actividades conlleva: charlas de psicología, talleres de concientización, la elaboración de un código de conducta online que minimice los riesgos, y finalmente el desarrollo de campañas en internet y medios tradicionales.

Reporting on a Talk I Gave Some Months Ago, the Headline in "La Opinion," Los Angeles' Premier Spanish Language Newspaper, Declared the City's School System "en crisis permanente." No One Wrote in to Disagree. The Claremont Letter. Volume 3, Issue 1

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Kerchner, Charles T.

2008-01-01

Reporting on a talk the author gave some months ago, the headline in "La Opinion," Los Angeles' premier Spanish language newspaper, declared the city's school system "en crisis permanente." No one wrote in to disagree. Indeed, at the end of "Learning from L.A.: Institutional Change in American Public Education" (Harvard Education Press) the author…

Quality of life, treatment adherence, and locus of control: multiple family groups for chronic medical illnesses.

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López-Larrosa, Silvia

2013-12-01

The Multiple Family Groups (MFGs) approach for patients with a chronic medical illness and their families is a structured psychoeducational program that unfolds in six weekly 90-minute sessions. In the MFGs, patients and family members explore new ways to balance illness and nonillness priorities in family life (Steinglass, 1998; Steinglass, 2000 Cuadernos de Terapia Familiar, 44-45, 11; Steinglass, Ostroff, & Steinglass, 2011 Family Process, 50, 393). © FPI, Inc.

Medical student perceptions of factors affecting productivity of problem-based learning tutorial groups: does culture influence the outcome?

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Das Carlo, Mandira; Swadi, Harith; Mpofu, Debbie

2003-01-01

The popularization of problem-based learning (PBL) has drawn attention to the motivational and cognitive skills necessary for medical students in group learning. This study identifies the effect of motivational and cognitive factors on group productivity of PBL tutorial groups. A self-administered questionnaire was completed by 115 students at the end of PBL tutorials for 4 themes. The questionnaire explored student perceptions about effect of motivation, cohesion, sponging, withdrawal, interaction, and elaboration on group productivity. We further analyzed (a) differences in perceptions between male and female students, (b) effect of "problems," and (c) effect of student progress over time on group productivity. There were linear relations between a tutorial group's success and the factors studied. Significant differences were noted between male and female student groups. Students and tutors need to recognize symptoms of ineffective PBL groups. Our study emphasizes the need to take into account cultural issues in setting ground rules for PBL tutorials.

Defining quality criteria for online continuing medical education modules using modified nominal group technique.

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Shortt, S E D; Guillemette, Jean-Marc; Duncan, Anne Marie; Kirby, Frances

2010-01-01

The rapid increase in the use of the Internet for continuing education by physicians suggests the need to define quality criteria for accredited online modules. Continuing medical education (CME) directors from Canadian medical schools and academic researchers participated in a consensus process, Modified Nominal Group Technique, to develop agreement on the most important quality criteria to guide module development. Rankings were compared to responses to a survey of a subset of Canadian Medical Association (CMA) members. A list of 17 items was developed, of which 10 were deemed by experts to be important and 7 were considered secondary. A quality module would: be needs-based; presented in a clinical format; utilize evidence-based information; permit interaction with content and experts; facilitate and attempt to document practice change; be accessible for later review; and include a robust course evaluation. There was less agreement among CMA members on criteria ranking, with consensus on ranking reached on only 12 of 17 items. In contrast to experts, members agreed that the need to assess performance change as a result of an educational experience was not important. This project identified 10 quality criteria for accredited online CME modules that representatives of Canadian organizations involved in continuing education believe should be taken into account when developing learning products. The lack of practitioner support for documentation of change in clinical behavior may suggest that they favor traditional attendance- or completion-based CME; this finding requires further research.

Comparing Hospital Processes and Outcomes in California Medicare Beneficiaries: Simulation Prompts Reconsideration.

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Escobar, Gabriel J; Baker, Jennifer M; Turk, Benjamin J; Draper, David; Liu, Vincent; Kipnis, Patricia

2017-01-01

This article is not a traditional research report. It describes how conducting a specific set of benchmarking analyses led us to broader reflections on hospital benchmarking. We reexamined an issue that has received far less attention from researchers than in the past: How variations in the hospital admission threshold might affect hospital rankings. Considering this threshold made us reconsider what benchmarking is and what future benchmarking studies might be like. Although we recognize that some of our assertions are speculative, they are based on our reading of the literature and previous and ongoing data analyses being conducted in our research unit. We describe the benchmarking analyses that led to these reflections. The Centers for Medicare and Medicaid Services' Hospital Compare Web site includes data on fee-for-service Medicare beneficiaries but does not control for severity of illness, which requires physiologic data now available in most electronic medical records.To address this limitation, we compared hospital processes and outcomes among Kaiser Permanente Northern California's (KPNC) Medicare Advantage beneficiaries and non-KPNC California Medicare beneficiaries between 2009 and 2010. We assigned a simulated severity of illness measure to each record and explored the effect of having the additional information on outcomes. We found that if the admission severity of illness in non-KPNC hospitals increased, KPNC hospitals' mortality performance would appear worse; conversely, if admission severity at non-KPNC hospitals' decreased, KPNC hospitals' performance would appear better. Future hospital benchmarking should consider the impact of variation in admission thresholds.

Cohort Study of ECG Left Ventricular Hypertrophy Trajectories: Ethnic Disparities, Associations With Cardiovascular Outcomes, and Clinical Utility.

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Iribarren, Carlos; Round, Alfred D; Lu, Meng; Okin, Peter M; McNulty, Edward J

2017-10-05

ECG left ventricular hypertrophy (LVH) is a well-known predictor of cardiovascular disease. However, no prior study has characterized patterns of presence/absence of ECG LVH ("ECG LVH trajectories") across the adult lifespan in both sexes and across ethnicities. We examined: (1) correlates of ECG LVH trajectories; (2) the association of ECG LVH trajectories with incident coronary heart disease, transient ischemic attack, ischemic stroke, hemorrhagic stroke, and heart failure; and (3) reclassification of cardiovascular disease risk using ECG LVH trajectories. We performed a cohort study among 75 412 men and 107 954 women in the Northern California Kaiser Permanente Medical Care Program who had available longitudinal exposures of ECG LVH and covariates, followed for a median of 4.8 (range ECG LVH was measured by Cornell voltage-duration product. Adverse trajectories of ECG LVH (persistent, new development, or variable pattern) were more common among blacks and Native American men and were independently related to incident cardiovascular disease with hazard ratios ranging from 1.2 for ECG LVH variable pattern and transient ischemic attack in women to 2.8 for persistent ECG LVH and heart failure in men. ECG LVH trajectories reclassified 4% and 7% of men and women with intermediate coronary heart disease risk, respectively. ECG LVH trajectories were significant indicators of coronary heart disease, stroke, and heart failure risk, independently of level and change in cardiovascular disease risk factors, and may have clinical utility. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Benefits and harms of lung cancer screening in HIV-infected individuals with CD4+ ≥ 500: a simulation study.

