Magnetic resonance image examinations in emergency medical care

International Nuclear Information System (INIS)

Yamashiro, Takanobu; Yoshizumi, Tohru; Ogura, Akio; Hongou, Takaharu; Kikumoto, Rikiya

2006-01-01

There is a growing consensus in terms of the need for effective use of magnetic resonance imaging (MRI) diagnostic devices in emergency medical care. However, a thorough assessment of risk management in emergency medical care is required because of the high magnetic field in the MRI room. To understand the conditions required for the execution of emergency MRI examinations in individual medical facilities, and to prepare guidelines for emergency MRI examinations, we carried out a questionnaire survey concerning emergency MRI examinations. We obtained responses from 71% of 230 medical facilities and used this information in considering a system of emergency MRI examinations. Moreover, some difficulties were experienced in half of the facilities where emergency MRI examinations had been enacted, the main cause of which was the medics. Based on the results of the questionnaire, guidelines are necessary to maintain an urgent system for MRI examinations. Moreover, we were able to comprehend the current state of emergency MRI examinations in other medical facilities through this investigation, and we are preparing a system for the implementation of emergency MRI examinations. (author)

Administrators' perspectives on end-of-life care for cancer patients in Japanese long-term care facilities.

Science.gov (United States)

Fukahori, Hiroki; Miyashita, Mitsunori; Morita, Tatsuya; Ichikawa, Takayuki; Akizuki, Nobuya; Akiyama, Miki; Shirahige, Yutaka; Eguchi, Kenji

2009-10-01

The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

Quality use of medicines in aged-care facilities in Australia.

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Roughead, Elizabeth E; Semple, Susan J; Gilbert, Andrew L

2003-01-01

Medication-related problems are most commonly reported in elderly patients. It is for this reason that the development of services supporting appropriate medication management in the elderly is paramount; particularly for those living in residential care facilities. In 1991, Australia had very limited services supporting the quality use of medicines for residents of aged-care facilities. Over 11 years, from 1991-2002, the range of services has expanded considerably. Federally funded medication review services are now available, with over 80% of residents provided with the service. Medication advisory committees, in accordance with national practice guidelines, have been established in many facilities to address issues concerning medication management. Fifty percent of Australian's pharmacies are registered to provide services, with over 10% of the country's pharmacists accredited to provide the service. National practice guidelines for medication management in aged-care facilities have been incorporated into accreditation standards for aged-care facilities, further integrating activity into the wider health system. The environment was created for these activities through the formation of the Pharmaceutical Health and Rational Use of Medicines (PHARM) Committee, an expert advisory committee, and the Australian Pharmaceutical Advisory Council (APAC), a representative council. Both groups had responsibility for advising the Federal Minister of Health. They both identified medication misadventure in residential aged care as a priority issue and through their recommendations the Government devoted funds to the development of best practice guidelines and research activity. Clinical pharmacy services in nursing-home and hostel settings were found to reduce the use of benzodiazepines, laxatives, NSAIDs and antacids leading to cost savings to the health system. Dose-administration aids were found to reduce error rates during medication administration, and the alteration of

38 CFR 17.65 - Approvals and provisional approvals of community residential care facilities.

Science.gov (United States)

2010-07-01

... approvals of community residential care facilities. 17.65 Section 17.65 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Community Residential Care § 17.65 Approvals and provisional approvals of community residential care facilities. (a) An approval of a facility meeting all of...

Purchased Behavioral Health Care Received by Military Health System Beneficiaries in Civilian Medical Facilities, 2000-2014.

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Wooten, Nikki R; Brittingham, Jordan A; Pitner, Ronald O; Tavakoli, Abbas S; Jeffery, Diana D; Haddock, K Sue

2018-02-06

Behavioral health conditions are a significant concern for the U.S. military and the Military Health System (MHS) because of decreased military readiness and increased health care utilization. Although MHS beneficiaries receive direct care in military treatment facilities, a disproportionate majority of behavioral health treatment is purchased care received in civilian facilities. Yet, limited evidence exists about purchased behavioral health care received by MHS beneficiaries. This longitudinal study (1) estimated the prevalence of purchased behavioral health care and (2) identified patient and visit characteristics predicting receipt of purchased behavioral health care in acute care facilities from 2000 to 2014. Medical claims with Major Diagnostic Code 19 (mental disorders/diseases) or 20 (alcohol/drug disorders) as primary diagnoses and TRICARE as the primary/secondary payer were analyzed for MHS beneficiaries (n = 17,943) receiving behavioral health care in civilian acute care facilities from January 1, 2000, to December 31, 2014. The primary dependent variable, receipt of purchased behavioral health care, was modeled for select mental health and substance use disorders from 2000 to 2014 using generalized estimating equations. Patient characteristics included time, age, sex, and race/ethnicity. Visit types included inpatient hospitalization and emergency department (ED). Time was measured in days and visits were assumed to be correlated over time. Behavioral health care was described by both frequency of patients and visit type. The University of South Carolina Institutional Review Board approved this study. From 2000 to 2014, purchased care visits increased significantly for post-traumatic stress disorder, adjustment, anxiety, mood, bipolar, tobacco use, opioid/combination opioid dependence, nondependent cocaine abuse, psychosocial problems, and suicidal ideation among MHS beneficiaries. The majority of care was received for mental health disorders (78

Primary medical care in Irish prisons.

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Barry, Joe M; Darker, Catherine D; Thomas, David E; Allwright, Shane P A; O'Dowd, Tom

2010-03-22

An industrial dispute between prison doctors and the Irish Prison Service (IPS) took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University Department of Primary Care. The review took place in 2008 and we report here on the principal findings of that review. This study utilised a mixed methods approach. An independent expert medical evaluator (one of the authors, DT) inspected the medical facilities, equipment and relevant custodial areas in eleven of the fourteen prisons within the IPS. Semistructured interviews took place with personnel who had operational responsibility for delivery of prison medical care. Prison doctors completed a questionnaire to elicit issues such as allocation of clinician's time, nurse and administrative support and resources available. There was wide variation in the standard of medical facilities and infrastructure provided across the IPS. The range of medical equipment available was generally below that of the equivalent general practice scheme in the community. There is inequality within the system with regard to the ratio of doctor-contracted time relative to the size of the prison population. There is limited administrative support, with the majority of prisons not having a medical secretary. There are few psychiatric or counselling sessions available. People in prison have a wide range of medical care needs and there is evidence to suggest that these needs are being met inconsistently in Irish prisons.

32 CFR 564.40 - Procedures for obtaining medical care.

Science.gov (United States)

2010-07-01

... care. (a) When a member of the ARNG incurs a disease or an injury, while performing training duty under... 32 National Defense 3 2010-07-01 2010-07-01 true Procedures for obtaining medical care. 564.40... benefits. (b) Authorization for care in civilian facility. (1) An individual who desires medical or dental...

Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

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Tariq Amina

2012-11-01

Full Text Available Abstract Background Medication incident reporting (MIR is a key safety critical care process in residential aged care facilities (RACFs. Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a design MIR artefacts that facilitate identification of the root causes of medication incidents, b integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.

Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety

Science.gov (United States)

2012-01-01

Background Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. Methods The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. Results The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. Conclusions This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes. PMID:23122411

Patient-driven resource planning of a health care facility evacuation.

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Petinaux, Bruno; Yadav, Kabir

2013-04-01

The evacuation of a health care facility is a complex undertaking, especially if done in an immediate fashion, ie, within minutes. Patient factors, such as continuous medical care needs, mobility, and comprehension, will affect the efficiency of the evacuation and translate into evacuation resource needs. Prior evacuation resource estimates are 30 years old. Utilizing a cross-sectional survey of charge nurses of the clinical units in an urban, academic, adult trauma health care facility (HCF), the evacuation needs of hospitalized patients were assessed periodically over a two-year period. Survey data were collected on 2,050 patients. Units with patients having low continuous medical care needs during an emergency evacuation were the postpartum, psychiatry, rehabilitation medicine, surgical, and preoperative anesthesia care units, the Emergency Department, and Labor and Delivery Department (with the exception of patients in Stage II labor). Units with patients having high continuous medical care needs during an evacuation included the neonatal and adult intensive care units, special procedures unit, and operating and post-anesthesia care units. With the exception of the neonate group, 908 (47%) of the patients would be able to walk out of the facility, 492 (25.5%) would require a wheelchair, and 530 (27.5%) would require a stretcher to exit the HCF. A total of 1,639 patients (84.9%) were deemed able to comprehend the need to evacuate and to follow directions; the remainder were sedated, blind, or deaf. The charge nurses also determined that 17 (6.9%) of the 248 adult intensive care unit patients were too ill to survive an evacuation, and that in 10 (16.4%) of the 61 ongoing surgery cases, stopping the case was not considered to be safe. Heath care facilities can utilize the results of this study to model their anticipated resource requirements for an emergency evacuation. This will permit the Incident Management Team to mobilize the necessary resources both within

Medical facility statistics in Japan.

Science.gov (United States)

Hamajima, Nobuyuki; Sugimoto, Takuya; Hasebe, Ryo; Myat Cho, Su; Khaing, Moe; Kariya, Tetsuyoshi; Mon Saw, Yu; Yamamoto, Eiko

2017-11-01

Medical facility statistics provide essential information to policymakers, administrators, academics, and practitioners in the field of health services. In Japan, the Health Statistics Office of the Director-General for Statistics and Information Policy at the Ministry of Health, Labour and Welfare is generating these statistics. Although the statistics are widely available in both Japanese and English, the methodology described in the technical reports are primarily in Japanese, and are not fully described in English. This article aimed to describe these processes for readers in the English-speaking world. The Health Statistics Office routinely conduct two surveys called the Hospital Report and the Survey of Medical Institutions. The subjects of the former are all the hospitals and clinics with long-term care beds in Japan. It comprises a Patient Questionnaire focusing on the numbers of inpatients, admissions, discharges, and outpatients in one month, and an Employee Questionnaire, which asks about the number of employees as of October 1. The Survey of Medical Institutions consists of the Dynamic Survey, which focuses on the opening and closing of facilities every month, and the Static Survey, which focuses on staff, facilities, and services as of October 1, as well as the number of inpatients as of September 30 and the total number of outpatients during September. All hospitals, clinics, and dental clinics are requested to submit the Static Survey questionnaire every three years. These surveys are useful tools for collecting essential information, as well as providing occasions to implicitly inform facilities of the movements of government policy.

Primary medical care in Irish prisons

Directory of Open Access Journals (Sweden)

Allwright Shane PA

2010-03-01

Full Text Available Abstract Background An industrial dispute between prison doctors and the Irish Prison Service (IPS took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University Department of Primary Care. The review took place in 2008 and we report here on the principal findings of that review. Methods This study utilised a mixed methods approach. An independent expert medical evaluator (one of the authors, DT inspected the medical facilities, equipment and relevant custodial areas in eleven of the fourteen prisons within the IPS. Semistructured interviews took place with personnel who had operational responsibility for delivery of prison medical care. Prison doctors completed a questionnaire to elicit issues such as allocation of clinician's time, nurse and administrative support and resources available. Results There was wide variation in the standard of medical facilities and infrastructure provided across the IPS. The range of medical equipment available was generally below that of the equivalent general practice scheme in the community. There is inequality within the system with regard to the ratio of doctor-contracted time relative to the size of the prison population. There is limited administrative support, with the majority of prisons not having a medical secretary. There are few psychiatric or counselling sessions available. Conclusions People in prison have a wide range of medical care needs and there is evidence to suggest that these needs are being met inconsistently in Irish prisons.

Current trends in use of intracanal medications in dental care facilities: questionnaire-based survey on training dental hygienists at educational institutions.

Science.gov (United States)

Furusawa, Masahiro; Yoshida, Takashi; Hosokawa, Souhei; Ariizumi, Yuugo

2013-01-01

The success of root canal therapy is dependent not only on removal of infected pulp (pulpectomy) followed by root canal enlargement, but also on the pharmacological effects of intracanal medications. Various intracanal medications are used. Formaldehyde preparations such as formocresol were common in the past, but these are no longer used in Europe or the US due to the biological toxicity of formaldehyde. In this study, a questionnaire was used to determine current trends in the use of intracanal medications at dental care facilities where dental hygiene students undergo practical training. The questionnaire comprised questions regarding the types of frequently used intracanal medications and their methods of application at dental care facilities in Saitama and Shizuoka prefectures. The results indicated that calcium hydroxide preparations were more commonly used in Europe or the US. However, these results also revealed that formaldehyde preparations were frequently used, which slightly differs from the scenario in Europe and the US. This study revealed that multiple intracanal medications were used for root canal therapy. Furthermore, it was also observed that cotton plugs were generally used as applicator tips for intracanal medications, whereas the use of absorbent paper points was relatively uncommon. The results suggest that the cost of absorbent paper points needs to be reduced.

Supply-side barriers to maternity-care in India: a facility-based analysis.

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Santosh Kumar

Full Text Available BACKGROUND: Health facilities in many low- and middle-income countries face several types of barriers in delivering quality health services. Availability of resources at the facility may significantly affect the volume and quality of services provided. This study investigates the effect of supply-side determinants of maternity-care provision in India. METHODS: Health facility data from the District-Level Household Survey collected in 2007-2008 were analyzed to explore the effects of supply-side factors on the volume of delivery care provided at Indian health facilities. A negative binomial regression model was applied to the data due to the count and over-dispersion property of the outcome variable (number of deliveries performed at the facility. RESULTS: Availability of a labor room (Incidence Rate Ratio [IRR]: 1.81; 95% Confidence Interval [CI]: 1.68-1.95 and facility opening hours (IRR: 1.43; CI: 1.35-1.51 were the most significant predictors of the volume of delivery care at the health facilities. Medical and paramedical staff were found to be positively associated with institutional deliveries. The volume of deliveries was also higher if adequate beds, essential obstetric drugs, medical equipment, electricity, and communication infrastructures were available at the facility. Findings were robust to the inclusion of facility's catchment area population and district-level education, health insurance coverage, religion, wealth, and fertility. Separate analyses were performed for facilities with and without a labor room and results were qualitatively similar across these two types of facilities. CONCLUSIONS: Our study highlights the importance of supply-side barriers to maternity-care India. To meet Millennium Development Goals 4 and 5, policymakers should make additional investments in improving the availability of medical drugs and equipment at primary health centers (PHCs in India.

Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: A targeted needs assessment using the Intervention Mapping framework.

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Kerstenetzky, Luiza; Birschbach, Matthew J; Beach, Katherine F; Hager, David R; Kennelty, Korey A

2018-02-01

Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy. We report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to SNF and LTC pharmacy staff. Applying the Intervention Mapping (IM) framework, a targeted needs assessment was performed using quantitative and qualitative methods. Using the hospital discharge medication list as reference, medication discrepancies in the SNF and LTC pharmacy lists were identified. SNF and LTC pharmacy staffs were also interviewed regarding the continuity of medication information post-discharge from the hospital. At least one medication discrepancy was discovered in 77.6% (n = 45/58) of SNF and 76.0% (n = 19/25) of LTC pharmacy medication lists. A total of 191 medication discrepancies were identified across all SNF and LTC pharmacy records. Of the 69 SNF staff interviewed, 20.3% (n = 14) reported patient care delays due to omitted documents during the hospital-to-SNF transition. During interviews, communication between the SNF/LTC pharmacy and the discharging hospital was described by facility staff as unidirectional with little opportunity for feedback on patient care concerns. The targeted needs assessment guided by the IM framework has lent to several planned process improvements initiatives to help reduce medication discrepancies during the hospital-to-SNF transition as well as improve communication between healthcare entities. Opening lines of

Using Tools of Strategic Management in Medical Facilities of Lublin Region

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Jaworzynska Magdalena

2017-06-01

Full Text Available The purpose of this article is to evaluate the use of tools of strategic management in hospitals in Lublin region. The study was conducted among 14 medical entities from the area of Lublin Voivodeship. The survey was addressed to economic directors or chief accountants of health care facilities and sent by post. The questionnaire was also helpful in conducting an in-depth interview as it provided a required structure. As part of the interviews with managers of health care facilities, information beyond the questionnaire was acquired, e.g. about the mission. According to studies, most health care facilities develop strategic plans (71.4%. For 21.4% of the studied facilities, the strategic plan is known mainly to management. In contrast, 28.6% of entities do not have a strategic plan. The presented results of the research can increase the effectiveness of activities in each area of the health care facility, continuous process improvement and rapid response to changes in the environment.

Medication errors in residential aged care facilities: a distributed cognition analysis of the information exchange process.

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Tariq, Amina; Georgiou, Andrew; Westbrook, Johanna

2013-05-01

Medication safety is a pressing concern for residential aged care facilities (RACFs). Retrospective studies in RACF settings identify inadequate communication between RACFs, doctors, hospitals and community pharmacies as the major cause of medication errors. Existing literature offers limited insight about the gaps in the existing information exchange process that may lead to medication errors. The aim of this research was to explicate the cognitive distribution that underlies RACF medication ordering and delivery to identify gaps in medication-related information exchange which lead to medication errors in RACFs. The study was undertaken in three RACFs in Sydney, Australia. Data were generated through ethnographic field work over a period of five months (May-September 2011). Triangulated analysis of data primarily focused on examining the transformation and exchange of information between different media across the process. The findings of this study highlight the extensive scope and intense nature of information exchange in RACF medication ordering and delivery. Rather than attributing error to individual care providers, the explication of distributed cognition processes enabled the identification of gaps in three information exchange dimensions which potentially contribute to the occurrence of medication errors namely: (1) design of medication charts which complicates order processing and record keeping (2) lack of coordination mechanisms between participants which results in misalignment of local practices (3) reliance on restricted communication bandwidth channels mainly telephone and fax which complicates the information processing requirements. The study demonstrates how the identification of these gaps enhances understanding of medication errors in RACFs. Application of the theoretical lens of distributed cognition can assist in enhancing our understanding of medication errors in RACFs through identification of gaps in information exchange. Understanding

The ecology of medical care in Beijing.

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Shuang Shao

Full Text Available BACKGROUND: We presented the pattern of health care consumption, and the utilization of available resources by describing the ecology of medical care in Beijing on a monthly basis and by describing the socio-demographic characteristics associated with receipt care in different settings. METHODS: A cohort of 6,592 adults, 15 years of age and older were sampled to estimate the number of urban-resident adults per 1,000 who visited a medical facility at least once in a month, by the method of three-stage stratified and cluster random sampling. Separate logistic regression analyses assessed the association between those receiving care in different types of setting and their socio-demographic characteristics. RESULTS: On average per 1,000 adults, 295 had at least one symptom, 217 considered seeking medical care, 173 consulted a physician, 129 visited western medical practitioners, 127 visited a hospital-based outpatient clinic, 78 visited traditional Chinese medical practitioners, 43 visited a primary care physician, 35 received care in an emergency department, 15 were hospitalized. Health care seeking behaviors varied with socio-demographic characteristics, such as gender, age, ethnicity, resident census register, marital status, education, income, and health insurance status. In term of primary care, the gate-keeping and referral roles of Community Health Centers have not yet been fully established in Beijing. CONCLUSIONS: This study represents a first attempt to map the medical care ecology of Beijing urban population and provides timely baseline information for health care reform in China.

Guidelines for Management Information Systems in Canadian Health Care Facilities

Science.gov (United States)

Thompson, Larry E.

1987-01-01

The MIS Guidelines are a comprehensive set of standards for health care facilities for the recording of staffing, financial, workload, patient care and other management information. The Guidelines enable health care facilities to develop management information systems which identify resources, costs and products to more effectively forecast and control costs and utilize resources to their maximum potential as well as provide improved comparability of operations. The MIS Guidelines were produced by the Management Information Systems (MIS) Project, a cooperative effort of the federal and provincial governments, provincial hospital/health associations, under the authority of the Canadian Federal/Provincial Advisory Committee on Institutional and Medical Services. The Guidelines are currently being implemented on a “test” basis in ten health care facilities across Canada and portions integrated in government reporting as finalized.

Is psychotropic medication use related to organisational and treatment culture in residential care.

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Peri, Kathryn; Kerse, Ngaire; Moyes, Simon; Scahill, Shane; Chen, Charlotte; Hong, Jae Beom; Hughes, Carmel M

2015-01-01

The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care. Cross-sectional analyses of staff and resident's record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers). In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants' assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98). Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture

Antenatal care visits' absenteeism at a secondary care medical facility in Southwest Nigeria.

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Oloko, Olakunle; Ogunbode, Olayinka Oladunjoye; Roberts, Olumuyiwa; Arowojolu, Ayodele Olatunji

2016-11-01

Antenatal care (ANC) is a specialised pattern of care organised for pregnant women with the goal of maintaining good health and promoting safe delivery of healthy infants. It is an indispensable part of effective maternity care services. This study identified the factors responsible for absenteeism from ANC follow-up visits. It was a hospital-based prospective cross-sectional descriptive study conducted at a faith based secondary healthcare facility in Ibadan, Nigeria. Relevant data were retrieved using interviewer-administered structured questionnaires and antenatal health record cards. The major reasons identified for absenteeism were delay in receiving hospital services due to long queues at service points and understaffing. The pregnant women aged 35 years and above were the most likely to miss the visits. Therefore, there is the need for hospital administrators and health care givers to make the services patient-friendly.

[Marketing in the system of military-medical facilities].

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Kostiuchenko, O M; Sviridova, T B

2014-02-01

Military medical facilities of the Ministry of Defence of the Russian, have received the right to provide additional services and have been involved in the sphere of market relations. The strong influence of market relations - an objective reality that must be used for the development of military medical institutions and improving quality of care.Effective commercial activity can improve capabilities of the military medical institutions. This requires constant study of market mechanisms to implement and develop their competitive advantage. The paper substantiates the need for the participation of military medical institutions in the provision of health services to the public on the terms of compensation incurred by financial institutions costs (paid medical services, medical assistance program of compulsory and voluntary health insurance). Taking into account the specifics of military medical institutions set out basic principles and recommendations have been implementing marketing approach in their management, the practical application of which will not only increase efficiency, but also create conditions to improve the financial and economic indicators. This knowledge will help the mechanism of functioning health care market and the rules of interaction of market counterparties.

Nursing Information Flow in Long-Term Care Facilities.