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Kong, Chung Yin; Sigel, Keith; Criss, Steven D; Sheehan, Deirdre F; Triplette, Matthew; Silverberg, Michael J; Henschke, Claudia I; Justice, Amy; Braithwaite, R Scott; Wisnivesky, Juan; Crothers, Kristina

2018-04-19

Lung cancer is the leading cause of non-AIDS-defining cancer deaths among HIV-infected individuals. Although lung cancer screening with low-dose computed tomography (LDCT) is endorsed by multiple national organizations, whether HIV-infected individuals would have similar benefit as uninfected individuals from lung cancer screening is unknown. Our objective was to determine the benefits and harms of lung cancer screening among HIV-infected individuals. We modified an existing simulation model, the Lung Cancer Policy Model, for HIV-infected patients. Veterans Aging Cohort Study, Kaiser Permanente Northern California HIV Cohort, and medical literature. Target population: HIV-infected current and former smokers. Lifetime. Population. Annual LDCT screening from ages 45, 50, or 55 until ages 72 or 77 years. Benefits assessed included lung cancer mortality reduction and life-years gained; harms assessed included numbers of LDCT examinations, false-positive results, and overdiagnosed cases. For HIV-infected patients with CD4 at least 500 and 100% antiretroviral therapy adherence, screening using the Centers for Medicare & Medicaid Services criteria (age 55-77, 30 pack-years of smoking, current smoker or quit within 15 years of screening) would reduce lung cancer mortality by 18.9%, similar to the mortality reduction of uninfected individuals. Alternative screening strategies utilizing lower screening age and/or pack-years criteria increase mortality reduction, but require more LDCT examinations. Strategies assumed 100% screening adherence. Lung cancer screening reduces mortality in HIV-infected patients with CD4 at least l500, with a number of efficient strategies for eligibility, including the current Centers for Medicare & Medicaid Services criteria.

Risk of fever and sepsis evaluations after routine immunizations in the neonatal intensive care unit.

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Navar-Boggan, A M; Halsey, N A; Golden, W C; Escobar, G J; Massolo, M; Klein, N P

2010-09-01

Premature infants can experience cardiorespiratory events such as apnea after immunization in the neonatal intensive care unit (NICU). These changes in clinical status may precipitate sepsis evaluations. This study evaluated whether sepsis evaluations are increased after immunizations in the NICU. We conducted a retrospective cohort study of infants older than 53 days who were vaccinated in the NICU at the KPMCP (Kaiser Permanente Medical Care Program). Chart reviews were carried out before and after all immunizations were administered and for all sepsis evaluations after age 53 days. The clinical characteristics of infants on the day before receiving a sepsis evaluation were compared between children undergoing post-immunization sepsis evaluations and children undergoing sepsis evaluation at other times. The incidence rate of sepsis evaluations in the post-immunization period was compared with the rate in a control time period not following immunization using Poisson regression. A total of 490 infants met the inclusion criteria. The rate of fever was increased in the 24 h period after vaccination (2.3%, Pimmunization than during the control period, although this was not statistically significant (P=0.09). Infants undergoing a sepsis evaluation after immunization were more likely to have an apneic, bradycardic or moderate-to-severe cardiorespiratory event in the day before the evaluation than were infants undergoing sepsis evaluations at other times (Pimmunization in the NICU, routine vaccination was not associated with increased risk of receiving sepsis evaluations. Providers may be deferring immunizations until infants are clinically stable, or may have a higher threshold for initiating sepsis evaluations after immunization than at other times.

Learning global health: a pilot study of an online collaborative intercultural peer group activity involving medical students in Australia and Indonesia.

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Ambrose, Mark; Murray, Linda; Handoyo, Nicholas E; Tunggal, Deif; Cooling, Nick

2017-01-13

There is limited research to inform effective pedagogies for teaching global health to undergraduate medical students. Theoretically, using a combination of teaching pedagogies typically used in 'international classrooms' may prove to be an effective way of learning global health. This pilot study aimed to explore the experiences of medical students in Australia and Indonesia who participated in a reciprocal intercultural participatory peer e-learning activity (RIPPLE) in global health. Seventy-one third year medical students (49 from Australia and 22 from Indonesia) from the University of Tasmania (Australia) and the University of Nusa Cendana (Indonesia) participated in the RIPPLE activity. Participants were randomly distributed into 11 intercultural 'virtual' groups. The groups collaborated online over two weeks to study a global health topic of their choice, and each group produced a structured research abstract. Pre- and post-RIPPLE questionnaires were used to capture students' experiences of the activity. Descriptive quantitative data were analysed with Microsoft Excel and qualitative data were thematically analysed. Students' motivation to volunteer for this activity included: curiosity about the innovative approach to learning; wanting to expand knowledge of global health; hoping to build personal and professional relationships; and a desire to be part of an intercultural experience. Afer completing the RIPPLE program, participants reported on global health knowledge acquisition, the development of peer relationships, and insight into another culture. Barriers to achieving the learning outcomes associated with RIPPLE included problems with establishing consistent online communication, and effectively managing time to simultaneously complete RIPPLE and other curricula activities. Medical students from both countries found benefits in working together in small virtual groups to complement existing teaching in global health. However, our pilot study

Implantação das mesas nacionais de negociação permanente do Sistema Único de Saúde em secretarias estaduais e municipais de saúde

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Carinne Magnago

Full Text Available Resumo O objetivo deste artigo é avaliar a implantação da mesa de negociação permanente e identificar os entraves e os avanços decorridos dos processos de negociação no âmbito dos estados e dos municípios brasileiros. O método usado foi estudo descritivo e exploratório, de abrangência nacional. A coleta de dados se deu em 2012 e 2013, por meio de survey com 519 gestores de saúde e grupos focais com 49 gestores e 11 integrantes da Mesa Nacional de Negociação Permanente. Dados foram analisados por estatística descritiva e por análise de conteúdo. Verificou-se existência de 132 mesas de negociação, das quais apenas 87 estão em funcionamento. Os principais motivos para não implantação das mesas são a falta de assessoria técnica e a utilização de outras ferramentas para negociação do trabalho. As principais mudanças nas relações de trabalho em decorrência da atuação das mesas de negociação foram a realização de concursos e de processos seletivos públicos, políticas de desprecarização do trabalho e a implantação de planos de cargos, carreiras e salários. Conclui-se que apesar da potencialidade das mesas como dispositivos de negociação, sua implantação e seu pleno funcionamento esbarram em grandes desafios.

76 FR 11243 - Farm, Ranch, and Rural Communities Committee

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2011-03-01

... CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov , 202-564-7273, US EPA, Office... Alicia Kaiser, Designated Federal Officer, at the contact information above. All requests must be... individuals with disabilities, please contact Alicia Kaiser at 202-564- 7273 or kaiser.alicia@epa.gov . To...

Team-Based Learning for Nursing and Medical Students: Focus Group Results From an Interprofessional Education Project.

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Feather, Rebecca A; Carr, Doug E; Reising, Deanna L; Garletts, Derrick M

2016-01-01

Past research indicates that inadequacies in health care delivery create substantial preventable quality issues that can be addressed through improving relationships among clinicians to decrease the negative effects on patient outcomes. The purpose of this article is to describe the implementation of an interprofessional education project with senior nursing and third-year medical students working in teams in a clinical setting. Results include data from focus groups conducted at the conclusion of the project.

Medical practice in organized settings. Redefining medical autonomy.

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Astrachan, J H; Astrachan, B M

1989-07-01

Physicians are perplexed by the ongoing erosion of their individual professional autonomy. While the economic forces underlying such change have received much attention, the evolution of new organizational forms that modify and often diminish medical autonomy is less well understood. The practice of medicine is becoming more organized and more hierarchical. We emphasize the importance of organized medical groups, including the medical staff organization, as structures for appropriate peer monitoring, and for counterbalancing the burgeoning influence of governance and administrative constraints on practice. There is an ongoing tension within organizations between management, governance, and physicians. Over time one or another of these groups achieves some measure of dominance, but good management requires a balance of power. The role of the medical staff, which is poorly represented in some health care institutions and under threat in others, is considered. In general, we find that medical work is becoming more hierarchical, and that physician "leaders" do not substitute for collegial processes.

Assessment of a Group Activity Based Educational Method to Teach Research Methodology to Undergraduate Medical Students of a Rural Medical College in Gujarat, India.

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Kumar, Dinesh; Singh, Uday Shankar; Solanki, Rajanikant

2015-07-01

Early undergraduate exposure to research helps in producing physicians who are better equipped to meet their professional needs especially the analytical skills. To assess the effectiveness and acceptability of small group method in teaching research methodology. Sixth semester medical undergraduates (III MBBS-part1) of a self-financed rural medical college. The workshop was of two full days duration consisting of daily two sessions by faculty for 30 minutes, followed by group activity of about four hours and presentation by students at the end of the day. A simple 8 steps approach was used. These steps are Identify a Problem, Refine the Problem, Determine a Solution, Frame the Question, Develop a Protocol, Take Action, Write the Report and Share your Experience. A Pre-test and post-test assessment was carried out using a questionnaire followed by anonymous feedback at the end of the workshop. The responses were evaluated by blinded evaluator. There were 95 (94.8%) valid responses out of the 99 students, who attended the workshop. The mean Pre-test and post-test scores were 4.21 and 10.37 respectively and the differences were found to be significant using Wilcoxon Sign Rank test (presearch methodology workshop can play a significant role in teaching research to undergraduate students in an interesting manner. However, the long term effect of such workshops needs to be evaluated.

[The meaning of "apology": the survivors of Nazi medical crimes and the Max Planck Society].

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Sachse, Carola

2011-09-01

Around the turn of the twenty-first century a new practice in international politics became established: representatives of political, economic and religious organisations apologised for the historical and political crimes of their own collectives, addressing the victims or the victims' descendants. At a public event in June 2001, a formal apology of this kind was made by the president of the Max Planck Society (MPS), who had previously launched an extensive programme of research into the National Socialist history of what was then the Kaiser Wilhelm Society. The majority of the eight invited survivors of human experimentation in Nazi concentration camps refused forgiveness. Instead, they called for the MPS not to content itself with historical research and analysis, but to ensure the continued remembrance of the victims and their suffering. Starting from this 2001 ritual of repentance, the paper examines the participants' diverse views of how to deal with the medical crimes of National Socialism, and asks about possibilities of going beyond historical retrospection to fulfil the imperative of remembrance.

Social organization of self-management support of persons with diabetes: a health systems comparison.

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Schiøtz, Michaela; Frølich, Anne; Krasnik, Allan; Taylor, Warren; Hsu, John

2012-09-01

Identify important organizational elements for providing self-management support (SMS). Semi-structured qualitative interviews conducted in two healthcare systems. Kaiser Permanente Northern California and the Danish Health Care System. 36 managers and healthcare professionals in the two healthcare systems. Elements important to providing self-management support to persons with diabetes. Healthcare professionals' provision of SMS was influenced by healthcare system organization and their perceptions of SMS, the capability and responsibility of healthcare systems, and their roles in the healthcare organization. Enabling factors for providing SMS included: strong leadership; aligned incentives; use of an integrated health information technology (HIT) system; multidisciplinary healthcare provider teams; ongoing training for healthcare professionals; outreach; and quality goals. Barriers to providing SMS included lack of collaboration between providers and skeptical attitudes towards prevention and outreach. Implementation of SMS can be improved by an understanding of the elements that enhance its provision: (1) initiatives seeking to improve collaboration and integration between providers; (2) implementation of an integrated HIT system; and (3) ongoing training of healthcare professionals.

NFP Investor Conference. Growth is back in sight.

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Haugh, Richard

2002-06-01

In a whirlwind of high-stakes meetings in New York City in mid-May, two dozen of the nation's largest hospitals and health systems strutted their stuff with a single goal: securing their future. Their message was clear: back-to-basics works, and now it's time to grow the business. Executives from 23 providers outlined their work on increasing revenue, boosting margins and shoring up balance sheets. They presented their market positions, strategic initiatives and financial results for investment analysts, credit raters and bond traders. The third annual Non-Profit Healthcare Investor Conference was co-sponsored by the American Hospital Association, Health Forum, the Healthcare Financial Management Association and Salomon Smith Barney. The focus on growth doesn't come without challenges Several common themes emerged from the presentations, among them pressure on reimbursement, workforce shortages, liability insurance issues and capacity constraints. Yet executives agree: it all comes down to the basics, and building the strength to keep their missions alive. As Thomas Meier, vice president and treasurer of Oakland, Calif.-based Kaiser Permanente, put it: "No margin, no mission, no más."

Data that drive: Closing the loop in the learning hospital system.

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Liu, Vincent X; Morehouse, John W; Baker, Jennifer M; Greene, John D; Kipnis, Patricia; Escobar, Gabriel J

2016-11-01

The learning healthcare system describes a vision of US healthcare that capitalizes on science, information technology, incentives, and care culture to drive improvements in the quality of health care. The inpatient setting, one of the most costly and impactful domains of healthcare, is an ideal setting in which to use data and information technology to foster continuous learning and quality improvement. The rapid digitization of inpatient medicine offers incredible new opportunities to use data from routine care to generate new discovery and thus close the virtuous cycle of learning. We use an object lesson-sepsis care within the 21 hospitals of the Kaiser Permanente Northern California integrated healthcare delivery system-to offer insight into the critical elements necessary for developing a learning hospital system. We then describe how a hospital-wide data-driven approach to inpatient care can facilitate improvements in the quality of hospital care. Journal of Hospital Medicine 2016;11:S11-S17. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

A renewed Medication Adherence Alliance call to action: harnessing momentum to address medication nonadherence in the United States.

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Zullig, Leah L; Granger, Bradi B; Bosworth, Hayden B

2016-01-01

Nonadherence to prescription medications is a common and costly problem with multiple contributing factors, spanning the dimensions of individual behavior change, psychology, medicine, and health policy, among others. Addressing the problem of medication nonadherence requires strategic input from key experts in a number of fields. The Medication Adherence Alliance is a group of key experts, predominately from the US, in the field of medication nonadherence. Members include representatives from consumer advocacy groups, community health providers, nonprofit groups, the academic community, decision-making government officials, and industry. In 2015, the Medication Adherence Alliance convened to review the current landscape of medication adherence. The group then established three working groups that will develop recommendations for shifting toward solutions-oriented science. From the perspective of the Medication Adherence Alliance, the objective of this commentary is to describe changes in the US landscape of medication adherence, framing the evolving field in the context of a recent think tank meeting of experts in the field of medication adherence.