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Wei, Quan; Courtney, Karen L

2018-04-01

 Long-term care (LTC), residential care requiring 24-hour nursing services, plays an important role in the health care service delivery system. The purpose of this study was to identify the needed clinical information and information flow to support LTC Registered Nurses (RNs) in care collaboration and clinical decision making.  This descriptive qualitative study combines direct observations and semistructured interviews, conducted at Alberta's LTC facilities between May 2014 and August 2015. The constant comparative method (CCM) of joint coding was used for data analysis.  Nine RNs from six LTC facilities participated in the study. The RN practice environment includes two essential RN information management aspects: information resources and information spaces. Ten commonly used information resources by RNs included: (1) RN-personal notes; (2) facility-specific templates/forms; (3) nursing processes/tasks; (4) paper-based resident profile; (5) daily care plans; (6) RN-notebooks; (7) medication administration records (MARs); (8) reporting software application (RAI-MDS); (9) people (care providers); and (10) references (i.e., books). Nurses used a combination of shared information spaces, such as the Nurses Station or RN-notebook, and personal information spaces, such as personal notebooks or "sticky" notes. Four essential RN information management functions were identified: collection, classification, storage, and distribution. Six sets of information were necessary to perform RN care tasks and communication, including: (1) admission, discharge, and transfer (ADT); (2) assessment; (3) care plan; (4) intervention (with two subsets: medication and care procedure); (5) report; and (6) reference. Based on the RN information management system requirements, a graphic information flow model was constructed.  This baseline study identified key components of a current LTC nursing information management system. The information flow model may assist health information

Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

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Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

2014-01-01

Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

Infection prevention and control in deployed military medical treatment facilities.

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Hospenthal, Duane R; Green, Andrew D; Crouch, Helen K; English, Judith F; Pool, Jane; Yun, Heather C; Murray, Clinton K

2011-08-01

Infections have complicated the care of combat casualties throughout history and were at one time considered part of the natural history of combat trauma. Personnel who survived to reach medical care were expected to develop and possibly succumb to infections during their care in military hospitals. Initial care of war wounds continues to focus on rapid surgical care with debridement and irrigation, aimed at preventing local infection and sepsis with bacteria from the environment (e.g., clostridial gangrene) or the casualty's own flora. Over the past 150 years, with the revelation that pathogens can be spread from patient to patient and from healthcare providers to patients (including via unwashed hands of healthcare workers, the hospital environment and fomites), a focus on infection prevention and control aimed at decreasing transmission of pathogens and prevention of these infections has developed. Infections associated with combat-related injuries in the recent operations in Iraq and Afghanistan have predominantly been secondary to multidrug-resistant pathogens, likely acquired within the military healthcare system. These healthcare-associated infections seem to originate throughout the system, from deployed medical treatment facilities through the chain of care outside of the combat zone. Emphasis on infection prevention and control, including hand hygiene, isolation, cohorting, and antibiotic control measures, in deployed medical treatment facilities is essential to reducing these healthcare-associated infections. This review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.

[Anesthesia practice in Catalan hospitals and other health care facilities].

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Villalonga, Antonio; Sabaté, Sergi; Campos, Juan Manuel; Fornaguera, Joan; Hernández, Carmen; Sistac, José María

2006-05-24

The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident

Evaluation of Antidiabetic Prescriptions from Medical Reimbursement Applications at Banaras Hindu University Health Care Facility

Directory of Open Access Journals (Sweden)

Dev Priya

2015-10-01

Full Text Available Background: Diabetes is on rapid increase in third world countries undergoing rapid transition in terms of development particularly in India, which is often being referred as Diabetic capital. It is a disease more prevalent at latter part of life of human beings when finances dwindle and social care gets neglected. The medication continues till the whole life on a regular basis. In present study, the objective has been to provide pharmacoeconomic medication to the diabetic pensioners in the backdrop as mentioned in above background.Methods: The data was collected at the medical reimbursement section of pensioners of the University. The data was examined to answer issues of therapeutic decisions in the light of the pharmacoeconomic considerations. In this paper essentially data on choice of prescriptions with the angle of pharmacoeconomic prudence were included. The dichotomy of specialist versus non specialist prescribers at the tertiary center (i.e. medical college hospital was compared. Effort was made to define merit of the prescription based on comprehensive considerations of patient profile, disease profile and therapeutic choice.Results: Total 72 prescriptions were analyzed for the study in which 475 drugs were prescribed to the patients.  Total antidiabetic drugs prescribed to the patients were 169. Out of 72 cases 39 were males and 33 were females with mean age 66.04 ± 5.80 (Mean ± SEM. The average number of drugs per prescription was 6.59 which was very high as per guidelines. Most commonly prescribed antidiabetic drug was Metformin (63.89% followed by Glimepiride (31.95%.Conclusion: This study reflects that there is need to make available the standard therapeutic optionat University Health Care Facility based upon pharmacoeconomic considerations.

Exploring Factors Affecting Emergency Medical Services Staffs’ Decision about Transporting Medical Patients to Medical Facilities

Directory of Open Access Journals (Sweden)

Abbasali Ebrahimian

2014-01-01

Full Text Available Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS staffs. So this study was performed to explore affecting factors in EMS staffs’ decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: “degree of perceived risk in EMS staffs and their patients.” This theme consisted of two main categories: (1 patient’s condition’ and (2 the context of the EMS mission’. The patent’s condition category emerged from “physical health statuses,” “socioeconomic statuses,” and “cultural background” subcategories. The context of the EMS mission also emerged from two subcategories of “characteristics of the mission” and EMS staffs characteristics’. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients’ needs for transportation in a prehospital situation.

Medication Administration Errors in an Adult Emergency Department of a Tertiary Health Care Facility in Ghana.

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Acheampong, Franklin; Tetteh, Ashalley Raymond; Anto, Berko Panyin

2016-12-01

This study determined the incidence, types, clinical significance, and potential causes of medication administration errors (MAEs) at the emergency department (ED) of a tertiary health care facility in Ghana. This study used a cross-sectional nonparticipant observational technique. Study participants (nurses) were observed preparing and administering medication at the ED of a 2000-bed tertiary care hospital in Accra, Ghana. The observations were then compared with patients' medication charts, and identified errors were clarified with staff for possible causes. Of the 1332 observations made, involving 338 patients and 49 nurses, 362 had errors, representing 27.2%. However, the error rate excluding "lack of drug availability" fell to 12.8%. Without wrong time error, the error rate was 22.8%. The 2 most frequent error types were omission (n = 281, 77.6%) and wrong time (n = 58, 16%) errors. Omission error was mainly due to unavailability of medicine, 48.9% (n = 177). Although only one of the errors was potentially fatal, 26.7% were definitely clinically severe. The common themes that dominated the probable causes of MAEs were unavailability, staff factors, patient factors, prescription, and communication problems. This study gives credence to similar studies in different settings that MAEs occur frequently in the ED of hospitals. Most of the errors identified were not potentially fatal; however, preventive strategies need to be used to make life-saving processes such as drug administration in such specialized units error-free.

Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries.

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Talib, Zohray; van Schalkwyk, Susan; Couper, Ian; Pattanaik, Swaha; Turay, Khadija; Sagay, Atiene S; Baingana, Rhona; Baird, Sarah; Gaede, Bernhard; Iputo, Jehu; Kibore, Minnie; Manongi, Rachel; Matsika, Antony; Mogodi, Mpho; Ramucesse, Jeremais; Ross, Heather; Simuyeba, Moses; Haile-Mariam, Damen

2017-12-01

African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.

The Optimizing Patient Transfers, Impacting Medical Quality, andImproving Symptoms:Transforming Institutional Care approach: preliminary data from the implementation of a Centers for Medicare and Medicaid Services nursing facility demonstration project.

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Unroe, Kathleen T; Nazir, Arif; Holtz, Laura R; Maurer, Helen; Miller, Ellen; Hickman, Susan E; La Mantia, Michael A; Bennett, Merih; Arling, Greg; Sachs, Greg A

2015-01-01

The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project aims to reduce avoidable hospitalizations of long-stay residents enrolled in 19 central Indiana nursing facilities. This clinical demonstration project, funded by the Centers for Medicare and Medicaid Services Innovations Center, places a registered nurse in each nursing facility to implement an evidence-based quality improvement program with clinical support from nurse practitioners. A description of the model is presented, and early implementation experiences during the first year of the project are reported. Important elements include better medical care through implementation of Interventions to Reduce Acute Care Transfers tools and chronic care management, enhanced transitional care, and better palliative care with a focus on systematic advance care planning. There were 4,035 long-stay residents in 19 facilities enrolled in OPTIMISTIC between February 2013 and January 2014. Root-cause analyses were performed for all 910 acute transfers of these long stay residents. Of these transfers, the project RN evaluated 29% as avoidable (57% were not avoidable and 15% were missing), and opportunities for quality improvement were identified in 54% of transfers. Lessons learned in early implementation included defining new clinical roles, integrating into nursing facility culture, managing competing facility priorities, communicating with multiple stakeholders, and developing a system for collecting and managing data. The success of the overall initiative will be measured primarily according to reduction in avoidable hospitalizations of long-stay nursing facility residents. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Importance of Pharmaceutical Training and Clinical Research at Medical Facilities.

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Myotoku, Michiaki

2017-01-01

To respond to advancements in medical techniques, and to address the separation of medical and dispensary practices, clinical professors are required to educate human resource staff to become highly-skilled pharmacists. For this purpose, it is extremely important for these professors to learn about cutting-edge practical skills and knowledge, as well as to advance their expertise. In addition, they need to conduct clinical research in cooperation with relevant facilities. As our university does not have its own hospital or pharmacy, it is important to provide training for clinical professors in clinical facilities. Such training mainly involves medical teams' in-hospital rounds and participation in conferences (nutrition support team; NST), operation of the pharmacy department, and intervention targeting improvement in the department's duties. We have conducted collaborative studies, provided research instructions, implemented studies aimed at improving the department's work (pharmacists appointed on wards at all times to ensure medical safety) as well as studies regarding team medical care (nutritional evaluation during outpatient chemotherapy), and resolved issues regarding this work (drug solution mixability in a hand-held constant infusion pump, and a safe pump-filling methods). Thus, it has become possible to keep track of the current state of a pharmacists' work within team medical care, to access information about novel drugs, to view clinical and prescription-claim data, to cooperate with other professionals (e.g., doctors and nurses), to promote pharmacists' self-awareness of their roles in cooperative medical practice, and to effectively maintain the hospital's clinical settings.

Encountering aged care: a mixed methods investigation of medical students' clinical placement experiences.

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Annear, Michael J; Lea, Emma; Lo, Amanda; Tierney, Laura; Robinson, Andrew

2016-02-04

Residential aged care is an increasingly important health setting due to population ageing and the increase in age-related conditions, such as dementia. However, medical education has limited engagement with this fast-growing sector and undergraduate training remains primarily focussed on acute presentations in hospital settings. Additionally, concerns have been raised about the adequacy of dementia-related content in undergraduate medical curricula, while research has found mixed attitudes among students towards the care of older people. This study explores how medical students engage with the learning experiences accessible in clinical placements in residential aged care facilities (RACFs), particularly exposure to multiple comorbidity, cognitive impairment, and palliative care. Fifth-year medical students (N = 61) completed five-day clinical placements at two Australian aged care facilities in 2013 and 2014. The placements were supported by an iterative yet structured program and academic teaching staff to ensure appropriate educational experiences and oversight. Mixed methods data were collected before and after the clinical placement. Quantitative data included surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults. Qualitative data were collected from focus group discussions concerning medical student expectations, learning opportunities, and challenges to engagement. Pre-placement surveys identified good dementia knowledge, but poor attitudes towards aged care and older adults. Negative placement experiences were associated with a struggle to discern case complexity and a perception of an aged care placement as an opportunity cost associated with reduced hospital training time. Irrespective of negative sentiment, post-placement survey data showed significant improvements in attitudes to working with older people and dementia knowledge. Positive student experiences were explained by in

Developing a national role description for medical directors in long-term care: survey-based approach.

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Rahim-Jamal, Sherin; Quail, Patrick; Bhaloo, Tajudaullah

2010-01-01

To develop a national role description for medical directors in long-term care (LTC) based on role functions drawn from the literature and the LTC industry. A questionnaire about the role functions identified from the literature was mailed or e-mailed to randomly selected medical directors, directors of care or nursing (DOCs), and administrators in LTC facilities. Long-term care facilities in Canada randomly selected from regional clusters. Medical directors, DOCs, and administrators in LTC facilities; a national advisory group of medical directors from the Long Term Care Medical Directors Association of Canada; and a volunteer group of medical directors. Respondents were asked to indicate, from the list of identified functions, 1) whether medical directors spent any time on each activity; 2) whether medical directors should spend time on each activity; and 3) if medical directors should spend time on an activity, whether the activity was "essential" or "desirable." An overall response rate of 37% was obtained. At least 80% of the respondents from all 3 groups (medical directors, DOCs, and administrators) highlighted 24 functions they deemed to be "essential" or "desirable," which were then included in the role description. In addition, the advisory group expanded the role description to include 5 additional responsibilities from the remaining 18 functions originally identified. A volunteer group of medical directors confirmed the resulting role description. The role description developed as a result of this study brings clarity to the medical director's role in Canadian LTC facilities; the functions outlined are considered important for medical directors to undertake. The role description could be a useful tool in negotiations pertaining to time commitment and expectations of a medical director and fair compensation for services rendered.

Protecting patients. Y2K and medical facilities using radiation sources

International Nuclear Information System (INIS)

Ibbott, G.S.; Ortiz, P.; Andreo, P.

1999-01-01

For all types of medical care, the Year 2000 problem could cause an almost unlimited number of potential problems associated with particular scheduling. As a part of its assistance to Member States on Year 2000 issues, the IAEA has prepared a report 'Safety Measures to Address the Year 2000 Issue at Medical facilities which use Radiation Generators and Radioactive Materials (TECDOC-1074) for the attention of State Authorities. The mid-1999 international workshop organized by IAEA and WHO helped to promote even greater awareness of steps that should be taken to prevent the Year 2000 bug from seriously affecting the health care community

Acute care in Tanzania: Epidemiology of acute care in a small community medical centre

Directory of Open Access Journals (Sweden)

Rachel M. Little

2013-12-01

Discussion: Respiratory infections, malaria, and skin or soft tissue infections are leading reasons for seeking medical care at a small community medical centre in Arusha, Tanzania, highlighting the burden of infectious diseases in this type of facility. Males may be more likely to present with trauma, burns, and laceration injuries than females. Many patients required one or no procedures to determine their diagnosis, most treatments administered were inexpensive, and most patients were discharged home, suggesting that providing acute care in this setting could be accomplished with limited resources.

Medication Review and Transitions of Care: A Case Report of a Decade-Old Medication Error.

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Comer, Rachel; Lizer, Mitsi

2017-10-01

A 69-year-old Caucasian male with a 25-year history of paranoid schizophrenia was brought to the emergency department because of violence toward the staff in his nursing facility. He was diagnosed with a urinary tract infection and was admitted to the behavioral health unit for medication stabilization. History included a five-year state psychiatric hospital admission and nursing facility placement. Because of poor cognitive function, the patient was unable to corroborate medication history, so the pharmacy student on rotation performed an in-depth chart review. The review revealed a transcription error in 2003 deleting amantadine 100 mg twice daily and adding amiodarone 100 mg twice daily. Subsequent hospitalization resulted in another transcription error increasing the amiodarone to 200 mg twice daily. All electrocardiograms conducted were negative for atrial fibrillation. Once detected, the consulted cardiologist discontinued the amiodarone, and the primary care provider was notified via letter and discharge papers. An admission four months later revealed that the nursing facility restarted the amiodarone. Amiodarone was discontinued and the facility was again notified. This case reviews how a 10-year-old medication error went undetected in the electronic medical records through numerous medication reconciliations, but was uncovered when a single comprehensive medication review was conducted.

Traveling abroad for medical care: U.S. medical tourists' expectations and perceptions of service quality.

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Guiry, Michael; Vequist, David G

2011-01-01

The SERVQUAL scale has been widely used to measure service quality in the health care industry. This research is the first study that used SERVQUAL to assess U.S. medical tourists' expectations and perceptions of the service quality of health care facilities located outside the United States. Based on a sample of U.S. consumers, who had traveled abroad for medical care, the results indicated that there were significant differences between U.S. medical tourists' perceived level of service provided and their expectations of the service that should be provided for four of the five dimensions of service quality. Reliability had the largest service quality gap followed by assurance, tangibles, and empathy. Responsiveness was the only dimension without a significantly different gap score. The study establishes a foundation for future research on service quality in the rapidly growing medical tourism industry.

Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

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Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

2015-05-01

Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania.

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Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini

2017-07-11

There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately

Current prevention and control of health care-associated infections in long-term care facilities for the elderly in Japan.

Science.gov (United States)

Kariya, Naoko; Sakon, Naomi; Komano, Jun; Tomono, Kazunori; Iso, Hiroyasu

2018-05-01

Residents of long-term care facilities for the elderly are vulnerable to health care-associated infections. However, compared to medical institutions, long-term care facilities for the elderly lag behind in health care-associated infection control and prevention. We conducted a epidemiologic study to clarify the current status of infection control in long-term care facilities for the elderly in Japan. A questionnaire survey on the aspects of infection prevention and control was developed according to SHEA/APIC guidelines and was distributed to 617 long-term care facilities for the elderly in the province of Osaka during November 2016 and January 2017. The response rate was 16.9%. The incidence rates of health care-associated infection outbreaks and residents with health care-associated infections were 23.4 per 100 facility-years and 0.18 per 1,000 resident-days, respectively. Influenza and acute gastroenteritis were reported most frequently. Active surveillance to identify the carrier of multiple drug-resistant organisms was not common. The overall compliance with 21 items selected from the SHEA/APIC guidelines was approximately 79.2%. All facilities had infection control manuals and an assigned infection control professional. The economic burdens of infection control were approximately US$ 182.6 per resident-year during fiscal year 2015. Importantly, these data implied that physicians and nurses were actively contributed to higher SHEA/APIC guideline compliance rates and the advancement of infection control measures in long-term care facilities for the elderly. Key factors are discussed to further improve the infection control in long-term care facilities for the elderly, particularly from economic and social structural standpoints. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

The relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan.

Science.gov (United States)

Yang, Ya-Ting; Iqbal, Usman; Ko, Hua-Lin; Wu, Chia-Rong; Chiu, Hsien-Tsai; Lin, Yi-Chieh; Lin, Wender; Elsa Hsu, Yi-Hsin

2015-06-01

The purpose of this study was to explore the relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan. Cross-sectional study from 2007 Taiwan Longitudinal Study on Ageing (TLSA) survey. Community-based study. A total of 4249 middle-aged and elderly subjects were recruited. None. Outpatient visits within 1 month, and hospitalization, emergency visits as well as to shop in pharmacy stores within 1 year, respectively. Adjusting for important confounding variables, the middle-aged and elderly with National Health Insurance (NHI) and commercial insurance compared with those with NHI alone tended to have outpatient visits. The middle-aged and elderly with longer time to access healthcare facilities were less likely to shop in pharmacy stores compared with those with shop in pharmacy stores compared with those with perceived convenience. Our study of Taiwan's experience could provide a valuable lesson for countries that are planning to launch universal health insurance system, locate budgets in health care and transportation. The middle-aged and elderly who were facing more challenges in accessing health care, no matter in perceived accessibility or real time to access health care, had less outpatient visits and more drug stores shopping. Strategic policies are needed to improve accessibility in increasing patients' perception on access and escalating convenience of transportation system for improving accessibility. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

78 FR 55671 - Hospital Care and Medical Services for Camp Lejeune Veterans

Science.gov (United States)

2013-09-11

... chemicals found in the drinking water included perchloroethylene, trichloroethylene, benzene, and vinyl..., Drug abuse, Health care, Health facilities, Health professions, Health records, Homeless, Medical...

[Risk of tuberculosis infection among care workers during an outbreak of tuberculosis at a care facility for the elderly].

Science.gov (United States)

Yanagihara, Hiroki

2014-07-01

Owing to limited evidence, the risk of and factors related to tuberculosis (TB) infection among care workers is not understood. We experienced an outbreak of TB with 2 cases of active TB (positive cultures) and 34 cases of latent TB infection at a care facility for the elderly. Using an epidemiological investigation of the outbreak, this study aimed to investigate the risk of and factors related to TB infection among care workers and to establish a system for TB control in care facilities for the elderly. The index patient (80-year-old woman; fever for 1.5 months) was diagnosed with TB [bI3: GAKKAI classification, sputum smear (3+)]. We investigated the contacts of the patient. On the basis of the epidemiological investigation, we conducted a contact examination of close contacts, including those of residents and care workers at the care facility and staff at the medical facility to which the patient was referred. Reviewing this information, we compared both the results of the QuantiFERON-TB Gold (QFT-GIT) test and the degree of contact in 10 care workers and 7 nurses who had close contact while providing care services to the patient. The QFT-GIT test was conducted twice: 3 weeks and 11-12 weeks after the last contact with the patient. The number of care workers who tested positive while providing care services to the patient were 3, 0, and 5 according to the contact time of patient, while each of the nurses spent approximately 20 min for the same. Care workers provided daily care services such as feeding, changing the patient's posture, turning in bed, diaper changing, bathing, and providing a bed bath, and nurses provided services such as the measurement of vital signs, hydration, administration of medication, and exchange of cooling material for lowering body temperature. In addition, care workers had been in contact with the patient while providing care services before the patient developed fever, and nurses initiated contact with the patient for care after the

[EVALUATION OF THE EFFECTIVENESS OF ADDITIONAL PROFESSIONAL EDUCATION ON THE BASIS OF HEALTH CARE FACILITY].

Science.gov (United States)

Bohomaz, V M; Rymarenko, P V

2014-01-01

In this study we tested methods of facility learning of health care workers as part of a modern model of quality management of medical services. The statistical and qualitative analysis of the effectiveness of additional training in emergency medical care at the health facility using an adapted curriculum and special mannequins. Under the guidance of a certified instructor focus group of 53 doctors and junior medical specialists studied 22 hours. According to a survey of employees trained their level of selfassessment of knowledge and skills sigificantly increased. Also significantly increased the proportion of correct answers in a formalized testing both categories of workers. Using androgological learning model, mannequins simulators and training in small groups at work create the most favorable conditions for effective individual and group practical skills of emergency medicine.

A mobility program for an inpatient acute care medical unit.

Science.gov (United States)

Wood, Winnie; Tschannen, Dana; Trotsky, Alyssa; Grunawalt, Julie; Adams, Danyell; Chang, Robert; Kendziora, Sandra; Diccion-MacDonald, Stephanie

2014-10-01

For many patients, hospitalization brings prolonged periods of bed rest, which are associated with such adverse health outcomes as increased length of stay, increased risk of falls, functional decline, and extended-care facility placement. Most studies of progressive or early mobility protocols designed to minimize these adverse effects have been geared toward specific patient populations and conducted by multidisciplinary teams in either ICUs or surgical units. Very few mobility programs have been developed for and implemented on acute care medical units. This evidence-based quality improvement project describes how a mobility program, devised for and put to use on a general medical unit in a large Midwestern academic health care system, improved patient outcomes.

Use of Medical Orders for Scope of Treatment for Heart Failure Patients During Postacute Care in Skilled Nursing Facilities.

Science.gov (United States)

Lum, Hillary; Obafemi, Oluyomi; Dukes, Joanna; Nowels, Molly; Samon, Kristina; Boxer, Rebecca S

2017-10-01

Individuals with heart failure (HF) who are hospitalized and admitted to skilled nursing facilities (SNFs) are at high risk for rehospitalization and death. The care preferences of this high-risk population have not been studied. To describe care preferences of patients with HF admitted to SNFs for rehabilitation based on Medical Orders for Scope of Treatment (MOST) documentation, and evaluate goal-concordant care based on MOST documentation, emergency department (ED) visits, and hospitalization. Retrospective study of patients with HF in 35 SNFs enrolled in a randomized controlled trial of HF-disease management versus usual care between July 2014 and May 2016. Validity of MOST forms, care preference documentation, and ED visits/hospitalizations within 60 days of SNF admission. Of 370 patients (mean age 78.6 years, 58% women, 25% systolic HF), 278 (75%) had a MOST form in the SNF chart, of which 96 forms (35%) were invalid. The most common reason for an invalid MOST form was missing date accompanying patient or provider signature. Of 182 valid MOST forms, 47% of patients chose no cardiopulmonary resuscitation ("No CPR"), 58% selected "Full Treatment," 17% chose "Selective Treatment," and 23% chose "Comfort-Focused Treatment." Patients who were older [odds ratio (OR) = 1.50, 95% confidence interval (CI) = 1.25, 1.81] and female (OR = 2.33, 95% CI = 1.18, 4.59) had higher odds of choosing "No CPR." Sixty-six of 182 patients (36%) with valid MOST forms had an ED/hospital visit within 60 days of SNF admission; only 3 patients received medical care that was potentially discordant: all 3 chose "Comfort-Focused Treatment" and were hospitalized for more than symptom management. Seventy-five percent of patients with HF admitted to SNFs had care preferences documented using the MOST form, and 95% received goal-concordant care based on care preferences documented during the SNF admission. Clinicaltrials.gov # NCT01822912. Copyright © 2017 AMDA – The Society for

Hospital to Post-Acute Care Facility Transfers: Identifying Targets for Information Exchange Quality Improvement.

Science.gov (United States)

Jones, Christine D; Cumbler, Ethan; Honigman, Benjamin; Burke, Robert E; Boxer, Rebecca S; Levy, Cari; Coleman, Eric A; Wald, Heidi L

2017-01-01

Information exchange is critical to high-quality care transitions from hospitals to post-acute care (PAC) facilities. We conducted a survey to evaluate the completeness and timeliness of information transfer and communication between a tertiary-care academic hospital and its related PAC facilities. This was a cross-sectional Web-based 36-question survey of 110 PAC clinicians and staff representing 31 PAC facilities conducted between October and December 2013. We received responses from 71 of 110 individuals representing 29 of 31 facilities (65% and 94% response rates). We collapsed 4-point Likert responses into dichotomous variables to reflect completeness (sufficient vs insufficient) and timeliness (timely vs not timely) for information transfer and communication. Among respondents, 32% reported insufficient information about discharge medical conditions and management plan, and 83% reported at least occasionally encountering problems directly related to inadequate information from the hospital. Hospital clinician contact information was the most common insufficient domain. With respect to timeliness, 86% of respondents desired receipt of a discharge summary on or before the day of discharge, but only 58% reported receiving the summary within this time frame. Through free-text responses, several participants expressed the need for paper prescriptions for controlled pain medications to be sent with patients at the time of transfer. Staff and clinicians at PAC facilities perceive substantial deficits in content and timeliness of information exchange between the hospital and facilities. Such deficits are particularly relevant in the context of the increasing prevalence of bundled payments for care across settings as well as forthcoming readmissions penalties for PAC facilities. Targets identified for quality improvement include structuring discharge summary information to include information identified as deficient by respondents, completion of discharge summaries

Primary care practice and facility quality orientation: influence on breast and cervical cancer screening rates.

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Goldzweig, Caroline Lubick; Parkerton, Patricia H; Washington, Donna L; Lanto, Andrew B; Yano, Elizabeth M

2004-04-01

Despite the importance of early cancer detection, variation in screening rates among physicians is high. Insights into factors influencing variation can guide efforts to decrease variation and increase screening rates. To explore the association of primary care practice features and a facility's quality orientation with breast and cervical cancer screening rates. Cross-sectional study of screening rates among 144 Department of Veterans Affairs (VA) medical centers and for a national sample of women. We linked practice structure and quality improvement characteristics of individual VA medical centers from 2 national surveys (1 to primary care directors and 1 to a stratified random sample of employees) to breast and cervical cancer screening rates determined from a review of random medical records. We conducted bivariate analyses and multivariate logistic regression of primary care practice and facility features on cancer screening rates, above and below the median. While the national screening rates were high for breast (87%) and cervical cancer (90%), higher screening rates were more likely when primary care providers were consistently notified of specialty visits and when staff perceived a greater organizational commitment to quality and anticipated rewards and recognition for better performance. Organization and quality orientation of the primary care practice and its facility can enhance breast and cervical cancer screening rates. Internal recognition of quality performance and an overall commitment to quality improvement may foster improved prevention performance, with impact varying by clinical service.

Medical Decision-Making Among Elderly People in Long Term Care.

Science.gov (United States)

Tymchuk, Alexander J.; And Others

1988-01-01

Presented informed consent information on high and low risk medical procedures to elderly persons in long term care facility in standard, simplified, or storybook format. Comprehension was significantly better for simplified and storybook formats. Ratings of decision-making ability approximated comprehension test results. Comprehension test…

Regulating food service in North Carolina's long-term care facilities.

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DePorter, Cindy H

2005-01-01

Other commentaries in this issue of the North Carolina Medical Journal describe innovative food and dining practices in some of our state's long-term care facilities. Federal and state regulations do not prohibit these innovations, and DFS supports the concept of "enhancements" of the dining experience in these facilities. The Division of Facilities Services, therefore, encourages facilities to assess and operationalize various dining methods, allowing residents to select their foods, dining times, dining partners, and other preferences. The regulations allow facilities to utilize innovative dining approaches, such as buffet lines, or family-style serving options, which allow residents to order at the table as they would in a restaurant. The regulations do not dictate whether facilities should serve food to residents on trays, in buffet lines, or in a family style. While there are many regulations, they leave room for innovative new ideas as long as these ideas do not compromise resident health or safety.. Food consumption and the dining experience are an integral part of the resident's life in a nursing facility. It is important that resident preferences are being honored, and the dining experience is as pleasant and home-like as possible. The facility's responsibility is to provide adequate nutrition and hydration that assures the resident is at his/her highest level of functioning emotionally, functionally, and physically. Meeting the unique needs of each resident in a facility can be a daunting task, but one of immense importance to the quality long-term care.

Assisted Living Facilities - CARE_LONG_TERM_FACILITIES_ISDH_IN: Residential Care Facilities, Nursing Homes, and Hospices in Indiana in 2007 (Indiana State Department of Health, Point Shapefile)

Data.gov (United States)

NSGIC State | GIS Inventory — CARE_LONG_TERM_FACILITIES_ISDH_IN is a point shapefile showing the locations of 86 residential care facilities, 525 long-term care facilities (nursing homes), and 81...

The role of service readiness and health care facility factors in attrition from Option B+ in Haiti: a joint examination of electronic medical records and service provision assessment survey data.

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Lipira, Lauren; Kemp, Christopher; Domercant, Jean Wysler; Honoré, Jean Guy; Francois, Kesner; Puttkammer, Nancy

2018-01-01

Option B+ is a strategy wherein pregnant or breastfeeding women with HIV are enrolled in lifelong antiretroviral therapy (ART) for prevention of mother-to-child transmission (PMTCT) of HIV. In Haiti, attrition from Option B+ is problematic and variable across health care facilities. This study explores service readiness and other facility factors as predictors of Option B+ attrition in Haiti. This analysis used longitudinal data from 2012 to 2014 from the iSanté electronic medical record system and cross-sectional data from Haiti's 2013 Service Provision Assessment. Predictors included Service Availability and Readiness Assessment (SARA) measures for antenatal care (ANC), PMTCT, HIV care services and ART services; general facility characteristics and patient-level factors. Multivariable Cox proportional hazards models modelled the time to first attrition. Analysis of data from 3147 women at 63 health care facilities showed no significant relationships between SARA measures and attrition. Having integrated ANC/PMTCT care and HIV-related training were significant protective factors. Being a public-sector facility, having a greater number of quality improvement activities and training in ANC were significant risk factors. Several facility-level factors were associated with Option B+ attrition. Future research is needed to explore unmeasured facility factors, clarify causal relationships, and incorporate community-level factors into the analysis of Option B+ attrition. © The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Medical microbiology laboratories in Dutch hospitals: essential for safe patient care].

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Bonten, M J M

2008-12-06

The Netherlands Health Care Inspectorate investigated the quality of medical microbiology laboratories in Dutch hospitals. By and large the laboratories fulfilled the requirements for appropriate care, although some processes were unsatisfactory and some were insufficiently formalised. In the Netherlands, laboratories for medical microbiology are integrated within hospitals and medical microbiologists are responsible for the diagnostic processes as well as for co-treatment of patients, infection prevention and research. This integrated model contrasts to the more industrialised model in many other countries, where such laboratories are physically distinct from hospitals with a strong focus on diagnostics. The Inspectorate also concludes that the current position of medical microbiology in Dutch hospitals is necessary for patient safety and that outsourcing of these facilities is considered unacceptable.

Mediating Systems of Care: Emergency Calls to Long-Term Care Facilities at Life's End.

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Waldrop, Deborah P; McGinley, Jacqueline M; Clemency, Brian

2018-04-09

Nursing home (NH) residents account for over 2.2 million emergency department visits yearly; the majority are cared for and transported by prehospital providers (emergency medical technicians and paramedics). The purpose of this study was to investigate prehospital providers' perceptions of emergency calls at life's end. This article focuses on perceptions of end-of-life calls in long-term care (LTC). This pilot study employed a descriptive cross-sectional design. Concepts from the symbolic interaction theory guided the exploration of perceptions and interpretations of emergency calls in LTC facilities. A purposeful sample of prehospital providers was developed from one agency in a small northeastern U.S. city. Semistructured interviews were conducted with 43 prehospital providers to explore their perceptions of factors that trigger emergency end-of-life calls in LTC facilities. Qualitative data analysis involved iterative coding in an inductive process that included open, systematic, focused, and axial coding. Interview themes illustrated the contributing factors as follows: care crises; dying-related turmoil; staffing ratios; and organizational protocols. Distress was crosscutting and present in all four themes. The findings illuminate how prehospital providers become mediators between NHs and emergency departments by managing tension, conflict, and challenges in patient care between these systems and suggest the importance of further exploration of interactions between LTC staff, prehospital providers, and emergency departments. Enhanced communication between LTC facilities and prehospital providers is important to address potentially inappropriate calls and transport requests and to identify means for collaboration in the care of sick frail residents.

Legionnaires' Disease: a Problem for Health Care Facilities

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... Clips Legionnaires’ Disease A problem for health care facilities Language: English (US) Español (Spanish) Recommend on Facebook ... drinking. Many people being treated at health care facilities, including long-term care facilities and hospitals, have ...

Medical Care during Pregnancy

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... for Educators Search English Español Medical Care During Pregnancy KidsHealth / For Parents / Medical Care During Pregnancy What's ... and their babies. What Is Prenatal Care Before Pregnancy? Prenatal care should start before you get pregnant. ...

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Suicide risk in long-term care facilities: a systematic review.

Science.gov (United States)

Mezuk, Briana; Rock, Andrew; Lohman, Matthew C; Choi, Moon

2014-12-01

Suicide risk is highest in later life; however, little is known about the risk of suicide among older adults in long-term care facilities (e.g., nursing homes and assisted living facilities). The goal of this paper is to review and synthesize the descriptive and analytic epidemiology of suicide in long-term care settings over the past 25 years. Four databases (PubMed, CINAHL Plus, Web of Knowledge, and EBSCOHost Academic Search Complete) were searched for empirical studies of suicide risk in nursing homes, assisted living, and other residential facilities from 1985 to 2013. Of the 4073 unique research articles identified, 37 were selected for inclusion in this review. Of the included reports, 21 were cross-sectional, 8 cohort, 3 qualitative, and 5 intervention studies. Most studies indicate that suicidal thoughts (active and passive) are common among residents (prevalence in the past month: 5-33%), although completed suicide is rare. Correlates of suicidal thoughts among long-term care residents include depression, social isolation, loneliness, and functional decline. Most studies examined only individual-level correlates of suicide, although there is suggestive evidence that organizational characteristics (e.g., bed size and staffing) may also be relevant. Existing research on suicide risk in long-term care facilities is limited but suggests that this is an important issue for clinicians and medical directors to be aware of and address. Research is needed on suicide risk in assisted living and other non-nursing home residential settings, as well as the potential role of organizational characteristics on emotional well-being for residents. Copyright © 2014 John Wiley & Sons, Ltd.

Primary Medical Care in Chile

DEFF Research Database (Denmark)

Scarpaci, Joseph L.

Primary medical care in Chile: accessibility under military rule [Front Cover] [Front Matter] [Title Page] Contents Tables Figures Preface Chapter 1: Introduction Chapter 2: The Restructuring of Medical Care Financing in Chile Chapter 3: Inflation and Medical Care Accessibility Chapter 4: Help......-Seeking Behavior of the Urban Poor Chapter 5: Spatial Organization and Medical Care Accessibility Chapter 6: Conclusion...

Employee influenza vaccination in residential care facilities.

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Apenteng, Bettye A; Opoku, Samuel T

2014-03-01

The organizational literature on infection control in residential care facilities is limited. Using a nationally representative dataset, we examined the organizational factors associated with implementing at least 1 influenza-related employee vaccination policy/program, as well as the effect of vaccination policies on health care worker (HCW) influenza vaccine uptake in residential care facilities. The study was a cross-sectional study using data from the 2010 National Survey of Residential Care Facilities. Multivariate logistic regression analysis was used to address the study's objectives. Facility size, director's educational attainment, and having a written influenza pandemic preparedness plan were significantly associated with the implementation of at least 1 influenza-related employee vaccination policy/program, after controlling for other facility-level factors. Recommending vaccination to employees, providing vaccination on site, providing vaccinations to employees at no cost, and requiring vaccination as a condition of employment were associated with higher employee influenza vaccination rates. Residential care facilities can improve vaccination rates among employees by adopting effective employee vaccination policies. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

An evaluation related to the effect of strategic facility management on choice of medical tourism destination

Directory of Open Access Journals (Sweden)

Tarcan Ertugrul

2015-01-01

Full Text Available This study based on literature review aims to evaluate and emphasize the affect of the strategic facility management (SFM on choice of medical tourism destination. Medical Tourism, which ranges from the health care services involving a cure to the wellness services involving no specific health trouble to pleasure and amusement services, is one of the most growing sectors in the world. Cost and quality of medical services are among the main reasons for the choice of destination. Strategic facility management has a positive correlation on the levels of quality, cost and customer satisfaction. Thus medical tourism and destination managers should take into account of the potential advantages of value creation offered through SFM in order to be chosen by customers (stakeholders.

[3D printing in health care facilities: What legislation in France?].

Science.gov (United States)

Montmartin, M; Meyer, C; Euvrard, E; Pazart, L; Weber, E; Benassarou, M

2015-11-01

Health care facilities more and more use 3D printing, including making their own medical devices (MDs). However, production and marketing of MDs are regulated. The goal of our work was to clarify what is the current French regulation that should be applied concerning the production of custom-made MDs produced by 3D printing in a health care facility. MDs consist of all devices used for diagnosis, prevention, or treatment of diseases in patients. Prototypes and anatomic models are not considered as MDs and no specific laws apply to them. Cutting guides, splints, osteosynthesis plates or prosthesis are MDs. In order to become a MD manufacturer in France, a health care facility has to follow the requirements of the 93/42/CEE directive. In addition, custom-made 3D-printed MDs must follow the annex VIII of the directive. This needs the writing of a declaration of conformity and the respect of the essential requirements (proving that a MD is secure and conform to what is expected), the procedure has to be qualified, a risk analysis and a control of the biocompatibility of the material have to be fulfilled. The documents proving that these rules have been respected have to be available. Becoming a regulatory manufacturer of MD in France is possible for a health care facility but the specifications have to be respected. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Quality along the continuum: a health facility assessment of intrapartum and postnatal care in Ghana.

Directory of Open Access Journals (Sweden)

Robin C Nesbitt

Full Text Available To evaluate quality of routine and emergency intrapartum and postnatal care using a health facility assessment, and to estimate "effective coverage" of skilled attendance in Brong Ahafo, Ghana.We conducted an assessment of all 86 health facilities in seven districts in Brong Ahafo. Using performance of key signal functions and the availability of relevant drugs, equipment and trained health professionals, we created composite quality categories in four dimensions: routine delivery care, emergency obstetric care (EmOC, emergency newborn care (EmNC and non-medical quality. Linking the health facility assessment to surveillance data we estimated "effective coverage" of skilled attendance as the proportion of births in facilities of high quality.Delivery care was offered in 64/86 facilities; only 3-13% fulfilled our requirements for the highest quality category in any dimension. Quality was lowest in the emergency care dimensions, with 63% and 58% of facilities categorized as "low" or "substandard" for EmOC and EmNC, respectively. This implies performing less than four EmOC or three EmNC signal functions, and/or employing less than two skilled health professionals, and/or that no health professionals were present during our visit. Routine delivery care was "low" or "substandard" in 39% of facilities, meaning 25/64 facilities performed less than six routine signal functions and/or had less than two skilled health professionals and/or less than one midwife. While 68% of births were in health facilities, only 18% were in facilities with "high" or "highest" quality in all dimensions.Our comprehensive facility assessment showed that quality of routine and emergency intrapartum and postnatal care was generally low in the study region. While coverage with facility delivery was 68%, we estimated "effective coverage" of skilled attendance at 18%, thus revealing a large "quality gap." Effective coverage could be a meaningful indicator of progress towards

Health Care Facilities Resilient to Climate Change Impacts

Directory of Open Access Journals (Sweden)

Jaclyn Paterson

2014-12-01

Full Text Available Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator’s guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change.

[A pilot study on pain assessment among elderly with severe dementiain residential aged care facilities of Reggio Emilia district].

Science.gov (United States)

Bargellini, Annalisa; Mastrangelo, Stefano; Cervi, Monica; Bagnasco, Michele; Reghizzi, Jlenia; Coriani, Sandra

2017-01-01

. A pilot study on pain assessment among elderly with severe dementia in residential aged care facilities of Reggio Emilia district. Despite the availability of pain assessment tools and best practice recommendations for the assessment and management of pain in people with severe dementia, pain in residential aged care facilities is still undetected or misinterpreted. To assess pain prevalence and analgesic load medication in people with severe cognitive impairment admitted to residential aged care facilities of Reggio Emilia (Italy) province. A pilot cross-sectional study was conducted on 84 elderly patients affected by severe dementia and resident in aged care facilities. Pain was assessed with the PAINAD observational scale, both at rest and during routine procedures: positioning in bed, from bed to standing position, from bed to chair or during the medication of a pressure sore (under challenge). 33.4% of patients had pain at rest, mainly mild, and 86.9 % under challenge. During routine interventions, in 64 patients (76.2%) pain increased compared to at rest condition (for 39, 2/3, moderate-severe); although 46 of them were prescribed as-required analgesic medication, none had received the drug. Also patients with analgesics on regular basis experienced more pain during routine procedures. Many patients experienced pain during routine procedures. The regular use of pain assessment tools and adequate training of all healthcare professionals are essential requirements for an effective pain control.

The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study.

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Riahi, Sanaz; Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

2017-01-05

Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. EMR implementation allowed Ontario Shores Centre for Mental Health

The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey

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Saliku Teresa

2009-03-01

Full Text Available Abstract Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1 delay in making the decision to seek care; 2 delay in reaching an appropriate obstetric facility; and 3 delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden

Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda

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Gertrude Namazzi

2015-03-01

Full Text Available Background: In Uganda maternal and neonatal mortality remains high due to a number of factors, including poor quality of care at health facilities. Objective: This paper describes the experience of building capacity for maternal and newborn care at a district hospital and lower-level health facilities in eastern Uganda within the existing system parameters and a robust community outreach programme. Design: This health system strengthening study, part of the Uganda Newborn Study (UNEST, aimed to increase frontline health worker capacity through district-led training, support supervision, and mentoring at one district hospital and 19 lower-level facilities. A once-off supply of essential medicines and equipment was provided to address immediate critical gaps. Health workers were empowered to requisition subsequent supplies through use of district resources. Minimal infrastructure adjustments were provided. Quantitative data collection was done within routine process monitoring and qualitative data were collected during support supervision visits. We use the World Health Organization Health System Building Blocks to describe the process of district-led health facility strengthening. Results: Seventy two per cent of eligible health workers were trained. The mean post-training knowledge score was 68% compared to 32% in the pre-training test, and 80% 1 year later. Health worker skills and competencies in care of high-risk babies improved following support supervision and mentoring. Health facility deliveries increased from 3,151 to 4,115 (a 30% increase in 2 years. Of 547 preterm babies admitted to the newly introduced kangaroo mother care (KMC unit, 85% were discharged alive to continue KMC at home. There was a non-significant declining trend for in-hospital neonatal deaths across the 2-year study period. While equipment levels remained high after initial improvement efforts, maintaining supply of even the most basic medications was a challenge, with

Patient satisfaction in Malaysia's busiest outpatient medical care.

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Ganasegeran, Kurubaran; Perianayagam, Wilson; Manaf, Rizal Abdul; Jadoo, Saad Ahmed Ali; Al-Dubai, Sami Abdo Radman

2015-01-01

This study aimed to explore factors associated with patient satisfaction of outpatient medical care in Malaysia. A cross-sectional exit survey was conducted among 340 outpatients aged between 13 and 80 years after successful clinical consultations and treatment acquirements using convenience sampling at the outpatient medical care of Tengku Ampuan Rahimah Hospital (HTAR), Malaysia, being the country's busiest medical outpatient facility. A survey that consisted of sociodemography, socioeconomic, and health characteristics and the validated Short-Form Patient Satisfaction Questionnaire (PSQ-18) scale were used. Patient satisfaction was the highest in terms of service factors or tangible priorities, particularly "technical quality" and "accessibility and convenience," but satisfaction was low in terms of service orientation of doctors, particularly the "time spent with doctor," "interpersonal manners," and "communication" during consultations. Gender, income level, and purpose of visit to the clinic were important correlates of patient satisfaction. Effort to improve service orientation among doctors through periodical professional development programs at hospital and national level is essential to boost the country's health service satisfaction.