Historia poblacional, orígenes africanos y microevolución de los actuales afro-colombianos inferidos desde caracteres epigenéticos en la dentición decidua y permanente

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Delgado Burbano, Miguel E.

2006-01-01

Full Text Available Setenta y cinco rasgos coronales no-métricos en la dentición permanente y decidua fueron registrados en 178 modelos dentales de individuos afro-colombianos pertenecientes a la comunidad de Guapi. Se recolectaron datos comparativos de 33 grupos africanos, otro grupo afro-estadounidense en la dentición permanente, en 4 grupos afro-americanos y otros 12 grupos de diferente ascendencia étnica, en la dentición decidua. Un análisis multivariado de componentes principales basado en frecuencias dentales, mostró que los afro-colombianos poseen gran afinidad genética con el Africa Sub-Sahariana, específicamente con grupos del Occidente, del Oriente y del Sur-Oriente africano. Este mismo análisis detectó una marcada divergencia dental con las poblaciones Norafricanas. Los resultados de esta investigación concuerdan con recientes estudios genéticos, basados en marcadores de ADNmt. A pesar que la dentición es evolutivamente conservativa y estable en una escala diacrónica corta, se concluyó que en 400 años de microevolución de los africanos en Colombia, su pool genético original se ha modificado levemente, debido a la influencia de presiones selectivas y flujo génico interétnico, con nativos americanos y grupos de origen caucásico. Se sugiere que los grupos afro-descendientes del Norte, Centro y Sur de América poseen historias poblacionales y evolutivas distintas, debido tanto a procesos de diferenciación fenotípica regional y local como a orígenes geográficos y étnicos diferentes.

Is migraine a risk factor for pediatric stroke?

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Gelfand, Amy A; Fullerton, Heather J; Jacobson, Alice; Sidney, Stephen; Goadsby, Peter J; Kurth, Tobias; Pressman, Alice

2015-12-01

Our understanding of risk factors for childhood stroke is incomplete. In adults, migraine with aura is associated with a two-fold increase in ischemic stroke risk. In this cohort study we examine the association between migraine and stroke among children in Kaiser Permanente Northern California (KPNC). Children ages 2-17 years who were members of KPNC for ≥6 months between 1997 and 2007 were included. Migraine cohort members had one or more of: an ICD-9 code for migraine, migraine listed as a significant health problem, or a prescription for a migraine-specific medication. The comparison group was children with no evidence of headache. Main outcome measures included stroke incidence rates and incidence rate ratios (IR). Among the 1,566,952 children within KPNC during the study period, 88,164 had migraine, and 1,323,142 had no evidence of headache. Eight migraineurs had a stroke (three (38%) hemorrhagic; five (63%) ischemic). Eighty strokes occurred in children without headache (53 (66%) hemorrhagic; 27 (34%) ischemic). The ischemic stroke incidence rate was 0.9/100,000 person-years in migraineurs vs. 0.4/100,000 person-years in those without headache; IR 2.0 (95% CI 0.8-5.2). A post-hoc analysis of adolescents (12-17 years) showed an increased risk of ischemic stroke among those with migraine; IR 3.4 (95% CI 1.2-9.5). The hemorrhagic stroke incidence rate was 0.5/100,000 person-years in migraineurs and 0.9/100,000 person-years in those without headache; IR 0.6 (95% CI 0.2-2.0). There was no statistically significant increase in hemorrhagic or ischemic stroke risk in pediatric migraineurs in this cohort study. A post-hoc analysis found that ischemic stroke risk was significantly elevated in adolescents with migraine. Future studies should focus on identifying risk factors for ischemic stroke among adolescent migraineurs. Based on adult data, we recommend that migraine aura status should be studied as a possible risk factor for ischemic stroke among adolescent

FY97 Environmental Technology Division Annual Report.

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1997-12-01

feasibility of using plasma arc pyrolysis to destroy and permanently render inert armament-related hazardous waste. Chemical manufacturers have used PAT for...34 Steel Times, June 1991. Health Risk Assessment for Plasma Pyrolysis Medical Waste Processor at Kaiser Foundation Hospitals’ Medical Center, 4647 Zion...vegetable crops to be tested include radishes, kale, bush beans, tomatoes , and chives. The range crops to be tested include alfalfa, sorghum, red top

Sleep quality in medical students: a comparison across the various phases of the medical course

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Corrêa, Camila de Castro; de Oliveira, Felipe Kazan; Pizzamiglio, Diego Scherlon; Ortolan, Erika Veruska Paiva; Weber, Silke Anna Theresa

2017-01-01

ABSTRACT Objective: To evaluate and compare subjective sleep quality in medical students across the various phases of the medical course. Methods: This was a cross-sectional study involving medical undergraduates at one medical school in the city of Botucatu, Brazil. All first- to sixth-year students were invited to complete the Pittsburgh Sleep Quality Index, which has been validated for use in Brazil. Participants were divided into three groups according to the phase of the medical course: group A (first- and second-years); group B (third- and fourth-years); and group C (fifth- and sixth-years). The results obtained for the instrument components were analyzed for the total sample and for the groups. Results: Of the 540 students invited to participate, 372 completed the instrument fully. Of those, 147 (39.5%) reported their sleep quality to be either very or fairly bad; 110 (29.5%) reported taking more than 30 min to fall asleep; 253 (68.0%) reported sleeping 6-7 h per night; 327 (87.9%) reported adequate sleep efficiency; 315 (84.6%) reported no sleep disturbances; 32 (8.6%) reported using sleeping medication; and 137 (36.9%) reported difficulty staying awake during the day at least once a week. Group comparison revealed that students in group A had worse subjective sleep quality and greater daytime dysfunction than did those in groups B and C. Conclusions: Medical students seem to be more exposed to sleep disturbance than other university students, and first- and second-years are more affected than those in other class years because they have worse subjective sleep quality. Active interventions should be implemented to improve sleep hygiene in medical students. PMID:29365004

Small group learning: effect on item analysis and accuracy of self-assessment of medical students.

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Biswas, Shubho Subrata; Jain, Vaishali; Agrawal, Vandana; Bindra, Maninder

2015-01-01

Small group sessions are regarded as a more active and student-centered approach to learning. Item analysis provides objective evidence of whether such sessions improve comprehension and make the topic easier for students, in addition to assessing the relative benefit of the sessions to good versus poor performers. Self-assessment makes students aware of their deficiencies. Small group sessions can also help students develop the ability to self-assess. This study was carried out to assess the effect of small group sessions on item analysis and students' self-assessment. A total of 21 female and 29 male first year medical students participated in a small group session on topics covered by didactic lectures two weeks earlier. It was preceded and followed by two multiple choice question (MCQ) tests, in which students were asked to self-assess their likely score. The MCQs used were item analyzed in a previous group and were chosen of matching difficulty and discriminatory indices for the pre- and post-tests. The small group session improved the marks of both genders equally, but female performance was better. The session made the items easier; increasing the difficulty index significantly but there was no significant alteration in the discriminatory index. There was overestimation in the self-assessment of both genders, but male overestimation was greater. The session improved the self-assessment of students in terms of expected marks and expectation of passing. Small group session improved the ability of students to self-assess their knowledge and increased the difficulty index of items reflecting students' better performance.

Irrompimento do primeiro molar permanente em crianças de 5 e 6 anos de idade: implicações da análise longitudinal para prevenção da cárie oclusal Emergence of the first permanent molar in 5-6-year-old children: implications from a longitudinal analysis for occlusal caries prevention

Directory of Open Access Journals (Sweden)

Paulo Frazão

2011-06-01

Full Text Available O tempo de irrompimento dentário é essencial para o planejamento de medidas de prevenção da cárie oclusal. Com a ampliação do ensino fundamental de oito para nove anos de duração, um número maior de crianças entre cinco e seis anos de idade é incluído na primeira série do ensino fundamental. OBJETIVO: O objetivo foi estimar as tendências do irrompimento dos primeiros molares permanentes em meninos e meninas de 5 e 6 anos de idade. MÉTODOS: Em estudo longitudinal, espaços dentários de 497 crianças de 60 meses e mais de idade foram examinados quatro vezes por um dentista calibrado (kappa > 0,97 durante 18 meses. O primeiro molar permanente foi considerado irrompido quando qualquer parte de sua superfície podia ser tocada por uma sonda de ponta esférica. A idade dos participantes foi medida em meses. Intervalos para 95% de confiança dos valores de prevalência e incidência foram apurados conforme o sexo para três coortes etárias: 60,0 a 65,9; 66,0 a 71,9; 72,0 a 77,9 meses. A razão entre as taxas de incidência foi estimada por meio de análise de regressão de Poisson. RESULTADOS: A maioria das crianças entre 66,0 e 71,9 meses e entre 72,0 e 77,9 meses tem pelo menos um molar permanente irrompido. No grupo de 66,0 a 71,9 meses, de cada três crianças pelo menos uma apresentou os quatro primeiros molares permanentes irrompidos. CONCLUSÃO. As tendências de irrompimento observadas justificam a necessidade da adoção de medidas de vigilância e de proteção específica em relação à lesão de cárie oclusal.The timing of tooth emergence is of considerable importance in the planning of prevention of occlusal caries. OBJECTIVE: The aim was to estimate the trends of emergence of the first permanent molars in girls and boys between 5-6 years of age, since more children are included in the first grade after Brazilian elementary education has been extended from eight to nine years of duration. METHODS: Dental spaces of 497

French experience with Uranium compounds: conclusions of medical working group

International Nuclear Information System (INIS)

Berard, P.; Mazeyrat, C.; Auriol, B.; Montegue, A.; Estrabaud, M.; Grappin, L.; Giraud, J.M.

2002-01-01

The authors who represent several organisations and industrial firms, present observations conducted for some thirty years in France, including routine monitoring or special measurements following contamination by uranium compounds. They propose recommendations for radio toxicological monitoring of workers exposed to industrial uranium compounds and they comment on urine and faecal collections in relation to specific exposures. Our working group, set up by the CEA Medical Adviser in 1975, consists of French specialists in uranium radio toxicology. Their role is to propose recommendations for the monitoring of working conditions and exposed workers. The different plants process chemically and metallurgically, and machine large quantities of uranium with various 235U enrichments. Radio toxicological monitoring of workers exposed to uranium compounds requires examinations prescribed according to the kind of product manipulated and the industrial risk of the workplace. The range of examinations that are useful for this kind of monitoring includes lung monitoring, urine analyses and faecal sampling. The authors present the frequency of the monitoring for routine or special conditions according to industrial exposure, time and duration of collection of excreta (urine and faeces), the necessity of a work break, precautions for preservation of the samples and the ways in interpreting excretion analysis according to natural food intakes

A population-based study of tumor gene expression and risk of breast cancer death among lymph node-negative patients.

Science.gov (United States)

Habel, Laurel A; Shak, Steven; Jacobs, Marlena K; Capra, Angela; Alexander, Claire; Pho, Mylan; Baker, Joffre; Walker, Michael; Watson, Drew; Hackett, James; Blick, Noelle T; Greenberg, Deborah; Fehrenbacher, Louis; Langholz, Bryan; Quesenberry, Charles P

2006-01-01

The Oncotype DX assay was recently reported to predict risk for distant recurrence among a clinical trial population of tamoxifen-treated patients with lymph node-negative, estrogen receptor (ER)-positive breast cancer. To confirm and extend these findings, we evaluated the performance of this 21-gene assay among node-negative patients from a community hospital setting. A case-control study was conducted among 4,964 Kaiser Permanente patients diagnosed with node-negative invasive breast cancer from 1985 to 1994 and not treated with adjuvant chemotherapy. Cases (n = 220) were patients who died from breast cancer. Controls (n = 570) were breast cancer patients who were individually matched to cases with respect to age, race, adjuvant tamoxifen, medical facility and diagnosis year, and were alive at the date of death of their matched case. Using an RT-PCR assay, archived tumor tissues were analyzed for expression levels of 16 cancer-related and five reference genes, and a summary risk score (the Recurrence Score) was calculated for each patient. Conditional logistic regression methods were used to estimate the association between risk of breast cancer death and Recurrence Score. After adjusting for tumor size and grade, the Recurrence Score was associated with risk of breast cancer death in ER-positive, tamoxifen-treated and -untreated patients (P = 0.003 and P = 0.03, respectively). At 10 years, the risks for breast cancer death in ER-positive, tamoxifen-treated patients were 2.8% (95% confidence interval [CI] 1.7-3.9%), 10.7% (95% CI 6.3-14.9%), and 15.5% (95% CI 7.6-22.8%) for those in the low, intermediate and high risk Recurrence Score groups, respectively. They were 6.2% (95% CI 4.5-7.9%), 17.8% (95% CI 11.8-23.3%), and 19.9% (95% CI 14.2-25.2%) for ER-positive patients not treated with tamoxifen. In both the tamoxifen-treated and -untreated groups, approximately 50% of patients had low risk Recurrence Score values. In this large, population-based study of lymph

The Impact of a Group Communication Course on Veterinary Medical Students' Perceptions of Communication Competence and Communication Apprehension.

Science.gov (United States)

Kedrowicz, April A

2016-01-01

This paper explores the impact of a group communication course on veterinary medical students' perceptions of communication competence and communication anxiety. Students enrolled in the Group Communication in Veterinary Medicine course completed the Personal Report of Communication Apprehension and the Communicative Competence Scale at the beginning (Time 1) and end (Time 2) of the semester. Results show that first-year veterinary students' self-perceptions of communication competence increased and their self-reported levels of communication apprehension decreased across multiple contexts from Time 1 to Time 2. This research provides support for experiential communication training fostering skill development and confidence.

Basis of integrated approach to sports and recreational activities of students of special medical groups

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L.V. Zaharova

2014-02-01

Full Text Available Purpose : to prove the superiority of techniques integrated approach to sports and recreational activities of students of special medical groups in the educational institution. Material / methods : the annual pedagogical experiment conducted on three groups that have been formed based on the results of preliminary studies based on diagnosis. Learning process based on the principle of improving training. Results : the advantages of an integrated approach to sports and recreational activities of students with disorders of the musculoskeletal system. Recommended approaches to increase physical and functional training. Also - the formation of a stable demand of motor activity, leading healthy lifestyles, in the acquisition of social status in the educational activity. Conclusions : the integrated approach will meet the educational needs of students to form a cultural competence of the individual in the preservation and conservation of health, ability to adapt and successfully implement their professional activities.