Social and cultural dimensions of hygiene in Cambodian health care facilities

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Faurand-Tournaire Anne-Laure

2011-02-01

Full Text Available Abstract Background The frequency of bloodborne pathogen healthcare-associated infections is thought to be high in developing Southeast Asian Countries. The underlying social-cultural logics contributing to the risks of transmission are rarely studied. This report provides some insights on the social and cultural factors that shape hygiene practices in Cambodian health care settings. Methods We conducted qualitative surveys in various public and private health facilities in Phnom Penh, the capital city and in provinces. We observed and interviewed 319 participants, health care workers and patients, regarding hygiene practices and social relationships amongst the health care staff and with patients. We also examined the local perceptions of hygiene, their impact on the relationships between the health care staff and patients, and perceptions of transmission risks. Data collection stem from face to face semi-structured and open-ended interviews and focus group discussions with various health care staffs (i.e. cleaners, nurses, midwives and medical doctors and with patients who attended the study health facilities. Results Overall responses and observations indicated that hygiene practices were burdened by the lack of adequate materials and equipements. In addition, many other factors were identified to influence and distort hygiene practices which include (1 informal and formal social rapports in hospitals, (2 major infection control roles played by the cleaners in absence of professional acknowledgment. Moreover, hygiene practices are commonly seen as an unessential matter to be devoted to low-ranking staff. Conclusion Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing interventions to improve infection control practices in a Cambodian medical setting.

Use of antibiotics in paediatric long-term care facilities.

Science.gov (United States)

Murray, M T; Johnson, C L; Cohen, B; Jackson, O; Jones, L K; Saiman, L; Larson, E L; Neu, N

2018-06-01

Adult long-term care (LTC) facilities have high rates of antibiotic use, raising concerns about antimicrobial resistance. Few studies have examined antibiotic use in paediatric LTC facilities. To describe antibiotic use in three paediatric LTC facilities and to describe the factors associated with use. A retrospective cohort study was conducted from September 2012 to December 2015 in three paediatric LTC facilities. Medical records were reviewed for demographics, healthcare-associated infections (HAIs), antimicrobial use and diagnostic testing. Logistic regression was used to identify predictors for antibiotic use. The association between susceptibility testing results and appropriate antibiotic coverage was determined using Chi-squared test. Fifty-eight percent (413/717) of residents had at least one HAI, and 79% (325/413) of these residents were treated with at least one antibiotic course, totalling 2.75 antibiotic courses per 1000 resident-days. Length of enrolment greater than one year, having a neurological disorder, having a tracheostomy, and being hospitalized at least once during the study period were significantly associated with receiving antibiotics when controlling for facility (all P facilities is widespread. There is further need to assess antibiotic use in paediatric LTC facilities. Evaluation of the adverse outcomes associated with inappropriate antibiotic use, including the prevalence of resistant organisms in paediatric LTC facilities, is critical. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review.

Science.gov (United States)

Kruse, Clemens Scott; Mileski, Michael; Vijaykumar, Alekhya Ganta; Viswanathan, Sneha Vishnampet; Suskandla, Ujwala; Chidambaram, Yazhini

2017-09-29

Long-term care (LTC) facilities are an important part of the health care industry, providing care to the fastest-growing group of the population. However, the adoption of electronic health records (EHRs) in LTC facilities lags behind other areas of the health care industry. One of the reasons for the lack of widespread adoption in the United States is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities. The objective of this systematic review was to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology. The authors conducted a systematic search of PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and MEDLINE databases. Papers were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 28 papers was selected to be included in the systematic review. Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in LTC facilities and enhanced quality outcomes. Approximately 43% (12/28) of the papers reported a mixed impact of EHRs on the management of documentation, and 33% (9/28) of papers reported positive quality outcomes using EHRs. Surprisingly, very few papers demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay, and productivity using EHRs. Overall, implementation of EHRs has been found to be effective in the few LTC

Electronic Information Systems Use in Residential Care Facilities: The Differential Effect of Ownership Status and Chain Affiliation.

Science.gov (United States)

Davis, Jullet A; Zakoscielna, Karolina; Jacobs, Lindsey

2016-03-01

The use of electronic information systems (EISs) including electronic health records continues to increase in all sectors of the health care industry. Research shows that EISs may be useful for improving care delivery and decreasing medical errors. The purpose of this project is twofold: First, we describe the prevalence of EIS use among residential care facilities (RCFs), and second, we explore utilization differences by ownership status and chain affiliation. We anticipate that RCFs that are non-profit and non-chain will use more EIS than other categories of RCFs. Data for this project come from the 2010 National Survey of Residential Care Facilities. The sample consists of 2,300 facilities. Overall use of EIS was greatest among RCFs that are non-profit and chain-affiliated. Conversely, the use was lowest among for-profit RCFs that were also non-chain affiliated. This may suggest that these facilities lack the necessary resources or motivation to invest in information systems. © The Author(s) 2014.

Measuring the diffusion of palliative care in long-term care facilities – a death census

Directory of Open Access Journals (Sweden)

Santos-Eggimann Brigitte

2009-01-01

Full Text Available Abstract Background The dissemination of palliative care for patients presenting complex chronic diseases at various stages has become an important matter of public health. A death census in Swiss long-term care facilities (LTC was set up with the aim of monitoring the frequency of selected indicators of palliative care. Methods The survey covered 150 LTC facilities (105 nursing homes and 45 home health services, each of which was asked to complete a questionnaire for every non-accidental death over a period of six months. The frequency of 4 selected indicators of palliative care (resort to a specialized palliative care service, the administration of opiates, use of any pain measurement scale or other symptom measurement scale was monitored in respect of the stages of care and analysed based on gender, age, medical condition and place of residence. Results Overall, 1200 deaths were reported, 29.1% of which were related to cancer. The frequencies of each indicator varied according to the type of LTC, mostly regarding the administration of opiate. It appeared that the access to palliative care remained associated with cancer, terminal care and partly with age, whereas gender and the presence of mental disorders had no effect on the indicators. In addition, the use of drugs was much more frequent than the other indicators. Conclusion The profile of patients with access to palliative care must become more diversified. Among other recommendations, equal access to opiates in nursing homes and in home health services, palliative care at an earlier stage and the systematic use of symptom management scales when resorting to opiates have to become of prime concern.

32 CFR 564.37 - Medical care.

Science.gov (United States)

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Medical care. 564.37 Section 564.37 National... REGULATIONS Medical Attendance and Burial § 564.37 Medical care. (a) General. The definitions of medical care; policies outlining the manner, conditions, procedures, and eligibility for care; and the sources from which...

Adverse event reporting in Czech long-term care facilities.

Science.gov (United States)

Hěib, Zdenřk; Vychytil, Pavel; Marx, David

2013-04-01

To describe adverse event reporting processes in long-term care facilities in the Czech Republic. Prospective cohort study involving a written questionnaire followed by in-person structured interviews with selected respondents. Long-term care facilities located in the Czech Republic. Staff of 111 long-term care facilities (87% of long-term care facilities in the Czech Republic). None. Sixty-three percent of long-term health-care facilities in the Czech Republic have adverse event-reporting processes already established, but these were frequently very immature programs sometimes consisting only of paper recording of incidents. Compared to questionnaire responses, in-person interview responses only partially tended to confirm the results of the written survey. Twenty-one facilities (33%) had at most 1 unconfirmed response, 31 facilities (49%) had 2 or 3 unconfirmed responses and the remaining 11 facilities (17%) had 4 or more unconfirmed responses. In-person interviews suggest that use of a written questionnaire to assess the adverse event-reporting process may have limited validity. Staff of the facilities we studied expressed an understanding of the importance of adverse event reporting and prevention, but interviews also suggested a lack of knowledge necessary for establishing a good institutional reporting system in long-term care.

Organizational forms of medical care in the event of radiation accidents in the German Democratic Republic

International Nuclear Information System (INIS)

Nack, P.; Arndt, D.; Schuettmann, W.

1977-01-01

Medical care of radiation casualties in the German Democratic Republic (GDR) is organized on two levels. On the level of users the responsible Medical Officers guarantee both the routine control of persons occupationally exposed to radiation and first aid in the event of accidents. On the second level medical treatment is given either in the Clinical Department of the National Board of Nuclear Safety and Radiation Protection or in specialized national health system clinics having facilities for intensive medical care. A decision on hospitalization is made according to the conditions of the accident and the necessary diagnostic and therapeutic measures as a rule are based on consultations between the responsible Medical Officer and the departments of the Board (Emergency Assistance Service, Clinical Department, Consultative Committee). For serious cases where haematological complications can be expected, a central medical clinic with facilities for bone-marrow transplants is available. The casualties are treated in local clinics which are provided with continuous support and advice by the Board. This support consists in: (i) immediate activity by a consultative committee of the Board's physicians and scientists experienced and trained in radiation protection and the treatment of radiation accidents; (ii) the requirement of compulsory examination methods and take-over of specialized laboratory investigations; and (iii) the use of a mobile emergency measuring system in cases of additional incorporation. It is the main principle of medical care in case of radiation accidents to consult, as early as possible, a medical consultative committee of the Board in the field of radiation protection at each step of medical care. (author)

Payment and Care for Hematopoietic Cell Transplantation Patients: Toward a Specialized Medical Home for Complex Care Patients.

Science.gov (United States)

Gajewski, James L; McClellan, Mark B; Majhail, Navneet S; Hari, Parameswaran N; Bredeson, Christopher N; Maziarz, Richard T; LeMaistre, Charles F; Lill, Michael C; Farnia, Stephanie H; Komanduri, Krishna V; Boo, Michael J

2018-01-01

Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time. Payment is linked to quality measures, including proportion of care delivered according to predefined pathways and demonstrated impact on outcomes. Some medical homes also include opportunities for shared savings by reducing overall costs of care. Recent proposals have suggested expanding the medical home model to specialized populations with complex needs because primary care teams may not have the facilities or the requisite expertise for their unique needs. An example of a successful care model that may provide valuable lessons for those creating specialty medical home models already exists in many hematopoietic cell transplantation (HCT) centers that deliver multidisciplinary, coordinated, and highly specialized care. The integration of care delivery in HCT centers has been driven by the specialty care their patients require and by the payment methodology preferred by the commercial payers, which has included bundling of both inpatient and outpatient care in the peritransplant interval. Commercial payers identify qualified HCT centers based on accreditation status and comparative performance, enabled in part by center-level comparative performance data available within a national outcomes database mandated by the Stem Cell Therapeutic and Research Act of 2005. Standardization across centers has been facilitated via voluntary accreditation implemented by Foundation for

Ecotoxicity of Wastewater from Medical Facilities: A Review

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Cidlinová A.

2018-03-01

Full Text Available Wastewater from medical facilities contains a wide range of chemicals (in particular pharmaceuticals, disinfectants, heavy metals, contrast media, and radionuclides and pathogens, therefore it constitutes a risk to the environment and human health. Many micropollutants are not efficiently eliminated during wastewater treatment and contaminate both surface water and groundwater. As we lack information about the long-term effects of low concentrations of micropollutants in the aquatic environment, it is not possible to rule out their adverse effects on aquatic organisms and human health. It is, therefore, necessary to focus on the evaluation of chronic toxicity in particular when assessing the environmental and health risks and to develop standards for the regulation of hazardous substances in wastewater from medical facilities on the basis of collected data. Wastewater from medical facilities is a complex mixture of many compounds that may have synergetic, antagonistic or additive effects on organisms. To evaluate the influence of a wide range of pollutants contained in the effluents from medical facilities on aquatic ecosystems, it is necessary to determine their ecotoxicity.

[Involvement of medical representatives in team medical care].

Science.gov (United States)

Hirotsu, Misaki; Sohma, Michiro; Takagi, Hidehiko

2009-04-01

In recent years, chemotherapies have been further advanced because of successive launch of new drugs, introduction of molecular targeting, etc., and the concept of so-called Team Medical Care ,the idea of sharing interdisciplinary expertise for collaborative treatment, has steadily penetrated in the Japanese medical society. Dr. Naoto Ueno is a medical oncologist at US MD Anderson Cancer Center, the birthplace of the Team Medical Care. He has advocated the concept of ABC of Team Oncology by positioning pharmaceutical companies as Team C. Under such team practice, we believe that medical representatives of a pharmaceutical company should also play a role as a member of the Team Medical Care by providing appropriate drug use information to healthcare professionals, supporting post-marketing surveillance of treated patients, facilitating drug information sharing among healthcare professionals at medical institutions, etc.

Examining physicians’ preparedness for tobacco cessation services in India: Findings from primary care public health facilities in two Indian states

Directory of Open Access Journals (Sweden)

Rajmohan Panda

2013-03-01

Full Text Available BackgroundA total of 275 million tobacco users live throughout India and are in need of tobacco cessation services. However, the preparation of physicians to deliver this service at primary care health facilities remains unknown.AimsThe study aimed to examine the primary care physicians’ preparedness to deliver tobacco cessation services in two Indian states.MethodResearchers surveyed physicians working in primary care public health facilities, primarily in rural areas using a semistructured interview schedule. Physicians’ preparedness was defined in the study as those possessing knowledge of tobacco cessation methods and exhibiting a positive attitude towards the benefits of tobacco cessation counselling as well as being willing to be part of tobacco prevention or cessation program.ResultsOverall only 17% of physicians demonstrated adequate preparation to provide tobacco cessation services at primary care health facilities in both the States. The findings revealed minimal tobacco cessation training during formal medical education (21.3% and on-the-job training (18.9%. Factors, like sex and age of service provider, type of health facility, location of health facility and number of patients attended by the service provider, failed to show significance during bivariate and regression analysis. Preparedness was significantly predicted by state health system.ConclusionThe study highlights a lack of preparedness of primary care physicians to deliver tobacco cessation services. Both the curriculum in medical school and on-the-job training require an addition of a learning component on tobacco cessation. The addition of this component will enable existing primary care facilities to deliver tobacco cessation services.

A security/safety survey of long term care facilities.

Science.gov (United States)

Acorn, Jonathan R

2010-01-01

What are the major security/safety problems of long term care facilities? What steps are being taken by some facilities to mitigate such problems? Answers to these questions can be found in a survey of IAHSS members involved in long term care security conducted for the IAHSS Long Term Care Security Task Force. The survey, the author points out, focuses primarily on long term care facilities operated by hospitals and health systems. However, he believes, it does accurately reflect the security problems most long term facilities face, and presents valuable information on security systems and practices which should be also considered by independent and chain operated facilities.

Safety measures to address the year 2000 issue at medical facilities which use radiation generators and radioactive materials

International Nuclear Information System (INIS)

1999-03-01

In resolution GC(42)/RES/11 on 'Measures to Address the Year 2000 (Y2K) Issue', adopted on 25 September 1998, the General Conference of the International Atomic Energy Agency (IAEA) - inter alia - urged Member States 'to share information with the Secretariat regarding diagnostic and corrective actions being planned or implemented by operating and regulatory organizations at their ... medical facilities which use radioactive materials to make those facilities Year 2000 ready', encouraged the Secretariat 'within existing resources to act as a clearing-house and central point of contact for Member States to exchange information regarding diagnostic and remediation actions being taken at ... medical facilities which use radioactive materials to make these facilities Year 2000 ready', urged the Secretariat 'to handle the information provided by Member States carefully' and requested the Director General to report to it at its next (1999) regular session on the implementation of that resolution. The IAEA Secretariat convened a group of consultants who met in Vienna from 14 to 18 December 1998 and produced this report. The consultants decided that the report should cover not just 'medical facilities which use radioactive materials' but also medical facilities which, while perhaps not using radioactive materials, use ionizing radiation produced by radiation generators such as accelerators. The reports issued together are: Achieving Year 2000 Readiness: Basic Processes; Safety Measures to Address the Year 2000 Issue at Medical Facilities Which Use Radiation Generators and Radioactive Materials; and Safety Measures to Address the Year 2000 Issue at Radioactive Waste Management Facilities. This report addresses means of dealing with the Y2K problem at medical facilities which use radiation generators and radioactive materials

Indicators of Dysphagia in Aged Care Facilities

Science.gov (United States)

Pu, Dai; Murry, Thomas; Wong, May C. M.; Yiu, Edwin M. L.; Chan, Karen M. K.

2017-01-01

Purpose: The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly individuals in aged care facilities. Method: A total of 878 individuals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating…

Characteristics of administrators and quality of care in Ontario care facilities

OpenAIRE

Keays, Sean Charles

2007-01-01

This exploratory study investigated administrator and facility predictors of quality of care (QOC) in care facilities (CF). Surveys were mailed to all 602 CF administrators in Ontario; half of whom responded. Quality was measured using the last certification inspection report obtained from the Ontario Ministry of Health and Long-Term Care public report on certified CF. Quality predictors were found using multiple regression analysis. Education and experience as an administrator in current pos...

Radiation safety and regulatory aspects in Medical Facilities

International Nuclear Information System (INIS)

Banerjee, Sharmila

2017-01-01

Radiation safety and regulatory aspect of medical facilities are relevant in the context where radiation is used in providing healthcare to human patients. These include facilities, which carry out radiological procedures in diagnostic radiology, including dentistry, image-guided interventional procedures, nuclear medicine, and radiation therapy. The safety regulations provide recommendations and guidance on meeting the requirements for the safe use of radiation in medicine. The different safety aspects which come under its purview are the personnel involved in medical facilities where radiological procedures are performed which include the medical practitioners, radiation technologists, medical physicists, radiopharmacists, radiation protection and over and above all the patients. Regulatory aspects cover the guidelines provided by ethics committees, which regulate the administration of radioactive formulation in human patients. Nuclear medicine is a modality that utilizes radiopharmaceuticals either for diagnosis of physiological disorders related to anatomy, physiology and patho-physiology and for diagnosis and treatment of cancer

Care coordination, medical complexity, and unmet need for prescription medications among children with special health care needs.

Science.gov (United States)

Aboneh, Ephrem A; Chui, Michelle A

Children with special health care needs (CSHCN) have multiple unmet health care needs including that of prescription medications. The objectives of this study were twofold: 1) to quantify and compare unmet needs for prescription medications for subgroups of CSHCN without and with medical complexity (CMC)-those who have multiple, chronic, and complex medical conditions associated with severe functional limitations and high utilization of health care resources, and 2) to describe its association with receipt of effective care coordination services and level of medical complexity. A secondary data analysis of the 2009/2010 National Survey of CSHCN, a nationally representative telephone survey of parents of CSHCN, was conducted. Logistic regression models were constructed to determine associations between unmet need for prescription medications and medical complexity and care coordination for families of CSHCN, while controlling for demographic variables such as race, insurance, education level, and household income. Analyses accounted for the complex survey design and sampling weights. CMC represented about 3% of CSHCN. CMC parents reported significantly more unmet need for prescription medications and care coordination (4%, 68%), compared to Non-CMC parents (2%, 40%). Greater unmet need for prescription medications was associated with unmet care coordination (adjusted OR 3.81; 95% CI: 2.70-5.40) and greater medical complexity (adjusted OR 2.01; 95% CI: 1.00-4.03). Traditional care coordination is primarily facilitated by nurses and nurse practitioners with little formal training in medication management. However, pharmacists are rarely part of the CSHCN care coordination model. As care delivery models for these children evolve, and given the complexity of and numerous transitions of care for these patients, pharmacists can play an integral role to improve unmet needs for prescription medications. Copyright © 2016 Elsevier Inc. All rights reserved.

RFID and medication care.

Science.gov (United States)

Lahtela, Antti; Saranto, Kaija

2009-01-01

Dynamic healthcare needs new IT innovations and applications to be able to treat the rapidly growing number of patients effectively and safely. The information technology has to support healthcare in developing practices and nursing patients without confronting any complications or errors. One critical and important part of healthcare is medication care, which is very vulnerable for different kind of errors, even on fatal errors. Thus, medication care needs new methods for avoiding errors in different situations during medication administration. This poster represents an RFID-based automated identification system for medication care in a hospital environment. This work is a part of the research project MaISSI (Managing IT Services and Service Implementation) at the University of Kuopio, Department of Computer Science, Finland.

[Organization of workplace first aid in health care facilities].

Science.gov (United States)

Ciavarella, M; Sacco, A; Bosco, Maria Giuseppina; Chinni, V; De Santis, A; Pagnanelli, A

2007-01-01

Laws D.Lgs. 626/94 and D.I. 388/03 attach particular importance to the organization of first aid in the workplace. Like every other enterprise, also hospitals and health care facilities have the obligation, as foreseen by the relevant legislation, to organize and manage first aid in the workplace. To discuss the topic in the light of the guidelines contained in the literature. We used the references contained in the relevant literature and in the regulations concerning organization of first aid in health care facilities. The regulations require the general manager of health care facilities to organize the primary intervention in case of emergencies in all health care facilities (health care or administrative, territorial and hospitals). In health care facilities the particular occupational risks, the general access of the public and the presence of patients who are already assumed to have altered states of health, should be the reason for particular care in guaranteeing the best possible management of a health emergency in the shortest time possible.

Assessment of health facility capacity to provide newborn care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania.

Science.gov (United States)

Winter, Rebecca; Yourkavitch, Jennifer; Wang, Wenjuan; Mallick, Lindsay

2017-12-01

Despite the importance of health facility capacity to provide comprehensive care, the most widely used indicators for global monitoring of maternal and child health remain contact measures which assess women's use of services only and not the capacity of health facilities to provide those services; there is a gap in monitoring health facilities' capacity to provide newborn care services in low and middle income countries. In this study we demonstrate a measurable framework for assessing health facility capacity to provide newborn care using open access, nationally-representative Service Provision Assessment (SPA) data from the Demographic Health Surveys Program. In particular, we examine whether key newborn-related services are available at the facility (ie, service availability, measured by the availability of basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal services), and whether the facility has the equipment, medications, training and knowledge necessary to provide those services (ie, service readiness, measured by general facility requirements, equipment, medicines and commodities, and guidelines and staffing) in five countries with high levels of neonatal mortality and recent SPA data: Bangladesh, Haiti, Malawi, Senegal, and Tanzania. In each country, we find that key services and commodities needed for comprehensive delivery and newborn care are missing from a large percentage of facilities with delivery services. Of three domains of service availability examined, scores for routine care availability are highest, while scores for newborn signal function availability are lowest. Of four domains of service readiness examined, scores for general requirements and equipment are highest, while scores for guidelines and staffing are lowest. Both service availability and readiness tend to be highest in hospitals and facilities in urban areas, pointing to substantial equity gaps in the availability of essential

Associations Among Health Care Workplace Safety, Resident Satisfaction, and Quality of Care in Long-Term Care Facilities.

Science.gov (United States)

Boakye-Dankwa, Ernest; Teeple, Erin; Gore, Rebecca; Punnett, Laura

2017-11-01

We performed an integrated cross-sectional analysis of relationships between long-term care work environments, employee and resident satisfaction, and quality of patient care. Facility-level data came from a network of 203 skilled nursing facilities in 13 states in the eastern United States owned or managed by one company. K-means cluster analysis was applied to investigate clustered associations between safe resident handling program (SRHP) performance, resident care outcomes, employee satisfaction, rates of workers' compensation claims, and resident satisfaction. Facilities in the better-performing cluster were found to have better patient care outcomes and resident satisfaction; lower rates of workers compensation claims; better SRHP performance; higher employee retention; and greater worker job satisfaction and engagement. The observed clustered relationships support the utility of integrated performance assessment in long-term care facilities.

Quality in health care and globalization of health services: accreditation and regulatory oversight of medical tourism companies.

Science.gov (United States)

Turner, Leigh G

2011-02-01

Patients are crossing national borders in search of affordable and timely health care. Many medical tourism companies are now involved in organizing cross-border health services. Despite the rapid expansion of the medical tourism industry, few standards exist to ensure that these businesses organize high-quality, competent international health care. Addressing the regulatory vacuum, 10 standards are proposed as a framework for regulating the medical tourism industry. Medical tourism companies should have to undergo accreditation review. Care should be arranged only at accredited international health-care facilities. Standards should be established to ensure that clients of medical tourism companies make informed choices. Continuity of care needs to become an integral feature of cross-border care. Restrictions should be placed on the use of waiver of liability forms by medical tourism companies. Medical tourism companies must ensure that they conform to relevant legislation governing privacy and confidentiality of patient information. Restrictions must be placed on the types of health services marketed by medical tourism companies. Representatives of medical tourism agencies should have to undergo training and certification. Medical travel insurance and medical complications insurance should be included in the health-care plans of patients traveling for care. To protect clients from financial losses, medical tourism companies should be mandated to contribute to compensation funds. Establishing high standards for the operation of medical tourism companies should reduce risks facing patients when they travel abroad for health care.

Wireless local network architecture for Naval medical treatment facilities

OpenAIRE

Deason, Russell C.

2004-01-01

Approved for public release; distribution is unlimited In today's Navy Medicine, an approach towards wireless networks is coming into view. The idea of developing and deploying workable Wireless Local Area Networks (WLAN) throughout Naval hospitals is but just a few years down the road. Currently Naval Medical Treatment Facilities (MTF) are using wired Local Area Networks (LANs) throughout the infrastructure of each facility. Civilian hospitals and other medical treatment facilities have b...

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

Design challenges for electronic medication administration record systems in residential aged care facilities: a formative evaluation.

Science.gov (United States)

Tariq, A; Lehnbom, E; Oliver, K; Georgiou, A; Rowe, C; Osmond, T; Westbrook, J

2014-01-01

Electronic medication administration record (eMAR) systems are promoted as a potential intervention to enhance medication safety in residential aged care facilities (RACFs). The purpose of this study was to conduct an in-practice evaluation of an eMAR being piloted in one Australian RACF before its roll out, and to provide recommendations for system improvements. A multidisciplinary team conducted direct observations of workflow (n=34 hours) in the RACF site and the community pharmacy. Semi-structured interviews (n=5) with RACF staff and the community pharmacist were conducted to investigate their views of the eMAR system. Data were analysed using a grounded theory approach to identify challenges associated with the design of the eMAR system. The current eMAR system does not offer an end-to-end solution for medication management. Many steps, including prescribing by doctors and communication with the community pharmacist, are still performed manually using paper charts and fax machines. Five major challenges associated with the design of eMAR system were identified: limited interactivity; inadequate flexibility; problems related to information layout and semantics; the lack of relevant decision support; and system maintenance issues. We suggest recommendations to improve the design of the eMAR system and to optimize existing workflows. Immediate value can be achieved by improving the system interactivity, reducing inconsistencies in data entry design and offering dedicated organisational support to minimise connectivity issues. Longer-term benefits can be achieved by adding decision support features and establishing system interoperability requirements with stakeholder groups (e.g. community pharmacies) prior to system roll out. In-practice evaluations of technologies like eMAR system have great value in identifying design weaknesses which inhibit optimal system use.

Instrumentation of the ESRF medical imaging facility

CERN Document Server

Elleaume, H; Berkvens, P; Berruyer, G; Brochard, T; Dabin, Y; Domínguez, M C; Draperi, A; Fiedler, S; Goujon, G; Le Duc, G; Mattenet, M; Nemoz, C; Pérez, M; Renier, M; Schulze, C; Spanne, P; Suortti, P; Thomlinson, W; Estève, F; Bertrand, B; Le Bas, J F

1999-01-01

At the European Synchrotron Radiation Facility (ESRF) a beamport has been instrumented for medical research programs. Two facilities have been constructed for alternative operation. The first one is devoted to medical imaging and is focused on intravenous coronary angiography and computed tomography (CT). The second facility is dedicated to pre-clinical microbeam radiotherapy (MRT). This paper describes the instrumentation for the imaging facility. Two monochromators have been designed, both are based on bent silicon crystals in the Laue geometry. A versatile scanning device has been built for pre-alignment and scanning of the patient through the X-ray beam in radiography or CT modes. An intrinsic germanium detector is used together with large dynamic range electronics (16 bits) to acquire the data. The beamline is now at the end of its commissioning phase; intravenous coronary angiography is intended to start in 1999 with patients and the CT pre-clinical program is underway on small animals. The first in viv...

"Medical tourism" and the global marketplace in health services: U.S. patients, international hospitals, and the search for affordable health care.

Science.gov (United States)

Turner, Leigh

2010-01-01

Health services are now advertised in a global marketplace. Hip and knee replacements, ophthalmologic procedures, cosmetic surgery, cardiac care, organ transplants, and stem cell injections are all available for purchase in the global health services marketplace. "Medical tourism" companies market "sun and surgery" packages and arrange care at international hospitals in Costa Rica, India, Mexico, Singapore, Thailand, and other destination nations. Just as automobile manufacturing and textile production moved outside the United States, American patients are "offshoring" themselves to facilities that use low labor costs to gain competitive advantage in the marketplace. Proponents of medical tourism argue that a global market in health services will promote consumer choice, foster competition among hospitals, and enable customers to purchase high-quality care at medical facilities around the world. Skeptics raise concerns about quality of care and patient safety, information disclosure to patients, legal redress when patients are harmed while receiving care at international hospitals, and harms to public health care systems in destination nations. The emergence of a global market in health services will have profound consequences for health insurance, delivery of health services, patient-physician relationships, publicly funded health care, and the spread of medical consumerism.

An ecological perspective on medical care: environmental, occupational, and public health impacts of medical supply and pharmaceutical chains.

Science.gov (United States)

Vatovec, Christine; Senier, Laura; Bell, Michael

2013-09-01

Healthcare organizations are increasingly examining the impacts of their facilities and operations on the natural environment, their workers, and the broader community, but the ecological impacts of specific healthcare services provided within these institutions have not been assessed. This paper provides a qualitative assessment of healthcare practices that takes into account the life-cycle impacts of a variety of materials used in typical medical care. We conducted an ethnographic study of three medical inpatient units: a conventional cancer ward, palliative care unit, and a hospice center. Participant observations (73 participants) of healthcare and support staff including physicians, nurses, housekeepers, and administrators were made to inventory materials and document practices used in patient care. Semi-structured interviews provided insight into common practices. We identified three major domains that highlight the cumulative environmental, occupational health, and public health impacts of medical supplies and pharmaceuticals used at our research sites: (1) medical supply procurement; (2) generation, handling, and disposal of medical waste; and (3) pharmaceutical handling and disposal. Impacts discovered through ethnographic inquiry included occupational exposures to chemotherapy and infectious waste, and public health exposures to pharmaceutical waste. This study provides new insight into the environmental, occupational, and public health impacts resulting from medical practices. In many cases, the lack of clear guidance and regulations regarding environmental impacts contributed to elevated harms to the natural environment, workers, and the broader community.

Designing Medical Facilities to Care for Patients with Highly Hazardous Communicable Diseases

Science.gov (United States)

2017-07-14

experience in biocontainment patient care. Pub Health Nursing 2010;140-6. 25Lowe JJ , Jelden KC, Schenarts PJ, Rupp LE, Jr, Hawes KJ, Tysor BN, Swansiger RG...units. Curr Opin-Infect Dis 2015;28:343-8. 27 Wadman MC, Schwedhelm SS, Watson S, Swanhorst J, Gibbs SG, Lowe JJ , Iwen PC, Hayes AK, Needham S...30 Lowe JJ , Gibbs SG, Schwedhelm SS, Nguyen J, Smith PW. Nebraska biocontainment unit perspective on disposal of Ebola medical waste. Am J Infect

Determinants of Contraceptive Availability at Medical Facilities in the Department of Veterans Affairs

Science.gov (United States)

Cope, Jacqueline R; Yano, Elizabeth M; Lee, Martin L; Washington, Donna L

2006-01-01

OBJECTIVE To describe the variation in provision of hormonal and intrauterine contraception among Veterans Affairs (VA) facilities. DESIGN Key informant, cross-sectional survey of 166 VA medical facilities. Data from public use data sets and VA administrative databases were linked to facility data to further characterize their contextual environments. PARTICIPANTS All VA hospital-based and affiliated community-based outpatient clinics delivering services to at least 400 unique women during fiscal year 2000. MEASUREMENTS Onsite availability of hormonal contraceptive prescription and intrauterine device (IUD) placement. RESULTS Ninety-seven percent of facilities offered onsite prescription and management of hormonal contraception whereas 63% offered placement of IUDs. After adjusting for facility caseload of reproductive-aged women, 3 organizational factors were independently associated with onsite IUD placement: (1) onsite gynecologist (adjusted odds ratio [OR], 20.35; 95% confidence interval [CI], 7.02 to 58.74; Pwomen's health training to other clinicians (adjusted OR, 3.40; 95% CI 1.19 to 9.76; P=.02). CONCLUSIONS VA's provision of hormonal and intrauterine contraception is in accordance with community standards, although onsite availability is not universal. Although contraception is a crucial component of a woman's health maintenance, her ability to obtain certain contraceptives from the facility where she obtains her primary care is largely influenced by the availability of a gynecologist. Further research is needed to determine how fragmentation of women's care into reproductive and nonreproductive services impacts access to contraception and the incidence of unintended pregnancy. PMID:16637943

Mapping the Characteristics of Critical Care Facilities: Assessment, Distribution, and Level of Critical Care Facilities from Central India.

Science.gov (United States)

Saigal, Saurabh; Sharma, Jai Prakash; Pakhare, Abhijit; Bhaskar, Santosh; Dhanuka, Sanjay; Kumar, Sanjay; Sabde, Yogesh; Bhattacharya, Pradip; Joshi, Rajnish

2017-10-01

In low- and middle-income countries such as India, where health systems are weak, the number of available Critical Care Unit (Intensive Care Unit [ICU]) beds is expected to be low. There is no study from the Indian subcontinent that has reported the characteristics and distribution of existing ICUs. We performed this study to understand the characteristics and distribution of ICUs in Madhya Pradesh (MP) state of Central India. We also aimed to develop a consensus scoring system and internally validate it to define levels of care and to improve health system planning and to strengthen referral networks in the state. We obtained a list of potential ICU facilities from various sources and then performed a cross-sectional survey by visiting each facility and determining characteristics for each facility. We collected variables with respect to infrastructure, human resources, equipment, support services, procedures performed, training courses conducted, and in-place policies or standard operating procedure documents. We identified a total of 123 ICUs in MP. Of 123 ICUs, 35 were level 1 facilities, 74 were level 2 facilities, and only 14 were level 3 facilities. Overall, there were 0.17 facilities per 100,000 population (95* confidence interval [CI] 0.14-0.20 per 100,000 populations). There were a total of 1816 ICU beds in the state, with an average of 2.5 beds per 100,000 population (95* CI 2.4-2.6 per 100,000 population). Of the total number of ICU beds, 250 are in level 1, 1141 are in level 2, and 425 are in level 3 facilities. This amounts to 0.34, 1.57, and 0.59 ICU beds per 100,000 population for levels 1, 2, and 3, respectively. This study could just be an eye opener for our healthcare authorities at both state and national levels to estimate the proportion of ICU beds per lac population. Similar mapping of intensive care services from other States will generate national data that is hitherto unknown.

Influence of awareness and availability of medical alternatives on parents seeking paediatric emergency care.

Science.gov (United States)

Ellbrant, Julia A; Åkeson, S Jonas; Karlsland Åkeson, Pia M

2018-06-01

Direct seeking of care at paediatric emergency departments may result from an inadequate awareness or a short supply of medical alternatives. We therefore evaluated the care-seeking patterns, availability of medical options and initial medical assessments - with overall reference to socioeconomic status - of parents at an urban paediatric emergency department in a Scandinavian country providing free paediatric healthcare. The parents of children assessed by paediatric emergency department physicians at a Swedish university hospital over a 25-day winter period completed a questionnaire on recent medical contacts and their reasons for attendance. Additional information was obtained from ledgers, patient records and population demographics. In total, 657 of 713 eligible patients (92%) were included. Seventy-nine per cent of their parents either failed to or managed to establish medical contact before the emergency department visit, whereas 21% sought care with no attempt at recent medical contact. Visits with a failed telephone or primary care contact (18%) were more common outside office hours ( p=0.014) and were scored as less urgent ( p=0.014). A perceived emergency was the main reason for no attempt at medical contact before the visit. Direct emergency department care-seeking was more common from the city district with the lowest socioeconomic status ( p=0.027). Although most parents in this Swedish study tried to seek medical advice before attending a paediatric emergency department, perceived emergency, a short supply of telephone health line or primary care facilities and lower socioeconomic status contributed to direct care-seeking by almost 40% of parents. Pre-hospital awareness and the availability of medical alternatives with an emphasis on major differences in socioeconomic status should therefore be considered to further optimize care-seeking in paediatric emergency departments.

Trauma facilities in Denmark - A nationwide cross-sectional benchmark study of facilities and trauma care organisation

DEFF Research Database (Denmark)

Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C.

2018-01-01

Background: Trauma is a leading cause of death among adults aged trauma facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities...... and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. Methods: We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark...... were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone...

Sound & Vibration 20 Design Guidelines for Health Care Facilities

CERN Document Server

Tocci, Gregory; Cavanaugh, William

2013-01-01

Sound, vibration, noise and privacy have significant impacts on health and performance. As a result, they are recognized as essential components of effective health care environments. However, acoustics has only recently become a prominent consideration in the design, construction, and operation of healthcare facilities owing to the absence, prior to 2010, of clear and objective guidance based on research and best practices. Sound & Vibration 2.0 is the first publication to comprehensively address this need. Sound & Vibration 2.0 is the sole reference standard for acoustics in health care facilities and is recognized by: the 2010 FGI Guidelines for the Design and Construction of Health Care Facilities (used in 60 countries); the US Green Building Council’s LEED for Health Care (used in 87 countries); The Green Guide for Health Care V2.2; and the International Code Council (2011). Sound & Vibration 2.0 was commissioned by the Facility Guidelines Institute in 2005, written by the Health Care Acous...

A medical facility proposal to use the SSC linac

International Nuclear Information System (INIS)

Funk, L.W.

1994-01-01

A consortium organized by the Texas National Research Laboratory Commission under a Department of Energy grant proposes to build and operate a Regional Medical Technology Center to function as a combined medical radioisotope production complex and proton cancer therapy facility using the Linear Accelerator (Linac) assets of the Superconducting Super Collider (SSC). The radioisotope production complex will serve as a domestic source of radioisotopes critically needed by the U.S. pharmaceutical industry and nuclear medicine facilities throughout North America. Presently, more than 70 percent of radioisotopes used in U.S. nuclear medicine procedures are produced outside the country. The Center's state-of-the-art proton cancer therapy facility will serve the Central United States, providing advanced capabilities and augmenting facilities in California and Massachusetts. Long-term, it is anticipated that the RMTC also will stimulate nuclear medicine research, advance medical diagnostic technologies, and generate new industrial applications for linear accelerator technology

Medical care of radiation accidents

International Nuclear Information System (INIS)

Nakao, Isamu

1986-01-01

Focusing on the population exposed to radioactivity released from a nuclear power plant, the paper gives an overview of medical strategies in emergency care, steps in medical care, and clinical procedures including decontamination and oral administration of iodine-131. Strategies for evacuation are presented depending on predicted exposure doses to the whole body and thyroid gland. Medical care consists of three steps. When the thyroid gland is supposed to be exposed to 5 - 50 rem or more, the oral administration of iodine-131 is recommended. (Namekawa, K.)

Trauma facilities in Denmark - a nationwide cross-sectional benchmark study of facilities and trauma care organisation.

Science.gov (United States)

Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C; Frederiksen, Christian A; Laursen, Christian B; Sloth, Erik; Mølgaard, Ole; Knudsen, Lars; Kirkegaard, Hans

2018-03-27

Trauma is a leading cause of death among adults aged facilities and the use multidisciplinary trauma teams. Because knowledge is sparse on the existing distribution of trauma facilities and the organisation of trauma care in Denmark, the aim of this study was to identify all Danish facilities that care for traumatized patients and to investigate the diversity in organization of trauma management. We conducted a systematic observational cross-sectional study. First, all hospitals in Denmark were identified via online services and clarifying phone calls to each facility. Second, all trauma care manuals on all facilities that receive traumatized patients were gathered. Third, anesthesiologists and orthopedic surgeons on call at all trauma facilities were contacted via telephone for structured interviews. A total of 22 facilities in Denmark were found to receive traumatized patients. All facilities used a trauma care manual and all had a multidisciplinary trauma team. The study found three different trauma team activation criteria and nine different compositions of teams who participate in trauma care. Training was heterogeneous and, beyond the major trauma centers, databases were only maintained in a few facilities. The study established an inventory of the existing Danish facilities that receive traumatized patients. The trauma team activation criteria and the trauma teams were heterogeneous in both size and composition. A national database for traumatized patients, research on nationwide trauma team activation criteria, and team composition guidelines are all called for.

Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities.

Science.gov (United States)

Bhuyan, Soumitra S; Zhu, He; Chandak, Aastha; Kim, Jungyoon; Stimpson, Jim P

2014-12-01

Healthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs. We used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs. In 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09-1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00-1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption. Our findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients' records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in

A simultaneous facility location and vehicle routing problem arising in health care logistics in the Netherlands

NARCIS (Netherlands)

Veenstra, Marjolein; Roodbergen, Kees Jan; Coelho, Leandro C.; Zhu, Stuart X.

2018-01-01

This paper introduces a simultaneous facility location and vehicle routing problem that arises in health care logistics in the Netherlands. In this problem, the delivery of medication from a local pharmacy can occur via lockers, from where patients that are within the coverage distance of a locker

Job Satisfactions of Nurses and Physicians Working in the Same Health Care Facility in Turkey

OpenAIRE

Züleyha Alper; Đlker Ercan; Güven Özkaya; Neriman Akansel

2011-01-01

Background: Job satisfaction is defined as the degree to which employees like or enjoy their jobs and the degreeof satisfaction is based on the importance placed upon this reward and benefit.Objective: Aim of this study was to determine the job satisfaction levels of nurses and physicians working in thesame health care facility, analyze the factors that may affect job satisfaction levels. This study was conducted asa descriptive study and was carried out in one Medical Care Center Northwester...

A medical facility proposal to use the SSC linac

International Nuclear Information System (INIS)

Funk, L.W.

1995-01-01

A consortium organized by the Texas National Research Laboratory Commission (TNRLC) under a Department of Energy (DOE) grant proposes to build and operate a Regional Medical Technology Center (RMTC) to function as a combined medical radioisotope production complex and proton cancer therapy facility using the linear accelerator (linac) assets of the cancelled Superconducting Super Collider (SSC). The radioisotope production complex will serve as a domestic source of radioisotopes critically needed by the U.S. pharmaceutical industry and nuclear medicine facilities throughout North America. Presently, more than 70 percent of radioisotopes used in U.S. nuclear medicine procedures are produced outside the country. The Center's state-of-the-art proton cancer therapy facility will serve the Central United States, providing advanced capabilities and augmenting facilities in California and Massachusetts. Long-term, it is anticipated that the RMTC also will stimulate nuclear medicine research, advance medical diagnostic technologies, and generate new industrial applications of linear accelerator technology. (orig.)

A medical facility proposal to use the SSC linac

Science.gov (United States)

Warren Funk, L.

1995-05-01

A consortium organized by the Texas National Research Laboratory Commission (TNRLC) under a Department of Energy (DOE) grant proposes to build and operate a Regional Medical Technology Center (RMTC) to function as a combined medical radioisotope production complex and proton cancer therapy facility using the linear accelerator (linac) assets of the cancelled Superconducting Super Collider (SSC). The radioisotope production complex will serve as a domestic source of radioisotopes critically needed by the U.S. pharmaceutical industry and nuclear medicine facilities throughout North America. Presently, more than 70 percent of radioisotopes used in U.S. nuclear medicine procedures are produced outside the country. The Center's state-of-the-art proton cancer therapy facility will serve the Central United States, providing advanced capabilities and augmenting facilities in California and Massachusetts. Long-term, it is anticipated that the RMTC also will stimulate nuclear medicine research, advance medical diagnostic technologies, and generate new industrial applications of linear accelerator technology.

The economics of health care quality and medical errors.