La formación inicial y permanente del profesorado de Educación Física a través del practicum

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Herminia María García Ruso

2013-05-01

Full Text Available En este artículo se muestran los aspectos más importantes del desarrollo de un proyecto de innovación educativa realizado durante las prácticas de enseñanza. En el proyecto intervinieron cuatro alumnos, futuros maestros especialistas de Educación Física, cuatro tutoras y dos supervisoras. Trataremos de exponer, con cierto matiz descriptivo, las fases seguidas en la realización de un proyecto de investigación-acción, los objetivos formulados, la metodología empleada, la elaboración de una unidad didáctica de expresión corporal y el análisis e interpretación de la información. Finalmente, explicaremos las conclusiones que giran alrededor de tres ejes: la relación de la Universidad y los Centros Educativos, la relación del supervisor y el tutor, y la valoración del propio seminario de investigación-acción como herramienta para la investigación y la formación inicial y permanente del profesorado.

Professional identity formation in the transition from medical school to working life: a qualitative study of group-coaching courses for junior doctors.

Science.gov (United States)

de Lasson, Lydia; Just, Eva; Stegeager, Nikolaj; Malling, Bente

2016-06-24

The transition from student to medical doctor is challenging and stressful to many junior doctors. To practice with confidence and professionalism the junior doctors have to develop a strong professional identity. Various suggestions on how to facilitate formation of professional identity have been offered including the possible positive effect of group-coaching courses. The purpose of this study was to explore how group-coaching might facilitate professional identity formation among junior doctors in the transition period. Group-coaching courses comprising three whole-day sessions and five 2 h sessions during a period of 4 months were offered to junior doctors in the first years after graduation. The purpose was to support the participants' professional development, ability to relate to patients, relatives and staff and career development. The coaches in this study had a background as health professionals combined with coaching educations. Data was obtained through observations, open-ended questionnaires and interviews. A generic thematic analysis was applied. Forty-five doctors participated in six coaching groups. The three main themes emerging in the sessions were: Adoption to medical culture, career planning, and work/life-balance. The junior doctors found the coaching intervention highly useful in order to cope with these challenges. Furthermore, the group was a forum where the junior doctors could share thoughts and feelings with colleagues without being afraid that this would endanger their professional career. Many found new ways to respond to everyday challenges mainly through a new awareness of patterns of thinking and feeling. The participants found that the group-coaching course supported their professional identity formation (thinking, feeling and acting as a doctor), adoption to medical culture, career planning and managing a healthy work/life-balance. Further studies in different contexts are recommended as well as studies using other methods to

Avaliação continuada da educação permanente na atenção à criança na estratégia saúde da família Continuous evaluation of permanent education concerning child care as part of the family health strategy

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Katia Virginia de Oliveira Feliciano

2008-03-01

Full Text Available Este artigo apresenta a avaliação continuada do trabalho realizado e os resultados que podem ser atribuídos à educação permanente na atenção à criança, desenvolvida junto às equipes de saúde da família, com gerência compartilhada pelo Programa de Extensão Comunitária do Instituto Materno Infantil Prof. Fernando Figueira (IMIP, e Secretarias Municipais de Saúde do Recife e Olinda, em Pernambuco, Brasil. Com apoio de consultores externos, o grupo executor realizou reflexão crítica sistemática, orientada pelas categorias desempenho, efeitos e efetividade, visando aprimorar o trabalho em seu decorrer. As fontes de informação foram os registros diários do grupo e das equipes e as percepções sobre o trabalho. Apesar da dificuldade de transformar em rotina as mudanças alcançadas, a educação permanente tem qualificado a atenção à criança. A satisfação das equipes reforça o sentimento de sua fecundidade e operacionalidade.This article presents a continuous evaluation of work involving permanent education regarding childcare and the results that can be attributed to it, as carried out by family health teams managed jointly by the Community Outreach Program of the Instituto Materno Infantil Prof. Fernando Figueira, IMIP and the Municipal Departments of Health of the city Recife and the city of Olinda, State of Pernambuco, Brazil. With the support of external consultants, the group carried out systematic critical reflection, organized around the categories of performance, effects and effectiveness, with a view to enhancing the work under way. The sources of information used were the daily registers of the group and the teams and their views regarding the work. Despite the difficulty of transforming the changes brought about into routines, continuous education seems to have improved the quality of childcare. The satisfaction the teams feel corroborates this feeling that this work is both feasible and productive.

Anomalías dentomaxilofaciales en dientes permanentes y su relación con traumas en la primera infancia Dental-maxillary-facial anomalies in permanent teeth and their relation to traumas in early childhood

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Arlene Liset Corrales León

2009-03-01

Full Text Available Se realizó un estudio descriptivo, longitudinal y retrospectivo que incluyó niños de 7 a 14 años de edad, pertenecientes al área de salud de la "Clínica Estomatológica Docente Guama" del municipio Pinar del Río, en el período comprendido entre febrero del 2003 a marzo de 2005, con el objetivo de determinar la presencia de anomalías dentomaxilofaciales en dentición permanente y su relación con traumas en la primera infancia. El universo de estudio estuvo constituido por 250 niños, y de ellos, se seleccionó una muestra de 60 niños y se les confeccionó una planilla recolectora de datos para la investigación. Los resultados obtenidos fueron procesados estadísticamente mediante el sistema automatizado STATISTIC y la prueba de CHI CUADRADO, en su aplicación de bondad de ajuste, y el paquete SPSS, para la prueba de comparación de proporciones. En todos los casos se prefija un nivel de significación de 0,05. Entre los resultados globales más significativos encontramos que fueron los traumas ocurridos en las edades de 5-6 años los que más anomalías dentomaxilofaciales causaron en la dentición permanente. Resultó el sexo masculino el más afectado por estas alteraciones, fueron los traumas recibidos directamente sobre los dientes, los mayores causantes de anomalías en la dentición permanente. Resultaron las hipoplasias del esmalte, como otras anomalías no ortodóncicas las más frecuentes; se comprobó que el sexo femenino tuvo mayor implicación psicosocial por estas alteraciones y se divulgaron a estomatólogos, padres y maestros orientaciones sobre la relación entre los traumas en la primera infancia y las anomalías dentomaxilofaciales en la dentición permanente.A descriptive, longitudinal and retrospective research was carried out including children from 7 to 14 years old belonging to the health area of "Guama" Dental University Clinic in Pinar del Rio Municipality, from February 2003 to March 2005 aimed at determining

Técnica para identificar faltas transitorias y permanentes en líneas de transmisión, utilizando la transformada Wavelet

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Miguel Martínez

2009-01-01

Full Text Available En el presente documento, se presenta un algoritmo que permite distinguir de forma clara y precisa, las faltas transitorias de las permanentes. Adicionalmente se determina el instante de extinción del arco secundario, para así evitar o controlar de forma efectiva y segura la operación de reconexión monofásica en sistemas de transporte de energía. El método de identificación se basa en la determinación de las características de alta frecuencia que posee la señal de tensión de la fase en falta antes del despeje y de la corriente en una fase sana y las relaciona de forma independiente mediante una auto-correlación cruzada. Para el análisis de la señal y extracción de los componentes de alta frecuencia, se ha utilizado la transformada Wavelet. El algoritmo propuesto se probó en un sistema base de 380 kV, funcionando de forma correcta en todos los escenarios planteados y logrando una identificación precisa en los primeros 25 ms de la falta.