Science.gov (United States)

Andel, Charles; Davidow, Stephen L; Hollander, Mark; Moreno, David A

2012-01-01

Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality rates with $1.1 billion or 10 million days of lost productivity from missed work based on short-term disability claims. The authors estimate that the economic impact is much higher, perhaps nearly $1 trillion annually when quality-adjusted life years (QALYs) are applied to those that die. Using the Institute of Medicine's (IOM) estimate of 98,000 deaths due to preventable medical errors annually in its 1998 report, To Err Is Human, and an average of ten lost years of life at $75,000 to $100,000 per year, there is a loss of $73.5 billion to $98 billion in QALYs for those deaths--conservatively. These numbers are much greater than those we cite from studies that explore the direct costs of medical errors. And if the estimate of a recent Health Affairs article is correct-preventable death being ten times the IOM estimate-the cost is $735 billion to $980 billion. Quality care is less expensive care. It is better, more efficient, and by definition, less wasteful. It is the right care, at the right time, every time. It should mean that far fewer patients are harmed or injured. Obviously, quality care is not being delivered consistently throughout U.S. hospitals. Whatever the measure, poor quality is costing payers and

Payment methods for outpatient care facilities

Science.gov (United States)

Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

2017-01-01

Background Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. Objectives To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Selection criteria Randomised

Facilities for Research and Development of Medical Radioisotopes

International Nuclear Information System (INIS)

Shin, Byung Chul; Choung, Won Myung; Park, Jin Ho

2003-03-01

This study is carried out by KAERI(Korea Atomic Energy Research Institute) to construct the basic facilities for development and production of medical radioisotope. For the characteristics of radiopharmaceuticals, the facilities should be complied with the radiation shield and GMP(Good Manufacturing Practice) guideline. The KAERI, which has carried out the research and development of the radiopharmaceuticals, made a design of these facilities and built them in the HANARO Center and opened the technique and facilities to the public to give a foundation for research and development of the radiopharmaceuticals. In the facilities, radiation shielding utilities and GMP instruments were set up and their operating manuals were documented. Every utilities and instruments were performed the test to confirm their efficiency and the approval for use of the facilities will be achieved from MOST(Ministry of Science and Technology). It is expected to be applied in development of therapeutic radioisotope such as Re-188 generator and Ho-166, as well as Tc-99m generator and Sr-89 chloride for medical use. And it also looks forward to the contribution to the related industry through the development of product in high demand and value

Winning market positioning strategies for long term care facilities.

Science.gov (United States)

Higgins, L F; Weinstein, K; Arndt, K

1997-01-01

The decision to develop an aggressive marketing strategy for its long term care facility has become a priority for the management of a one-hundred bed facility in the Rocky Mountain West. Financial success and lasting competitiveness require that the facility in question (Deer Haven) establish itself as the preferred provider of long term care for its target market. By performing a marketing communications audit, Deer Haven evaluated its present market position and created a strategy for solidifying and dramatizing this position. After an overview of present conditions in the industry, we offer a seven step process that provides practical guidance for positioning a long term care facility. We conclude by providing an example application.

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

Directory of Open Access Journals (Sweden)

Naoko Kozuki

Full Text Available This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing

Health facility service availability and readiness for intrapartum and immediate postpartum care in Malawi: A cross-sectional survey.

Science.gov (United States)

Kozuki, Naoko; Oseni, Lolade; Mtimuni, Angella; Sethi, Reena; Rashidi, Tambudzai; Kachale, Fannie; Rawlins, Barbara; Gupta, Shivam

2017-01-01

This analysis seeks to identify strengths and gaps in the existing facility capacity for intrapartum and immediate postpartum fetal and neonatal care, using data collected as a part of Malawi's Helping Babies Breath program evaluation. From August to September 2012, the Maternal and Child Health Integrated Program (MCHIP) conducted a cross-sectional survey in 84 Malawian health facilities to capture current health facility service availability and readiness and health worker capacity and practice pertaining to labor, delivery, and immediate postpartum care. The survey collected data on availability of equipment, supplies, and medications, and health worker knowledge and performance scores on intrapartum care simulation and actual management of real clients at a subset of facilities. We ran linear regression models to identify predictors of high simulation performance of routine delivery care and management of asphyxiated newborns across all facilities surveyed. Key supplies for infection prevention and thermal care of the newborn were found to be missing in many of the surveyed facilities. At the health center level, 75% had no clinician trained in basic emergency obstetric care or newborn care and 39% had no midwife trained in the same. We observed that there were no proportional increases in available transport and staff at a facility as catchment population increased. In simulations of management of newborns with breathing problems, health workers were able to complete a median of 10 out of 16 tasks for a full-term birth case scenario and 20 out of 30 tasks for a preterm birth case scenario. Health workers who had more years of experience appeared to perform worse. Our study provides a benchmark and highlights gaps for future evaluations and studies as Malawi continues to make strides in improving facility-based care. Further progress in reducing the burden of neonatal and fetal death in Malawi will be partly predicated on guaranteeing properly equipped and

Medical Isotope Production Analyses In KIPT Neutron Source Facility

International Nuclear Information System (INIS)

Talamo, Alberto; Gohar, Yousry

2016-01-01

Medical isotope production analyses in Kharkov Institute of Physics and Technology (KIPT) neutron source facility were performed to include the details of the irradiation cassette and the self-shielding effect. An updated detailed model of the facility was used for the analyses. The facility consists of an accelerator-driven system (ADS), which has a subcritical assembly using low-enriched uranium fuel elements with a beryllium-graphite reflector. The beryllium assemblies of the reflector have the same outer geometry as the fuel elements, which permits loading the subcritical assembly with different number of fuel elements without impacting the reflector performance. The subcritical assembly is driven by an external neutron source generated from the interaction of 100-kW electron beam with a tungsten target. The facility construction was completed at the end of 2015, and it is planned to start the operation during the year of 2016. It is the first ADS in the world, which has a coolant system for removing the generated fission power. Argonne National Laboratory has developed the design concept and performed extensive design analyses for the facility including its utilization for the production of different radioactive medical isotopes. 99 Mo is the parent isotope of 99m Tc, which is the most commonly used medical radioactive isotope. Detailed analyses were performed to define the optimal sample irradiation location and the generated activity, for several radioactive medical isotopes, as a function of the irradiation time.

Medical Isotope Production Analyses In KIPT Neutron Source Facility

Energy Technology Data Exchange (ETDEWEB)

Talamo, Alberto [Argonne National Lab. (ANL), Argonne, IL (United States); Gohar, Yousry [Argonne National Lab. (ANL), Argonne, IL (United States)

2016-01-01

Medical isotope production analyses in Kharkov Institute of Physics and Technology (KIPT) neutron source facility were performed to include the details of the irradiation cassette and the self-shielding effect. An updated detailed model of the facility was used for the analyses. The facility consists of an accelerator-driven system (ADS), which has a subcritical assembly using low-enriched uranium fuel elements with a beryllium-graphite reflector. The beryllium assemblies of the reflector have the same outer geometry as the fuel elements, which permits loading the subcritical assembly with different number of fuel elements without impacting the reflector performance. The subcritical assembly is driven by an external neutron source generated from the interaction of 100-kW electron beam with a tungsten target. The facility construction was completed at the end of 2015, and it is planned to start the operation during the year of 2016. It is the first ADS in the world, which has a coolant system for removing the generated fission power. Argonne National Laboratory has developed the design concept and performed extensive design analyses for the facility including its utilization for the production of different radioactive medical isotopes. ⁹⁹Mo is the parent isotope of ^99mTc, which is the most commonly used medical radioactive isotope. Detailed analyses were performed to define the optimal sample irradiation location and the generated activity, for several radioactive medical isotopes, as a function of the irradiation time.

Development and validation of fall risk screening tools for use in residential aged care facilities.

Science.gov (United States)

Delbaere, Kim; Close, Jacqueline C T; Menz, Hylton B; Cumming, Robert G; Cameron, Ian D; Sambrook, Philip N; March, Lyn M; Lord, Stephen R

2008-08-18

To develop screening tools for predicting falls in nursing home and intermediate-care hostel residents who can and cannot stand unaided. Prospective cohort study in residential aged care facilities in northern Sydney, New South Wales, June 1999-June 2003. 2005 people aged 65-104 years (mean +/- SD, 85.7+/-7.1 years). Demographic, health, and physical function assessment measures; number of falls over a 6-month period; validity of the screening models. Ability to stand unaided was identified as a significant event modifier for falls. In people who could stand unaided, having either poor balance or two of three other risk factors (previous falls, nursing home residence, and urinary incontinence) increased the risk of falling in the next 6 months threefold (sensitivity, 73%; specificity, 55%). In people who could not stand unaided, having any one of three risk factors (previous falls, hostel residence, and using nine or more medications) increased the risk of falling twofold (sensitivity, 87%; specificity, 29%). These two screening models are useful for identifying older people living in residential aged care facilities who are at increased risk of falls. The screens are easy to administer and contain items that are routinely collected in residential aged care facilities in Australia.

Awareness of Racial Disparities in Kidney Transplantation among Health Care Providers in Dialysis Facilities.

Science.gov (United States)

Kim, Joyce J; Basu, Mohua; Plantinga, Laura; Pastan, Stephen O; Mohan, Sumit; Smith, Kayla; Melanson, Taylor; Escoffery, Cam; Patzer, Rachel E

2018-05-07

Despite the important role that health care providers at dialysis facilities have in reducing racial disparities in access to kidney transplantation in the United States, little is known about provider awareness of these disparities. We aimed to evaluate health care providers' awareness of racial disparities in kidney transplant waitlisting and identify factors associated with awareness. We conducted a cross-sectional analysis of a survey of providers from low-waitlisting dialysis facilities ( n =655) across all 18 ESRD networks administered in 2016 in the United States merged with 2014 US Renal Data System and 2014 US Census data. Awareness of national racial disparity in waitlisting was defined as responding "yes" to the question: "Nationally, do you think that African Americans currently have lower waitlisting rates than white patients on average?" The secondary outcome was providers' perceptions of racial difference in waitlisting at their own facilities. Among 655 providers surveyed, 19% were aware of the national racial disparity in waitlisting: 50% (57 of 113) of medical directors, 11% (35 of 327) of nurse managers, and 16% (35 of 215) of other providers. In analyses adjusted for provider and facility characteristics, nurse managers (versus medical directors; odds ratio, 7.33; 95% confidence interval, 3.35 to 16.0) and white providers (versus black providers; odds ratio, 2.64; 95% confidence interval, 1.39 to 5.02) were more likely to be unaware of a national racial disparity in waitlisting. Facilities in the South (versus the Northeast; odds ratio, 3.05; 95% confidence interval, 1.04 to 8.94) and facilities with a low percentage of blacks (versus a high percentage of blacks; odds ratio, 1.86; 95% confidence interval, 1.02 to 3.39) were more likely to be unaware. One quarter of facilities had >5% racial difference in waitlisting within their own facilities, but only 5% were aware of the disparity. Among a limited sample of dialysis facilities with low

APSIC guidelines for disinfection and sterilization of instruments in health care facilities

Directory of Open Access Journals (Sweden)

Moi Lin Ling

2018-02-01

Full Text Available Abstract Background The Asia Pacific Society of Infection Control launched its revised Guidelines for Disinfection and Sterilization of Instruments in Health Care Facilities in February 2017. This document describes the guidelines and recommendations for the reprocessing of instruments in healthcare setting. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in sterilization and disinfection. Method The guidelines were revised by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results It recommends the centralization of reprocessing, training of all staff with annual competency assessment, verification of cleaning, continual monitoring of reprocessing procedures to ensure their quality and a corporate strategy for dealing with single-use and single-patient use medical equipment/devices. Detailed recommendations are also given with respect to reprocessing of endoscopes. Close working with the Infection Prevention & Control department is also recommended where decisions related to reprocessing medical equipment/devices are to be made. Conclusions Sterilization facilities should aim for excellence in practices as this is part of patient safety. The guidelines that come with a checklist help service providers identify gaps for improvement to reach this goal.

Factors promoting resident deaths at aged care facilities in Japan: a review.

Science.gov (United States)

Sugimoto, Kentaro; Ogata, Yasuko; Kashiwagi, Masayo

2018-03-01

Due to an increasingly ageing population, the Japanese government has promoted elderly deaths in aged care facilities. However, existing facilities were not designed to provide resident end-of-life care and the proportion of aged care facility deaths is currently less than 10%. Consequently, the present review evaluated the factors that promote aged care facility resident deaths in Japan from individual- and facility-level perspectives to exploring factors associated with increased resident deaths. To achieve this, MEDLINE, CINAHL, Web of Science and Ichushi databases were searched on 23 January 2016. Influential factors were reviewed for two healthcare services (insourcing and outsourcing facilities) as well as external healthcare agencies operating outside facilities. Of the original 2324 studies retrieved, 42 were included in analysis. Of these studies, five focused on insourcing, two on outsourcing, seven on external agencies and observed facility/agency-level factors. The other 28 studies identified individual-level factors related to death in aged care facilities. The present review found that at both facility and individual levels, in-facility resident deaths were associated with healthcare service provision, confirmation of resident/family end-of-life care preference and staff education. Additionally, while outsourcing facilities did not require employment of physicians/nursing staff to accommodate resident death, these facilities required visits by physicians and nursing staff from external healthcare agencies as well as residents' healthcare input. This review also found few studies examining outsourcing facilities. The number of healthcare outsourcing facilities is rapidly increasing as a result of the Japanese government's new tax incentives. Consequently, there may be an increase in elderly deaths in outsourcing healthcare facilities. Accordingly, it is necessary to identify the factors associated with residents' deaths at outsourcing facilities. �

Organisational culture in residential aged care facilities: a cross-sectional observational study.

Science.gov (United States)

Etherton-Beer, Christopher; Venturato, Lorraine; Horner, Barbara

2013-01-01

Organisational culture is increasingly recognised as important for provision of high-quality long-term care. We undertook this study to measure organisational culture in residential aged care facilities in two Australian states. Cross-sectional observational study in 21 residential aged care facilities in Western Australia (n = 14) and Queensland (n = 7), Australia. Staff and next-of-kin of residents participated. Measurement comprised surveys of facility staff and residents' next-of-kin, and structured observation of indicators of care quality. Staff tended to rate organisational culture positively. Some qualitative feedback from staff emphasised negative perceptions of communication, leadership and teamwork. Staffing levels were perceived as a dominant challenge, threatening care quality. Direct observation revealed variability within and between facilities but suggested that most facilities (n = 12) were in the typical range, or were quality facilities (n = 8). There was scope to strengthen organisational culture in participating aged care facilities.

Influenza in long-term care facilities.

Science.gov (United States)

Lansbury, Louise E; Brown, Caroline S; Nguyen-Van-Tam, Jonathan S

2017-09-01

Long-term care facility environments and the vulnerability of their residents provide a setting conducive to the rapid spread of influenza virus and other respiratory pathogens. Infections may be introduced by staff, visitors or new or transferred residents, and outbreaks of influenza in such settings can have devastating consequences for individuals, as well as placing extra strain on health services. As the population ages over the coming decades, increased provision of such facilities seems likely. The need for robust infection prevention and control practices will therefore remain of paramount importance if the impact of outbreaks is to be minimised. In this review, we discuss the nature of the problem of influenza in long-term care facilities, and approaches to preventive and control measures, including vaccination of residents and staff, and the use of antiviral drugs for treatment and prophylaxis, based on currently available evidence. © 2017 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Study of the Relevance of the Quality of Care, Operating Efficiency and Inefficient Quality Competition of Senior Care Facilities.

Science.gov (United States)

Lin, Jwu-Rong; Chen, Ching-Yu; Peng, Tso-Kwei

2017-09-11

The purpose of this research is to examine the relation between operating efficiency and the quality of care of senior care facilities. We designed a data envelopment analysis, combining epsilon-based measure and metafrontier efficiency analyses to estimate the operating efficiency for senior care facilities, followed by an iterative seemingly unrelated regression to evaluate the relation between the quality of care and operating efficiency. In the empirical studies, Taiwan census data was utilized and findings include the following: Despite the greater operating scale of the general type of senior care facilities, their average metafrontier technical efficiency is inferior to that of nursing homes. We adopted senior care facility accreditation results from Taiwan as a variable to represent the quality of care and examined the relation of accreditation results and operating efficiency. We found that the quality of care of general senior care facilities is negatively related to operating efficiency; however, for nursing homes, the relationship is not significant. Our findings show that facilities invest more in input resources to obtain better ratings in the accreditation report. Operating efficiency, however, does not improve. Quality competition in the industry in Taiwan is inefficient, especially for general senior care facilities.

WASH and gender in health care facilities: The uncharted territory.

Science.gov (United States)

Kohler, Petra; Renggli, Samuel; Lüthi, Christoph

2017-11-08

Health care facilities in low- and middle-income countries are high-risk settings, and face special challenges to achieving sustainable water, sanitation, and hygiene (WASH) services. Our applied interdisciplinary research conducted in India and Uganda analyzed six dimensions of WASH services in selected health care facilities, including menstrual hygiene management. To be effective, WASH monitoring strategies in health care facilities must include gender sensitive measures. We present a novel strategy, showing that applied gender sensitive multitool assessments are highly productive in assessments of WASH services and facilities from user and provider perspectives. We discuss its potential for applications at scale and as an area of future research.

The Medical Cyclotron Facility in RMC, Parel, BARC

International Nuclear Information System (INIS)

Gopalakrishna, Arjun; Banerjee, Sharmila

2017-01-01

The Medical Cyclotron Facility in Radiation Medicine Centre (RMC) is the first one of its kind, installed in 2002. "1"8F based radiotracers are produced in this facility on a routine basis for Positron Emission Tomography (PET), of in-house patients, as well as for supply to other nuclear medicine centers in Mumbai as well as Pune. The facility consists of the following sub parts - Cyclotron and support equipment; Radiochemistry synthesis laboratory; Quality control (QC) laboratory

Development by a Large Integrated Health Care System of an Objective Methodology for Evaluation of Medical Oncology Service Sites.

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Bjegovich-Weidman, Marija; Kahabka, Jill; Bock, Amy; Frick, Jacob; Kowalski, Helga; Mirro, Joseph

2012-03-01

Aurora Health Care (AHC) is the largest health care system in Wisconsin, with 14 acute care hospitals. In early 2010, a group of 18 medical oncologists became affiliated with AHC. This affiliation added 13 medical oncology infusion clinics to our existing 12 sites. In the era of health care reform and declining reimbursement, we need an objective method and criteria to evaluate our 25 outpatient medical oncology sites. We developed financial, clinical, and strategic tools for the evaluation and management of our cancer subservice lines and outpatient sites. The key to our success has been the direct involvement of stakeholders with a vested interest in the services in the selection of the criteria and evaluation process. We developed our objective metrics for evaluation based on strategic, financial, operational, and patient experience criteria. Strategic criteria included: population trends, full-time equivalent (FTE) medical oncologists/primary care physicians, FTE radiation oncologists, FTE oncologic surgeons, new annual cases of patients with cancer, and market share trends. Financial criteria per site included: physician work relative value units, staff FTE by type, staff salaries, and profit and loss. Operational criteria included: facility by type (clinic v hospital based), hours of operation, and facility detail (eg, No. of chairs, No. of procedure and examination rooms, square footage). Patient experience criteria included: nursing model primary/nurse navigators, multidisciplinary support at site, Press Ganey (South Bend, IN; health care performance improvement company) results, and employee engagement score. The outcome of our data analysis has resulted in the development of recommendations for AHC senior leadership and geographic market leadership to consider the consolidation of four sites (phase one, four sites; phase two, two sites) and priority strategic sites to address capacity issues that limit growth. The recommendations if implemented would

Redefining "Medical Care."

Science.gov (United States)

Roth, Lauren R

President Donald J. Trump has said he will repeal the Affordable Care Act (ACA) and replace it with health savings accounts (HSAs). Conservatives have long preferred individual accounts to meet social welfare needs instead of more traditional entitlement programs. The types of "medical care" that can be reimbursed through an HSA are listed in section 213(d) of the Internal Revenue Code (Code) and include expenses "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." In spite of the broad language, regulations and court interpretations have narrowed this definition substantially. It does not include the many social factors that determine health outcomes. Though the United States spends over seventeen percent of gross domestic product (GDP) on "healthcare", the country's focus on the traditional medicalized model of health results in overall population health that is far beneath the results of other countries that spend significantly less. Precision medicine is one exceptional way in which American healthcare has focused more on individuals instead of providing broad, one-size-fits-all medical care. The precision medicine movement calls for using the genetic code of individuals to both predict future illness and to target treatments for current illnesses. Yet the definition of "medical care" under the Code remains the same for all. My proposal for precision healthcare accounts involves two steps-- the first of which requires permitting physicians to write prescriptions for a broader range of goods and services. The social determinants of health are as important to health outcomes as are surgical procedures and drugs--or perhaps more so according to many population health studies. The second step requires agencies and courts to interpret what constitutes "medical care" under the Code differently depending on the taxpayer's income level. Childhood sports programs and payments

Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand.

Directory of Open Access Journals (Sweden)

Nithra Kitreerawutiwong

Full Text Available Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district health promotion hospitals (THPHs were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2.A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district health promotion hospitals (THPHs led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses.THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30, followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06. THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22.Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas.

Improving water, sanitation and hygiene in health-care facilities, Liberia.

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Abrampah, Nana Mensah; Montgomery, Maggie; Baller, April; Ndivo, Francis; Gasasira, Alex; Cooper, Catherine; Frescas, Ruben; Gordon, Bruce; Syed, Shamsuzzoha Babar

2017-07-01

The lack of proper water and sanitation infrastructures and poor hygiene practices in health-care facilities reduces facilities' preparedness and response to disease outbreaks and decreases the communities' trust in the health services provided. To improve water and sanitation infrastructures and hygiene practices, the Liberian health ministry held multistakeholder meetings to develop a national water, sanitation and hygiene and environmental health package. A national train-the-trainer course was held for county environmental health technicians, which included infection prevention and control focal persons; the focal persons acted as change agents. In Liberia, only 45% of 701 surveyed health-care facilities had an improved water source in 2015, and only 27% of these health-care facilities had proper disposal for infectious waste. Local ownership, through engagement of local health workers, was introduced to ensure development and refinement of the package. In-county collaborations between health-care facilities, along with multisectoral collaboration, informed national level direction, which led to increased focus on water and sanitation infrastructures and uptake of hygiene practices to improve the overall quality of service delivery. National level leadership was important to identify a vision and create an enabling environment for changing the perception of water, sanitation and hygiene in health-care provision. The involvement of health workers was central to address basic infrastructure and hygiene practices in health-care facilities and they also worked as stimulators for sustainable change. Further, developing a long-term implementation plan for national level initiatives is important to ensure sustainability.

The association between the physical environment and the well-being of older people in residential care facilities: A multilevel analysis.

Science.gov (United States)

Nordin, Susanna; McKee, Kevin; Wijk, Helle; Elf, Marie

2017-12-01

To investigate the associations between the quality of the physical environment and the psychological and social well-being of older people living in residential care facilities. Many older people in care facilities have cognitive and physical frailties and are at risk of experiencing low levels of well-being. High-quality physical environments can support older people as frailty increases and promote their well-being. Although the importance of the physical environment for residents' well-being is recognized, more research is needed. A cross-sectional survey of 20 care facilities from each of which 10 residents were sampled. As the individual resident data were nested in the facilities, a multilevel analysis was conducted. Data were collected during 2013 and 2014. The care facilities were purposely sampled to ensure a high level of variation in their physical characteristics. Residents' demographic and health data were collected via medical records and interviews. Residents' well-being and perceived quality of care were assessed via questionnaires and interviews. Environmental quality was assessed with a structured observational instrument. Multilevel analysis indicated that cognitive support in the physical environment was associated with residents' social well-being, after controlling for independence and perceived care quality. However, no significant association was found between the physical environment and residents' psychological well-being. Our study demonstrates the role of the physical environment for enhancing the social well-being of frail older people. Professionals and practitioners involved in the design of care facilities have a responsibility to ensure that such facilities meet high-quality specifications. © 2017 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South AfricaExperiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

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Dudu G. Sokhela

2013-07-01

Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans.Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service.Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed.Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

Seeking health care through international medical tourism.

Science.gov (United States)

Eissler, Lee Ann; Casken, John

2013-06-01

The purpose of this study was the exploration of international travel experiences for the purpose of medical or dental care from the perspective of patients from Alaska and to develop insight and understanding of the essence of the phenomenon of medical tourism. The study is conceptually oriented within a model of health-seeking behavior. Using a qualitative design, 15 Alaska medical tourists were individually interviewed. The data were analyzed using a hermeneutic process of inquiry to uncover the meaning of the experience. Six themes reflecting the experiences of Alaska medical tourists emerged: "my motivation," "I did the research," "the medical care I need," "follow-up care," "the advice I give," and "in the future." Subthemes further categorized data for increased understanding of the phenomenon. The thematic analysis provides insight into the experience and reflects a modern approach to health-seeking behavior through international medical tourism. The results of this study provide increased understanding of the experience of obtaining health care internationally from the patient perspective. Improved understanding of medical tourism provides additional information about a contemporary approach to health-seeking behavior. Results of this study will aid nursing professionals in counseling regarding medical tourism options and providing follow-up health care after medical tourism. Nurses will be able to actively participate in global health policy discussions regarding medical tourism trends. © 2013 Sigma Theta Tau International.

Piloting community-based medical care for survivors of sexual assault in conflict-affected Karen State of eastern Burma.

Science.gov (United States)

Tanabe, Mihoko; Robinson, Keely; Lee, Catherine I; Leigh, Jen A; Htoo, Eh May; Integer, Naw; Krause, Sandra K

2013-05-21

Given the challenges to ensuring facility-based care in conflict settings, the Women's Refugee Commission and partners have been pursuing a community-based approach to providing medical care to survivors of sexual assault in Karen State, eastern Burma. This new model translates the 2004 World Health Organization's Clinical Management of Rape Survivors facility-based protocol to the community level through empowering community health workers to provide post-rape care. The aim of this innovative study is to examine the safety and feasibility of community-based medical care for survivors of sexual assault to contribute to building an evidence base on alternative models of care in humanitarian settings. A process evaluation was implemented from July-October 2011 to gather qualitative feedback from trained community health workers, traditional birth attendants, and community members. Two focus group discussions were conducted among the highest cadre health care workers from the pilot and non-pilot sites. In Karen State, eight focus group discussions were convened among traditional birth attendants and 10 among women and men of reproductive age. Qualitative feedback contributed to an understanding of the model's feasibility. Pilot site community health workers showed interest in providing community-based care for survivors of sexual assault. Traditional birth attendants attested to the importance of making this care available. Community health workers were deeply aware of the need to maintain confidentiality and offer compassionate care. They did not raise safety as an excess concern in the provision of treatment. Data speak to the promising "feasibility" of community-based post-rape care. More time, awareness-raising, and a larger catchment population are necessary to answer the safety perspective. The pilot is an attempt to translate facility-based protocol to the community level to offer solutions for settings where traditional methods of post-rape care are not

Accountable care organization readiness and academic medical centers.

Science.gov (United States)

Berkowitz, Scott A; Pahira, Jennifer J

2014-09-01

As academic medical centers (AMCs) consider becoming accountable care organizations (ACOs) under Medicare, they must assess their readiness for this transition. Of the 253 Medicare ACOs prior to 2014, 51 (20%) are AMCs. Three critical components of ACO readiness are institutional and ACO structure, leadership, and governance; robust information technology and analytic systems; and care coordination and management to improve care delivery and health at the population level. All of these must be viewed through the lens of unique AMC mission-driven goals.There is clear benefit to developing and maintaining a centralized internal leadership when it comes to driving change within an ACO, yet there is also the need for broad stakeholder involvement. Other important structural features are an extensive primary care foundation; concomitant operation of a managed care plan or risk-bearing entity; or maintaining a close relationship with post-acute-care or skilled nursing facilities, which provide valuable expertise in coordinating care across the continuum. ACOs also require comprehensive and integrated data and analytic systems that provide meaningful population data to inform care teams in real time, promote quality improvement, and monitor spending trends. AMCs will require proven care coordination and management strategies within a population health framework and deployment of an innovative workforce.AMC core functions of providing high-quality subspecialty and primary care, generating new knowledge, and training future health care leaders can be well aligned with a transition to an ACO model. Further study of results from Medicare-related ACO programs and commercial ACOs will help define best practices.

Cost recovery of NGO primary health care facilities: a case study in Bangladesh

OpenAIRE

Alam, Khurshid; Ahmed, Shakil

2010-01-01

Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC), a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Give...

Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

Science.gov (United States)

Berendes, Sima; Lako, Richard L; Whitson, Donald; Gould, Simon; Valadez, Joseph J

2014-10-01

We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states. © 2014 John Wiley & Sons Ltd.

Undergraduate medical education in emergency medical care: a nationwide survey at German medical schools.

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Beckers, Stefan K; Timmermann, Arnd; Müller, Michael P; Angstwurm, Matthias; Walcher, Felix

2009-05-12

Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21); problem-based learning at 29% (n = 10), e-learning at 3% (n = 1), and internship in ambulance service is mandatory at 11% (n = 4). In terms of assessment methods, multiple-choice exams (15 to 70 questions) are favoured (89%, n = 31), partially supplemented by open questions (31%, n = 11). Some faculties also perform single practical tests (43%, n = 15), objective structured clinical examination (OSCE; 29%, n = 10) or oral examinations (17%, n = 6). Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education in emergency medical care.

Undergraduate medical education in emergency medical care: A nationwide survey at German medical schools

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Timmermann Arnd

2009-05-01

Full Text Available Abstract Background Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Methods Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Results Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21; problem-based learning at 29% (n = 10, e-learning at 3% (n = 1, and internship in ambulance service is mandatory at 11% (n = 4. In terms of assessment methods, multiple-choice exams (15 to 70 questions are favoured (89%, n = 31, partially supplemented by open questions (31%, n = 11. Some faculties also perform single practical tests (43%, n = 15, objective structured clinical examination (OSCE; 29%, n = 10 or oral examinations (17%, n = 6. Conclusion Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard

Fear and overprotection in Australian residential aged-care facilities: The inadvertent impact of regulation on quality continence care.

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Ostaszkiewicz, Joan; O'Connell, Beverly; Dunning, Trisha

2016-06-01

Most residents in residential aged-care facilities are incontinent. This study explored how continence care was provided in residential aged-care facilities, and describes a subset of data about staffs' beliefs and experiences of the quality framework and the funding model on residents' continence care. Using grounded theory methodology, 18 residential aged-care staff members were interviewed and 88 hours of field observations conducted in two facilities. Data were analysed using a combination of inductive and deductive analytic procedures. Staffs' beliefs and experiences about the requirements of the quality framework and the funding model fostered a climate of fear and risk adversity that had multiple unintended effects on residents' continence care, incentivising dependence on continence management, and equating effective continence care with effective pad use. There is a need to rethink the quality of continence care and its measurement in Australian residential aged-care facilities. © 2015 AJA Inc.

LDS hospital, a facility of Intermountain Health Care, Salt Lake City, Utah.

Science.gov (United States)

Peck, M; Nelson, N; Buxton, R; Bushnell, J; Dahle, M; Rosebrock, B; Ashton, C A

1997-01-01

On-line documentation by nurses and a comprehensive text management system are functional in several facilities of intermountain Health Care (IHC). The following articles detail factors in the design and implementation of this computerized network as experienced at LDS Hospital, part of the IHC system. Areas discussed are the system's applications for medical decision support, communication, patient classification, nurse staffing versus cost, emergency department usage, patient problem/event recording, clinical outcomes, and text publication. Users express satisfaction with the time saving, consistency of reporting, and cohesiveness of these applications.

Leading by walking around in long-term care and transitional care facilities.

Science.gov (United States)

Kemerer, Douglas; Cwiekala-Lewis, Klaudia

2017-05-30

Nursing staff in long-term care/transitional care (LTC/TC) facilities in the US work in unique environments that can be stressful and demanding. There is much in the literature that describes different leadership styles in nursing, but a limited amount on leadership in LTC/TC environments. This article explores the concept of leading by walking around (LBWA), also known as leadership by walking, to cultivate therapeutic work environments in LTC/TC facilities in the US. It defines therapeutic work environments and describes the specific environment of LTC/TC facilities. It also briefly describes the nursing hierarchy and nurse education in the US. Finally, it describes the cultivation of therapeutic work environments by using LBWA and includes two examples of the concept in action.

[The effects of multimedia-assisted instruction on the skin care learning of nurse aides in long-term care facilities].

Science.gov (United States)

Wu, Yu-Ling; Kao, Yu-Hsiu

2014-08-01

Skin care is an important responsibility of nurse aides in long-term care facilities, and the nursing knowledge, attitudes, and skills of these aides significantly affects quality of care. However, the work schedule of nurse aides often limits their ability to obtain further education and training. Therefore, developing appropriate and effective training programs for nurse aides is critical to maintaining and improving quality of care in long-term care facilities. This study investigates the effects of multimedia assisted instruction on the skin care learning of nurse aides working in long-term care facilities. A quasi-experimental design and convenient sampling were adopted in this study. Participants included 96 nurse aides recruited from 5 long-term care facilities in Taoyuan County, Taiwan. The experimental group received 3 weeks of multimedia assisted instruction. The control group did not receive this instruction. The Skin Care Questionnaire for Nurse Aides in Long-term Care Facilities and the Skin Care Behavior Checklist were used for assessment before and after the intervention. (1) Posttest scores for skin care knowledge, attitudes, behavior, and the skin care checklist were significantly higher than pretest scores for the intervention group. There was no significant difference between pretest and posttest scores for the control group. (2) A covariance analysis of pretest scores for the two groups showed that the experimental group earned significantly higher average scores than their control group peers for skin care knowledge, attitudes, behavior, and the skin care checklist. The multimedia assisted instruction demonstrated significant and positive effects on the skin care leaning of nurse aides in long-term care facilities. This finding supports the use of multimedia assisted instruction in the education and training of nurse aides in long-term care facilities in the future.

Factors influencing deprescribing for residents in Advanced Care Facilities: insights from General Practitioners in Australia and Sweden.

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Bolmsjö, Beata Borgström; Palagyi, Anna; Keay, Lisa; Potter, Jan; Lindley, Richard I

2016-11-05

General Practitioners (GPs) are responsible for primary prescribing decisions in most settings. Elderly patients living in Advanced Care Facilities (ACFs) often have significant co-morbidities to consider when selecting an appropriate drug therapy. Careful assessment is required when considering appropriate medication use in frail older patients as they have multiple diseases and thus multiple medication. Many physicians seem reluctant to discontinue other physicians' prescriptions, resulting in further polypharmacy. Therefore it is relevant to ascertain and synthesise the GP views from multiple settings to understand the processes that might promote appropriate deprescribing medications in the elderly. The aims of this study were to 1) compare and contrast behavioural factors influencing the deprescribing practices of GPs providing care for ACF residents in two separate countries, 2) review health policy and ACF systems in each setting for their potential impact on the prescribing of medications for an older person in residential care of the elderly, and 3) based on these findings, provide recommendations for future ACF deprescribing initiatives. A review and critical synthesis of qualitative data from two interview studies of knowledge, attitudes, and behavioural practices held by GPs towards medication management and deprescribing for residents of ACFs in Australia and Sweden was conducted. A review of policies and health care infrastructure was also carried out to describe the system of residential aged care in the both countries. Our study has identified that deprescribing by GPs in ACFs is a complex process and that there are numerous barriers to medication reduction for aged care residents in both countries, both with similarities and differences. The factors affecting deprescribing behaviour were identified and divided into: intentions, skills and abilities and environmental factors. In this study we show that the GPs' behaviour of deprescribing in two

Beyond "medical tourism": Canadian companies marketing medical travel.

Science.gov (United States)

Turner, Leigh

2012-06-15

Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, "Liberation therapy" for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other businesses market regional, cross

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

OpenAIRE

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

Antimicrobial stewardship in long-term care facilities in Belgium: a questionnaire-based survey of nursing homes to evaluate initiatives and future developments

Directory of Open Access Journals (Sweden)

François Kidd

2016-03-01

Full Text Available Abstract Background The use of antimicrobials is intense and often inappropriate in long-term care facilities. Antimicrobial resistance has increased in acute and chronic care facilities, including those in Belgium. Evidence is lacking concerning antimicrobial stewardship programmes in chronic care settings. The medical coordinator practicing in Belgian nursing homes is a general practitioner designated to coordinate medical activity. He is likely to be the key position for effective implementation of such programmes. The aim of this study was to evaluate past, present, and future developments of antimicrobial stewardship programmes by surveying medical coordinators working in long-term care facilities in Belgium. Methods We conducted an online questionnaire-based survey of 327 Belgian medical coordinators. The questionnaire was composed of 33 questions divided into four sections: characteristics of the respondents, organisational frameworks for implementation of the antimicrobial stewardship programme, tools to promote appropriate antimicrobial use and priorities of action. Questions were multiple choice, rating scale, or free text. Results A total of 39 medical coordinators (12 % completed the questionnaire. Past or present antimicrobial stewardship initiatives were reported by 23 % of respondents. The possibility of future developments was rated 2.7/5. The proposed key role of medical coordinators was rated <3/5 by 36 % of respondents. General practitioners, nursing staff, and hospital specialists are accepted as important roles. The use of antimicrobial guidelines was reported by only 19 % of respondents. Education was considered the cornerstone for any future developments. Specific diagnostic recommendations were considered useful, but chest x-rays were judged difficult to undertake. The top priority identified was to reduce unnecessary treatment of asymptomatic urinary infections. Conclusions Our study shows that the implementation of

Challenges in conducting research in pediatric long-term care facilities.

Science.gov (United States)

Larson, Elaine L; Cohen, Bevin; Murray, Meghan; Saiman, Lisa

2014-10-01

Children residing in long-term care facilities (LTCFs) have complex medical problems and unique care needs, yet research in this setting is rare. As part of an intervention study to improve patient safety (Keep It Clean for Kids [KICK]), we describe the challenges encountered and recommend approaches to build a successful and sustained collaborative relationship between pediatric LTCFs and the research team. We implemented a program with 5 components: leadership commitment, active staff participation by the creation of KICK teams, workflow assessments, staff training in the World Health Organization's "5 Moments for Hand Hygiene," and electronic monitoring and feedback to staff regarding hand hygiene practices. Major challenges encountered were establishing trust, building research teams, enhancing staff participation, and engaging families and visitors. Approaches to deal with these challenges are discussed. Conducting research in pediatric LTCFs requires sustained commitment to dealing with challenges and establishing collaborative relationships with administrative and frontline staff. © The Author(s) 2014.

Factors related to the decision-making for moving the older adults into long-term care facilities in Taiwan.

Science.gov (United States)

Hsieh, Yen-Ping; Huang, Ying-Chia; Lan, Shou-Jen; Ho, Ching-Sung

2017-09-01

To investigate the relationships between demographic characteristics of the elderly, type of long-term care (LTC) facilities, and the reasons for moving into LTC facilities. Research participants included people aged over 65 years, living in LTC facilities. A total of 1280 questionnaires were distributed to 111 LTC facilities in Taiwan; 480 questionnaires were retrieved, and 232 were included in the valid sample. The study used a non-linear canonical correlation analysis, which assesses the relationships among similar sets of categorical variables. The results showed that the older adults in quadrant I were characterized by being involved in the decision-making regarding the choice of LTC facilities and received economic support from their children. The older adults in quadrant II mainly lived in LTC facilities to receive medical care, whereas those in quadrant III typically included individuals with low income, who did not choose to live in LTC facilities. Furthermore, those in quadrant IV had positive cognitions associated with LTC facilities. We believe that the results of the present study will facilitate policy-making in the field of LTC, provide reference to the practitioners and the older adults, and identify the types of decisions older adults make when moving into LTC facilities, thus assisting older adults to improve their strategies regarding staying in LTC facilities. Geriatr Gerontol Int 2017; 17: 1319-1327. © 2016 Japan Geriatrics Society.

Relationship between the presence of baccalaureate-educated RNs and quality of care: a cross-sectional study in Dutch long-term care facilities.

Science.gov (United States)

Backhaus, Ramona; van Rossum, Erik; Verbeek, Hilde; Halfens, Ruud J G; Tan, Frans E S; Capezuti, Elizabeth; Hamers, Jan P H

2017-01-19

Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents' age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was

Afraid of medical care school-aged children's narratives about medical fear.

Science.gov (United States)

Forsner, Maria; Jansson, Lilian; Söderberg, Anna

2009-12-01

Fear can be problematic for children who come into contact with medical care. This study aimed to illuminate the meaning of being afraid when in contact with medical care, as narrated by children 7-11 years old. Nine children participated in the study, which applied a phenomenological hermeneutic analysis methodology. The children experienced medical care as "being threatened by a monster," but the possibility of breaking this spell of fear was also mediated. The findings indicate the important role of being emotionally hurt in a child's fear to create, together with the child, an alternate narrative of overcoming this fear.

Regulatory control and challenges in Medical facilities using ionising radiation sources

International Nuclear Information System (INIS)

Agarwal, S.P.

2008-01-01

Medical facilities utilising ionising radiation sources for diagnostic and treatment of cancer are regulated under the provisions of Atomic Energy (Radiation Protection) Rules, 2004 promulgated under the Atomic Energy Act 1962. The Competent Authority for the enforcement of the rules is Chairman, Atomic Energy Regulatory Board (AERB). Practice specific codes are issued by AERB for medical facilities such as Radiotherapy, Nuclear Medicine and Radiology. Regulatory process for control of medical facilities covers the entire life cycle of the radiation sources in three stages viz pre-Iicensing, during useful life and decommissioning and disposal. Pre-Iicensing requirements include use of type approved sources and equipment, approval of design layout of the facility and installation, exclusive (safe and secure) source storage facility when the equipment is not in use, radiation (area/individual) monitoring devices, qualified, trained and certified manpower, emergency response plans and commitment from the licensee for the safe disposal of disused/decayed sources. Compliance to these requirements makes the applicant eligible to obtain license from AERB for the operation of the medical facility. During the use of radiation sources, specific prior approval of the Competent Authority is required in respect of every source replacement, sale, transfer, transport, import and export. Further, all licensees are required to send the periodic safety Status reports to AERB as well as reporting of any off normal events. AERB conducts inspection of the facilities to ensure compliance with the safety requirements during operation of the facility. Violation of safety norms by licensee attracts enforcement action which includes suspension, modification or withdrawal of licensee for operation of the facility. Upon completion of the useful life of the source, the licensee decommissions the facility and returns the source to the original supplier. For returning the source, prior

Care Facilities Licensed by LDHH, Geographic NAD83, LDHH (2006) [LDHH_care_facilities_06_07_full_LDHH_2006

Data.gov (United States)

Louisiana Geographic Information Center — A portion of the facilities licensed by the Louisiana Department of Health and Hospitals, Health Standards Section. This database includes Adult Day Cares, Adult Day...

Nuclear security of Cuba’s medical facilities

International Nuclear Information System (INIS)

Dahlstrom, Danielle

2016-01-01

Cuba is a leading hub for medical research and cancer treatment in Latin America and the Caribbean. Physical protection is installed at radiotherapy facilities to detect entry of and delay access to an intruder. This minimizes the likelihood of unauthorized access and maximizes nuclear security.

Healthcare facility commissioning – the transition of clinical services

CSIR Research Space (South Africa)

Van der Watt, R

2016-07-01

Full Text Available structure of bricks and mortar into a functional facility with staff, equipment, medication, supplies, etc. ready to eventually receive patients who need care and cure. Beyond these tangible elements, there are also many intangibles which are required, e... in order for the new facility to deliver the intended clinical services. These include links to the emergency services which brings patients in need of emergency care to the facility, links to other healthcare facilities for more specialized care...

Medical Care Tasks among Spousal Dementia Caregivers: Links to Care-Related Sleep Disturbances.

Science.gov (United States)

Polenick, Courtney A; Leggett, Amanda N; Maust, Donovan T; Kales, Helen C

2018-05-01

Medical care tasks are commonly provided by spouses caring for persons living with dementia (PLWDs). These tasks reflect complex care demands that may interfere with sleep, yet their implications for caregivers' sleep outcomes are unknown. The authors evaluated the association between caregivers' medical/nursing tasks (keeping track of medications; managing tasks such as ostomy care, intravenous lines, or blood testing; giving shots/injections; and caring for skin wounds/sores) and care-related sleep disturbances. A retrospective analysis of cross-sectional data from the 2011 National Health and Aging Trends Study and National Study of Caregiving was conducted. Spousal caregivers and PLWDs/proxies were interviewed by telephone at home. The U.S. sample included 104 community-dwelling spousal caregivers and PLWDs. Caregivers reported on their sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and sleep disturbances. PLWDs (or proxies) reported on their health conditions and sleep problems. Caregivers who performed a higher number of medical/nursing tasks reported significantly more frequent care-related sleep disturbances, controlling for sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and PLWDs' sleep problems and health conditions. Post hoc tests showed that wound care was independently associated with more frequent care-related sleep disturbances after accounting for the other medical/nursing tasks and covariates. Spousal caregivers of PLWDs who perform medical/nursing tasks may be at heightened risk for sleep disturbances and associated adverse health consequences. Interventions to promote the well-being of both care partners may benefit from directly addressing caregivers' needs and concerns about their provision of medical/nursing care. Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights

Medication Refusal: Resident Rights, Administration Dilemma.

Science.gov (United States)

Haskins, Danielle R; Wick, Jeannette Y

2017-12-01

Occasionally, residents actively or passively refuse to take medications. Residents may refuse medication for a number of reasons, including religious beliefs, dietary restrictions, misunderstandings, cognitive impairment, desire to self-harm, or simple inconvenience. This action creates a unique situation for pharmacists and long-term facility staff, especially if patients have dementia. Residents have the legal right to refuse medications, and long-term care facilities need to employ a process to resolve disagreement between the health care team that recommends the medication and the resident who refuses it. In some cases, simple interventions like selecting a different medication or scheduling medications in a different time can address and resolve the resident's objection. If the medical team and the resident cannot resolve their disagreement, often an ethics consultation is helpful. Documenting the resident's refusal to take any or all medications, the health care team's actions and any other outcomes are important. Residents' beliefs may change over time, and the health care team needs to be prepared to revisit the issue as necessary.