The impact of SHS exposure on health status and exacerbations among patients with COPD

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Mark D Eisner

2009-05-01

Full Text Available Mark D Eisner1,3, Carlos Iribarren3, Edward H Yelin2, Stephen Sidney3, Patricia P Katz2, Gabriela Sanchez3, Paul D Blanc11Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine; 2Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco, CA, USA; 3Division of Research, Kaiser Permanente, Oakland, CA, USAAbstract: Secondhand smoke (SHS is a major contributor to indoor air pollution. Because it contains respiratory irritants, it may adversely influence the clinical course of persons with chronic obstructive pulmonary disease (COPD. We used data from nonsmoking members of the FLOW cohort of COPD (n = 809 to elucidate the impact of SHS exposure on health status and exacerbations (requiring emergency department visits or hospitalization. SHS exposure was measured by a validated survey instrument (hours of exposure during the past week. Physical health status was measured by the SF-12 Physical Component Summary Score and disease-specific health-related quality of life (HRQL by the Airways Questionnaire 20-R. Health care utilization for COPD was determined from Kaiser Permanente Northern California computerized databases. Compared to no SHS exposure, higher level SHS exposure was associated with poorer physical health status (mean score decrement −1.78 points; 95% confidence interval [CI] −3.48 to −0.074 points after controlling for potential confounders. Higher level SHS exposure was also related to poorer disease-specific HRQL (mean score increment 0.63; 95% CI 0.016 to 1.25 and less distance walked during the Six-Minute Walk test (mean decrement −50 feet; 95% CI −102 to 1.9. Both lower level and higher level SHS exposure was related to increased risk of emergency department (ED visits (hazard ratio [HR] 1.40; 95% CI 0.96 to 2.05 and HR 1.41; 95% CI 0.94 to 2.13. Lower level and higher level SHS exposure were associated with a greater risk of

Simulation based medical education; teaching normal delivery on intermediate fidelity simulator to medical students.

Science.gov (United States)

Shah, Nighat; Baig, Lubna; Shah, Nusrat; Hussain, Riffat; Aly, Syed Moyn

2017-10-01

To assess the effectiveness of medium fidelity simulator in teaching normal vaginal delivery to medical students. The quasi-experimental study was conducted at the professional development centre of the Jinnah Sindh Medical University, Karachi, from June to December 2015, and comprised medical students. Third-year medical students were included. They were divided into two groups. Group A was taught normal delivery through traditional PowerPoint and group B through simulator. The instruments used for assessing knowledge were pre-test and post-test, for skills of labour/delivery checklist of performance was used, and perception forms were filled to evaluate workshops/learning environment by students. Of the 76 participants, there were 36(47.4%) in group A and 40(52.6%) in group B. The overall mean age of the participants was 20.86±0.76 years in group B and 20.60±0.95 years in group A (p=0.19). The mean grade point average of the participants was 2.89±0.47 in group A and 2.87±0.48 in group B (p=0.81).Group B performed much better in skill of delivery having a mean score of 8.91±3.20compared to group A which had mean of 5.67±1.84 (pSimulation-based skill learning showed significantly better results.

Perspectives on Research Participation and Facilitation Among Dialysis Patients, Clinic Personnel, and Medical Providers: A Focus Group Study.

Science.gov (United States)

Flythe, Jennifer E; Narendra, Julia H; Dorough, Adeline; Oberlander, Jonathan; Ordish, Antoinette; Wilkie, Caroline; Dember, Laura M

2017-12-19

Most prospective studies involving individuals receiving maintenance dialysis have been small, and many have had poor clinical translatability. Research relevance can be enhanced through stakeholder engagement. However, little is known about dialysis clinic stakeholders' perceptions of research participation and facilitation. The objective of this study was to characterize the perspectives of dialysis clinic stakeholders (patients, clinic personnel, and medical providers) on: (1) research participation by patients and (2) research facilitation by clinic personnel and medical providers. We also sought to elucidate stakeholder preferences for research communication. Qualitative study. 7 focus groups (59 participants: 8 clinic managers, 14 nurses/patient care technicians, 8 social workers/dietitians, 11 nephrologists/advanced practice providers, and 18 patients/care partners) from 7 North Carolina dialysis clinics. Clinics and participants were purposively sampled. Focus groups were recorded and transcribed. Thematic analysis. We identified 11 themes that captured barriers to and facilitators of research participation by patients and research facilitation by clinic personnel and medical providers. We collapsed these themes into 4 categories to create an organizational framework for considering stakeholder (narrow research understanding, competing personal priorities, and low patient literacy and education levels), relationship (trust, buy-in, and altruistic motivations), research design (convenience, follow-up, and patient incentives), and dialysis clinic (professional demands, teamwork, and communication) aspects that may affect stakeholder interest in participating in or facilitating research. These themes appear to shape the degree of research readiness of a dialysis clinic environment. Participants preferred short research communications delivered in multiple formats. Potential selection bias and inclusion of English-speaking participants only. Our findings

Advanced Accelerators for Medical Applications

Science.gov (United States)

Uesaka, Mitsuru; Koyama, Kazuyoshi

We review advanced accelerators for medical applications with respect to the following key technologies: (i) higher RF electron linear accelerator (hereafter “linac”); (ii) optimization of alignment for the proton linac, cyclotron and synchrotron; (iii) superconducting magnet; (iv) laser technology. Advanced accelerators for medical applications are categorized into two groups. The first group consists of compact medical linacs with high RF, cyclotrons and synchrotrons downsized by optimization of alignment and superconducting magnets. The second group comprises laser-based acceleration systems aimed of medical applications in the future. Laser plasma electron/ion accelerating systems for cancer therapy and laser dielectric accelerating systems for radiation biology are mentioned. Since the second group has important potential for a compact system, the current status of the established energy and intensity and of the required stability are given.

Sickness absence, marginality, and medically unexplained physical symptoms: a focus-group study of patients' experiences.

Science.gov (United States)

Aamland, Aase; Werner, Erik L; Malterud, Kirsti

2013-06-01

Medically unexplained physical symptoms (MUPS) form a major cause of sickness absence. The purpose of this study was to explore factors which may influence further marginalization among patients with MUPS on long-term sickness absence. Two focus-group discussions were conducted with a purposive sample of 12 participants, six men and six women, aged 24-59 years. Their average duration of sickness absence was 10.5 months. Participants were invited to share stories about experiences from the process leading to the ongoing sickness absence, with a focus on the causes being medically unexplained. Systematic text condensation was applied for analysis. Inspired by theories of marginalization and coping, the authors searched for knowledge of how patients' positive resources can be mobilized to counteract processes of marginality. Analysis revealed how invisible symptoms and lack of objective findings were perceived as an additional burden to the sickness absence itself. Factors that could counteract further marginalization were a supportive social network, positive coping strategies such as keeping to the daily schedule and physical activity, and positive attention and confidence from professionals. Confidence from both personal and professional contacts is crucial. GPs have an important and appreciated role in this aspect.

75 FR 55578 - Farm, Ranch, and Rural Communities Committee

Science.gov (United States)

2010-09-13

... basis. FOR FURTHER INFORMATION CONTACT: Alicia Kaiser, Designated Federal Officer, kaiser.alicia@epa.gov... statements to the FRRCC should be sent to Alicia Kaiser, Designated Federal Officer, at the contact... information on access or services for individuals with disabilities, please contact Alicia Kaiser at 202-564...

Epstein-Barr virus, cytomegalovirus, and multiple sclerosis susceptibility: A multiethnic study.

Science.gov (United States)

Langer-Gould, Annette; Wu, Jun; Lucas, Robyn; Smith, Jessica; Gonzales, Edlin; Amezcua, Lilyana; Haraszti, Samantha; Chen, Lie Hong; Quach, Hong; James, Judith A; Barcellos, Lisa F; Xiang, Anny H

2017-09-26

To determine whether Epstein-Barr virus (EBV) or cytomegalovirus (CMV) seropositivity is associated with multiple sclerosis (MS) in blacks and Hispanics and to what extent measures of the hygiene hypothesis or breastfeeding could explain these findings. EBV and CMV have been associated with MS risk in whites, and the timing and frequency of both viruses vary by factors implicated in the hygiene hypothesis. Incident cases of MS or its precursor, clinically isolated syndrome (CIS), and matched controls (blacks, 111 cases/128 controls; Hispanics, 173/187; whites, 235/256) were recruited from the membership of Kaiser Permanente Southern California. Logistic regression models accounted for HLA-DRB1*1501 status, smoking, socioeconomic status, age, sex, genetic ancestry, and country of birth. Epstein-Barr nuclear antigen-1 (EBNA-1) seropositivity was independently associated with an increased odds of MS/CIS in all 3 racial/ethnic groups ( p < 0.001 for blacks and whites, p = 0.02 for Hispanics). In contrast, CMV seropositivity was associated with a lower risk of MS/CIS in Hispanics ( p = 0.004) but not in blacks ( p = 0.95) or whites ( p = 0.96). Being born in a low/middle-income country was associated with a lower risk of MS in Hispanics ( p = 0.02) but not after accounting for EBNA-1 seropositivity. Accounting for breastfeeding did not diminish the association between CMV and MS in Hispanics. The consistency of EBNA-1 seropositivity with MS across racial/ethnic groups and between studies points to a strong biological link between EBV infection and MS risk. The association between past CMV infection and MS risk supports the broader hygiene hypothesis, but the inconsistency of this association across racial/ethnic groups implies noncausal associations. © 2017 American Academy of Neurology.

A novel telemonitoring device for improving diabetes control: protocol and results from a randomized clinical trial.

Science.gov (United States)

Pressman, Alice R; Kinoshita, Linda; Kirk, Susan; Barbosa, Gina Monraz; Chou, Cathy; Minkoff, Jerome

2014-02-01

Telemedicine is one approach to managing patients with chronic illness. Several telephone-based monitoring studies of diabetes patients have shown improved glycosylated hemoglobin (HbA1c), blood pressure (BP), and low-density lipoprotein (LDL) levels. The purpose of this study was to evaluate an investigational in-home telemetry device for improving glucose and BP control over 6 months for patients with type 2 diabetes. The device was used to transmit weekly blood glucose, weight, and BP readings to a diabetes care manager. We conducted a two-arm, parallel-comparison, single-blind, randomized controlled trial among Kaiser Permanente Northern California members 18-75 years old with type 2 diabetes mellitus and entry HbA1c levels between 7.5% and 10.0%. Participants were randomly assigned to either the telemonitoring arm or the usual care arm. We observed very small, nonsignificant changes in fructosamine (telemonitoring, -54.9 μmol; usual care, -59.4 μmol) and systolic BP (telemonitoring, -6.3 mm Hg; usual care, -3.2 mm Hg) from baseline to 6 weeks in both groups. At 6 months, we observed no significant intergroup differences in change from baseline for HbA1c, fructosamine, or self-efficacy. However, LDL cholesterol in the telemonitoring arm decreased more than in the usual care arm (-17.1 mg/dL versus -5.4 mg/dL; P=0.045). Although HbA1c improved significantly over 6 months in both groups, the difference in improvement between the groups was not significant. This lack of significance may be due to the relatively healthy status of the volunteers in our study and to the high level of care provided by the care managers in the Santa Rosa, CA clinic. Further study in subgroups of less healthy diabetes patients is recommended.

Design thinking.

Science.gov (United States)

Brown, Tim

2008-06-01

In the past, design has most often occurred fairly far downstream in the development process and has focused on making new products aesthetically attractive or enhancing brand perception through smart, evocative advertising. Today, as innovation's terrain expands to encompass human-centered processes and services as well as products, companies are asking designers to create ideas rather than to simply dress them up. Brown, the CEO and president of the innovation and design firm IDEO, is a leading proponent of design thinking--a method of meeting people's needs and desires in a technologically feasible and strategically viable way. In this article he offers several intriguing examples of the discipline at work. One involves a collaboration between frontline employees from health care provider Kaiser Permanente and Brown's firm to reengineer nursing-staff shift changes at four Kaiser hospitals. Close observation of actual shift changes, combined with brainstorming and rapid prototyping, produced new procedures and software that radically streamlined information exchange between shifts. The result was more time for nursing, better-informed patient care, and a happier nursing staff. Another involves the Japanese bicycle components manufacturer Shimano, which worked with IDEO to learn why 90% of American adults don't ride bikes. The interdisciplinary project team discovered that intimidating retail experiences, the complexity and cost of sophisticated bikes, and the danger of cycling on heavily trafficked roads had overshadowed people's happy memories of childhood biking. So the team created a brand concept--"Coasting"--to describe a whole new category of biking and developed new in-store retailing strategies, a public relations campaign to identify safe places to cycle, and a reference design to inspire designers at the companies that went on to manufacture Coasting bikes.

Validation of a Malay Version of the Smartphone Addiction Scale among Medical Students in Malaysia.

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Siew Mooi Ching

Full Text Available This study was initiated to determine the psychometric properties of the Smart Phone Addiction Scale (SAS by translating and validating this scale into the Malay language (SAS-M, which is the main language spoken in Malaysia. This study can distinguish smart phone and internet addiction among multi-ethnic Malaysian medical students. In addition, the reliability and validity of the SAS was also demonstrated.A total of 228 participants were selected between August 2014 and September 2014 to complete a set of questionnaires, including the SAS and the modified Kimberly Young Internet addiction test (IAT in the Malay language.There were 99 males and 129 females with ages ranging from 19 to 22 years old (21.7±1.1 included in this study. Descriptive and factor analyses, intra-class coefficients, t-tests and correlation analyses were conducted to verify the reliability and validity of the SAS. Bartlett's test of sphericity was significant (p <0.01, and the Kaiser-Mayer-Olkin measure of sampling adequacy for the SAS-M was 0.92, indicating meritoriously that the factor analysis was appropriate. The internal consistency and concurrent validity of the SAS-M were verified (Cronbach's alpha = 0.94. All of the subscales of the SAS-M, except for positive anticipation, were significantly related to the Malay version of the IAT.This study developed the first smart phone addiction scale among medical students. This scale was shown to be reliable and valid in the Malay language.

A study to enhance medical students’ professional decision-making, using teaching interventions on common medications

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Jane Wilcock

2015-06-01