Longitudinal variation in pressure injury incidence among long-term aged care facilities.

Science.gov (United States)

Jorgensen, Mikaela; Siette, Joyce; Georgiou, Andrew; Westbrook, Johanna I

2018-05-04

To examine variation in pressure injury (PI) incidence among long-term aged care facilities and identify resident- and facility-level factors that explain this variation. Longitudinal incidence study using routinely-collected electronic care management data. A large aged care service provider in New South Wales and the Australian Capital Territory, Australia. About 6556 people aged 65 years and older who were permanent residents in 60 long-term care facilities between December 2014 and November 2016. Risk-adjusted PI incidence rates over eight study quarters. Incidence density over the study period was 1.33 pressure injuries per 1000 resident days (95% confidence interval (CI) = 1.29-1.37). Funnel plots were used to identify variation among facilities. On average, 14% of facilities had risk-adjusted PI rates that were higher than expected in each quarter (above 95% funnel plot control limits). Ten percent of facilities had persistently high rates in any three or more consecutive quarters (n = 6). The variation between facilities was only partly explained by resident characteristics in multilevel regression models. Residents were more likely to have higher-pressure injury rates in facilities in regional areas compared with major city areas (adjusted incidence rate ratio = 1.25, 95% CI = 1.04-1.51), and facilities with persistently high rates were more likely to be located in areas with low socioeconomic status (P = 0.038). There is considerable variation among facilities in PI incidence. This study demonstrates the potential of routinely-collected care management data to monitor PI incidence and to identify facilities that may benefit from targeted intervention.

Benchmarking facilities providing care: An international overview of initiatives

Science.gov (United States)

Thonon, Frédérique; Watson, Jonathan; Saghatchian, Mahasti

2015-01-01

We performed a literature review of existing benchmarking projects of health facilities to explore (1) the rationales for those projects, (2) the motivation for health facilities to participate, (3) the indicators used and (4) the success and threat factors linked to those projects. We studied both peer-reviewed and grey literature. We examined 23 benchmarking projects of different medical specialities. The majority of projects used a mix of structure, process and outcome indicators. For some projects, participants had a direct or indirect financial incentive to participate (such as reimbursement by Medicaid/Medicare or litigation costs related to quality of care). A positive impact was reported for most projects, mainly in terms of improvement of practice and adoption of guidelines and, to a lesser extent, improvement in communication. Only 1 project reported positive impact in terms of clinical outcomes. Success factors and threats are linked to both the benchmarking process (such as organisation of meetings, link with existing projects) and indicators used (such as adjustment for diagnostic-related groups). The results of this review will help coordinators of a benchmarking project to set it up successfully. PMID:26770800

Understanding the information dynamics of medication administration in residential aged care facilities (RACFs): a prerequisite for design of effective ICT systems.

Science.gov (United States)

Tariq, Amina; Georgiou, Andrew; Westbrook, Johanna

2013-01-01

Medication information is a critical part of the information required to ensure residents' safety in the highly collaborative care context of RACFs. Studies report poor medication information as a barrier to improve medication management in RACFs. Research exploring medication work practices in aged care settings remains limited. This study aimed to identify contextual and work practice factors contributing to breakdowns in medication information exchange in RACFs in relation to the medication administration process. We employed non-participant observations and semi-structured interviews to explore information practices in three Australian RACFs. Findings identified inefficiencies due to lack of information timeliness, manual stock management, multiple data transcriptions, inadequate design of essential documents such as administration sheets and a reliance on manual auditing procedures. Technological solutions such as electronic medication administration records offer opportunities to overcome some of the identified problems. However these interventions need to be designed to align with the collaborative team based processes they intend to support.

Psychotropic medication patterns among youth in foster care.

Science.gov (United States)

Zito, Julie M; Safer, Daniel J; Sai, Devadatta; Gardner, James F; Thomas, Diane; Coombes, Phyllis; Dubowski, Melissa; Mendez-Lewis, Maria

2008-01-01

Studies have revealed that youth in foster care covered by Medicaid insurance receive psychotropic medication at a rate > 3 times that of Medicaid-insured youth who qualify by low family income. Systematic data on patterns of medication treatment, particularly concomitant drugs, for youth in foster care are limited. The purpose of this work was to describe and quantify patterns of psychotropic monotherapy and concomitant therapy prescribed to a randomly selected, 1-month sample of youth in foster care who had been receiving psychotropic medication. METHODS. Medicaid data were accessed for a July 2004 random sample of 472 medicated youth in foster care aged 0 through 19 years from a southwestern US state. Psychotropic medication treatment data were identified by concomitant pattern, frequency, medication class, subclass, and drug entity and were analyzed in relation to age group; gender; race or ethnicity; International Classification of Diseases, Ninth Revision, psychiatric diagnosis; and physician specialty. Of the foster children who had been dispensed psychotropic medication, 41.3% received > or = 3 different classes of these drugs during July 2004, and 15.9% received > or = 4 different classes. The most frequently used medications were antidepressants (56.8%), attention-deficit/hyperactivity disorder drugs (55.9%), and antipsychotic agents (53.2%). The use of specific psychotropic medication classes varied little by diagnostic grouping. Psychiatrists prescribed 93% of the psychotropic medication dispensed to youth in foster care. The use of > or = 2 drugs within the same psychotropic medication class was noted in 22.2% of those who were given prescribed drugs concomitantly. Concomitant psychotropic medication treatment is frequent for youth in foster care and lacks substantive evidence as to its effectiveness and safety.

Use of information systems in Air Force medical treatment facilities in strategic planning and decision-making.

Science.gov (United States)

Yap, Glenn A; Platonova, Elena A; Musa, Philip F

2006-02-01

An exploratory study used Ansoff's strategic planning model as a framework to assess perceived effectiveness of information systems in supporting strategic business plan development at Air Force medical treatment facilities (MTFs). Results showed information systems were most effective in supporting historical trend analysis, strategic business plans appeared to be a balance of operational and strategic plans, and facilities perceived a greater need for new clinical, vice administrative, information systems to support strategic planning processes. Administrators believed information systems should not be developed at the local level and perceived information systems have the greatest impact on improving clinical quality outcomes, followed by ability to deliver cost effective care and finally, ability to increase market share.

Military Medical Care: Questions and Answers

Science.gov (United States)

2013-07-24

conditions. Qualifying conditions include: • Diagnosis in an infant or toddler of a neuromuscular developmental condition or other condition expected to...TRICARE and Medicare Payments to Providers and the Sustainable Growth Rate ......... 19 Medicare and TRICARE for Life...training, medical research and development , health information technology, facility planning, public health, medical logistics, acquisition, budget, and

HIV testing in nonhealthcare facilities among adolescent MSM.

Science.gov (United States)

Marano, Mariette R; Stein, Renee; Williams, Weston O; Wang, Guoshen; Xu, Songli; Uhl, Gary; Cheng, Qi; Rasberry, Catherine N

2017-07-01

To describe the extent to which Centers for Disease Control and Prevention (CDC)-funded HIV testing in nonhealthcare facilities reaches adolescent MSM, identifies new HIV infections, and links those newly diagnosed to medical care. We describe HIV testing, newly diagnosed positivity, and linkage to medical care for adolescent MSM who received a CDC-funded HIV test in a nonhealthcare facility in 2015. We assess outcomes by race/ethnicity, HIV-related risk behaviors, and US geographical region. Of the 703 890 CDC-funded HIV testing events conducted in nonhealthcare facilities in 2015, 6848 (0.9%) were provided to adolescent MSM aged 13-19 years. Among those tested, 1.8% were newly diagnosed with HIV, compared with 0.7% among total tests provided in nonhealthcare facilities regardless of age and sex. The odds of testing positive among black adolescent MSM were nearly four times that of white adolescent MSM in multivariable analysis (odds ratio = 3.97, P adolescent MSM newly diagnosed with HIV, 67% were linked to HIV medical care. Linkage was lower among black (59%) and Hispanic/Latino adolescent MSM (71%) compared with white adolescent MSM (88%). CDC-funded nonhealthcare facilities can reach and provide HIV tests to adolescent MSM and identify new HIV infections; however, given the low rate of HIV testing overall and high engagement in HIV-related risk behaviors, there are opportunities to increase access to HIV testing and linkage to care for HIV-positive adolescent MSM. Efforts are needed to identify and address the barriers that prevent black and Hispanic/Latino adolescent MSM from being linked to HIV medical care in a timely manner.

Medical returns: seeking health care in Mexico.

Science.gov (United States)

Horton, Sarah; Cole, Stephanie

2011-06-01

Despite the growing prevalence of transnational medical travel among immigrant groups in industrialized nations, relatively little scholarship has explored the diverse reasons immigrants return home for care. To date, most research suggests that cost, lack of insurance and convenience propel US Latinos to seek health care along the Mexican border. Yet medical returns are common even among Latinos who do have health insurance and even among those not residing close to the border. This suggests that the distinct culture of medicine as practiced in the border clinics Latinos visit may be as important a factor in influencing medical returns as convenience and cost. Drawing upon qualitative interviews, this article presents an emic account of Latinos' perceptions of the features of medical practice in Mexico that make medical returns attractive. Between November 15, 2009 and January 15, 2010, we conducted qualitative interviews with 15 Mexican immigrants and nine Mexican Americans who sought care at Border Hospital, a private clinic in Tijuana. Sixteen were uninsured and eight had insurance. Yet of the 16 uninsured, six had purposefully dropped their insurance to make this clinic their permanent "medical home." Moreover, those who substituted receiving care at Border Hospital for their US health insurance plan did so not only because of cost, but also because of what they perceived as the distinctive style of medical practice at Border Hospital. Interviewees mentioned the rapidity of services, personal attention, effective medications, and emphasis on clinical discretion as features distinguishing "Mexican medical practice," opposing these features to the frequent referrals and tests, impersonal doctor-patient relationships, uniform treatment protocols and reliance on surgeries they experienced in the US health care system. While interviewees portrayed these features as characterizing a uniform "Mexican medical culture," we suggest that they are best described as

THE EFFECTIVENESS OF THE IMPLEMENTATION OF TECHNOLOGY SUBSTITUTING INPATIENT TREATMENT DURING THE MEDICAL CARE PROVISION TO WOMEN WITH BENIGN GYNECOLOGICAL NEOPLASMS

Directory of Open Access Journals (Sweden)

A. A. Lobganidze

2017-01-01

Full Text Available Relevance. Over the last decades, such technology substituting inpatient treatment as outpatient treatment has been actively discussed and used in practice. Despite this fact, many problems of outpatient treatment have not been solved in full, no effective leverages contributing to creating economic incentives for increasing the volume and range of medical services in day hospitals have been found in the mandatory medical insurance system.Objective. Based on an in-depth analysis of medical care provision to women with benign gynaecological neoplasms, to offer measures for improvement of medical care in outpatient facilities, particularly by using technologies substituting inpatient treatment, and to evaluate their effectiveness.Materials and methods. A comprehensive retrospective evaluation of outpatient and inpatient medical care was conducted in St. Petersburg over the period from 2008 to 2015. The information contained in the database of billed and paid invoices of the obligatory medical insurance system of St. Petersburg was studied. For the total period of eight years, the data on medical care provision to 81 622 women suffering from benign tumors of the female reproductive organs, particularly in day hospitals, were obtained. In the period 2015–2016, medical care provision to patients with benign neoplasms of the gynecological sphere was thoroughly analyzed. In 18 women’s health departments and 19 in-patient facilities in all districts of the city, all cases of treatment of patients in the basic women’s health departments and in-patient facilities were analyzed by experts. By Taking into account the obtained results, an organizational experiment on introducing substituting technologies followed by evaluating the effectiveness of their use was developed and implemented on the basis of the medical institutions in one of the districts of St. Petersburg.Results. The activeness of outpatient facilities for treatment of women with benign

Organisational fundamentals of medical care in catastrophes

International Nuclear Information System (INIS)

Ahnefeld, F.W.

1983-01-01

The author presents definitions, considerations, and fundamentals of discussion. He starts by listing the institutions, equipment and traning required for medical care and life-saving services in cases of emergency. A central coordination service for medical care and life saving is proposed. The present situation is reviewed, future needs are stated, and the necessary components of a medical service are listed. (DG) [de

Physicians' professionalism at primary care facilities from patients' perspective: The importance of doctors' communication skills.

Science.gov (United States)

Sari, Merry Indah; Prabandari, Yayi Suryo; Claramita, Mora

2016-01-01

Professionalism is the core duty of a doctor to be responsible to the society. Doctors' professionalism depicts an internalization of values and mastery of professionals' standards as an important part in shaping the trust between doctors and patients. Professionalism consists of various attributes in which current literature focused more on the perspective of the health professionals. Doctors' professionalism may influence patients' satisfaction, and therefore, it is important to know from the patients' perspectives what was expected of medical doctors' professionalism. This study was conducted to determine the attributes of physician professionalism from the patient's perspective. This was a qualitative research using a phenomenology study design. In-depth interviews were conducted with 18 patients with hypertension and diabetes who had been treated for at least 1 year in primary care facilities in the city of Yogyakarta, Indonesia. The results of the interview were transcribed, encoded, and then classified into categories. Communication skills were considered as the top priority of medical doctors' attributes of professionalism in the perspectives of the patients. This study revealed that communication skill is the most important aspects of professionalism which greatly affected in the process of health care provided by the primary care doctors. Doctor-patient communication skills should be intensively trained during both basic and postgraduate medical education.

An Application of Business Process Management to Health Care Facilities.

Science.gov (United States)

Hassan, Mohsen M D

The purpose of this article is to help health care facility managers and personnel identify significant elements of their facilities to address, and steps and actions to follow, when applying business process management to them. The ABPMP (Association of Business Process Management Professionals) life-cycle model of business process management is adopted, and steps from Lean, business process reengineering, and Six Sigma, and actions from operations management are presented to implement it. Managers of health care facilities can find in business process management a more comprehensive approach to improving their facilities than Lean, Six Sigma, business process reengineering, and ad hoc approaches that does not conflict with them because many of their elements can be included under its umbrella. Furthermore, the suggested application of business process management can guide and relieve them from selecting among these approaches, as well as provide them with specific steps and actions that they can follow. This article fills a gap in the literature by presenting a much needed comprehensive application of business process management to health care facilities that has specific steps and actions for implementation.

Caring to Care: Applying Noddings' Philosophy to Medical Education.

Science.gov (United States)

Balmer, Dorene F; Hirsh, David A; Monie, Daphne; Weil, Henry; Richards, Boyd F

2016-12-01

The authors argue that Nel Noddings' philosophy, "an ethic of caring," may illuminate how students learn to be caring physicians from their experience of being in a caring, reciprocal relationship with teaching faculty. In her philosophy, Noddings acknowledges two important contextual continuities: duration and space, which the authors speculate exist within longitudinal integrated clerkships. In this Perspective, the authors highlight core features of Noddings' philosophy and explore its applicability to medical education. They apply Noddings' philosophy to a subset of data from a previously published longitudinal case study to explore its "goodness of fit" with the experience of eight students in the 2012 cohort of the Columbia-Bassett longitudinal integrated clerkship. In line with Noddings' philosophy, the authors' supplementary analysis suggests that students (1) recognized caring when they talked about "being known" by teaching faculty who "cared for" and "trusted" them; (2) responded to caring by demonstrating enthusiasm, action, and responsibility toward patients; and (3) acknowledged that duration and space facilitated caring relations with teaching faculty. The authors discuss how Noddings' philosophy provides a useful conceptual framework to apply to medical education design and to future research on caring-oriented clinical training, such as longitudinal integrated clerkships.

Development of a Medical Cyclotron Production Facility

Science.gov (United States)

Allen, Danny R.

2003-08-01

Development of a Cyclotron manufacturing facility begins with a business plan. Geographics, the size and activity of the medical community, the growth potential of the modality being served, and other business connections are all considered. This business used the customer base established by NuTech, Inc., an independent centralized nuclear pharmacy founded by Danny Allen. With two pharmacies in operation in Tyler and College Station and a customer base of 47 hospitals and clinics the existing delivery system and pharmacist staff is used for the cyclotron facility. We then added cyclotron products to contracts with these customers to guarantee a supply. We partnered with a company in the process of developing PET imaging centers. We then built an independent imaging center attached to the cyclotron facility to allow for the use of short-lived isotopes.

Development of a Medical Cyclotron Production Facility

International Nuclear Information System (INIS)

Allen, Danny R.

2003-01-01

Development of a Cyclotron manufacturing facility begins with a business plan. Geographics, the size and activity of the medical community, the growth potential of the modality being served, and other business connections are all considered. This business used the customer base established by NuTech, Inc., an independent centralized nuclear pharmacy founded by Danny Allen. With two pharmacies in operation in Tyler and College Station and a customer base of 47 hospitals and clinics the existing delivery system and pharmacist staff is used for the cyclotron facility. We then added cyclotron products to contracts with these customers to guarantee a supply. We partnered with a company in the process of developing PET imaging centers. We then built an independent imaging center attached to the cyclotron facility to allow for the use of short-lived isotopes

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

Science.gov (United States)

Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

2018-04-23

This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

Barriers to ethical nursing practice for older adults in long-term care facilities.

Science.gov (United States)

Choe, Kwisoon; Kang, Hyunwook; Lee, Aekyung

2018-03-01

To explore barriers to ethical nursing practice for older adults in long-term care facilities from the perspectives of nurses in South Korea. The number of older adults admitted to long-term care facilities is increasing rapidly in South Korea. To provide this population with quality care, a solid moral foundation should be emphasised to ensure the provision of ethical nursing practices. Barriers to implementing an ethical nursing practice for older adults in long-term care facilities have not been fully explored in previous literature. A qualitative, descriptive design was used to explore barriers to ethical nursing practice as perceived by registered nurses in long-term care facilities in South Korea. Individual interviews were conducted with 17 registered nurses recruited using purposive (snowball) sampling who care for older adults in long-term care facilities in South Korea. Data were analysed using qualitative content analysis. Five main themes emerged from the data analysis concerning barriers to the ethical nursing practice of long-term care facilities: emotional distress, treatments restricting freedom of physical activities, difficulty coping with emergencies, difficulty communicating with the older adult patients and friction between nurses and nursing assistants. This study has identified methods that could be used to improve ethical nursing practices for older adults in long-term care facilities. Because it is difficult to improve the quality of care through education and staffing alone, other factors may also require attention. Support programmes and educational opportunities are needed for nurses who experience emotional distress and lack of competency to strengthen their resilience towards some of the negative aspects of care and being a nurse that were identified in this study. © 2017 John Wiley & Sons Ltd.

[Quality Indicators of Primary Health Care Facilities in Austria].

Science.gov (United States)

Semlitsch, Thomas; Abuzahra, Muna; Stigler, Florian; Jeitler, Klaus; Posch, Nicole; Siebenhofer, Andrea

2017-07-11

Background The strengthening of primary health care is one major goal of the current national health reform in Austria. In this context, a new interdisciplinary concept was developed in 2014 that defines structures and requirements for future primary health care facilities. Objective The aim of this project was the development of quality indicators for the evaluation of the scheduled primary health care facilities in Austria, which are in accordance with the new Austrian concept. Methods We used the RAND/NPCRDC method for the development and selection of the quality indicators. We conducted systematic literature searches for existing measures in international databases for quality indicators as well as in bibliographic databases. All retrieved measures were evaluated and rated by an expert panel in a 2-step process regarding relevance and feasibility. Results Overall, the literature searches yielded 281 potentially relevant quality indicators, which were summarized to 65 different quality measures for primary health care. Out of these, the panel rated and accepted 30 measures as relevant and feasible for use in Austria. Five of these indicators were structure measures, 14 were process measures and the remaining 11 were outcome measures. Based on the Austrian primary health care concept, the final set of quality indicators was grouped in the 5 following domains: Access to primary health care (5), quality of care (15), continuity of care (5), coordination of care (4), and safety (1). Conclusion This set of quality measures largely covers the four defined functions of primary health care. It enables standardized evaluation of primary health care facilities in Austria regarding the implementation of the Austrian primary health care concept as well as improvement in healthcare of the population. © Georg Thieme Verlag KG Stuttgart · New York.

Beyond "medical tourism": Canadian companies marketing medical travel

Science.gov (United States)

2012-01-01

Background Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, “Liberation therapy” for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. Methods Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. Results Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other

Radiation protection medical care of radiation workers

International Nuclear Information System (INIS)

Walt, H.

1988-01-01

Radiation protection medical care for radiation workers is part of the extensive programme protecting people against dangers emanating from the peaceful application of ionizing radiation. Thus it is a special field of occupational health care and emergency medicine in case of radiation accidents. It has proved helpful in preventing radiation damage as well as in early detection, treatment, after-care, and expert assessment. The medical checks include pre-employment and follow-up examinations, continued long-range medical care as well as specific monitoring of individuals and defined groups of workers. Three levels of action are involved: works medical officers specialized in radiation protection, the Institute of Medicine at the National Board for Atomic Safety and Radiation Protection, and a network of clinical departments specialized in handling cases of acute radiation damage. An account is given of categories, types, and methods of examinations for radiation workers and operators. (author)

42 CFR 456.143 - Content of medical care evaluation studies.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.143 Section 456.143 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...: Medical Care Evaluation Studies § 456.143 Content of medical care evaluation studies. Each medical care...

Expectations and needs of Ugandan women for improved quality of childbirth care in health facilities: A qualitative study.

Science.gov (United States)

Kyaddondo, David; Mugerwa, Kidza; Byamugisha, Josaphat; Oladapo, Olufemi T; Bohren, Meghan A

2017-12-01

To describe the experiences, expectations, and needs of urban Ugandan women in relation to good-quality facility childbirth. Women who had given birth in the 12 months prior to the study were purposively sampled and interviewed, or included in focus groups. Thematic analysis was used, and the data were interpreted within the context of an existing quality of care framework. Forty-five in-depth interviews and six focus group discussions were conducted. Respect and dignity, timely communication, competent skilled staff, and availability of medical supplies were central to women's accounts of quality care, or a lack of it. The hope for a live baby motivated women to seek facility-based childbirth. They expected to encounter competent, respectful, and caring staff with appropriate skills. In some cases, they could only fulfill these expectations through additional personal financial payments to staff, for clinical supplies, or to guarantee that they would be attended by someone with suitable skills. Long-term improvement in quality of maternity care in Uganda requires enhancement of the interaction between women and health staff in facilities, and investment in staff and resources to ensure that safe, respectful care is not dependent on willingness and/or capacity to pay. © 2017 International Federation of Gynecology and Obstetrics. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

Payment methods for outpatient care facilities.

Science.gov (United States)

Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

2017-03-03

Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Randomised trials, non-randomised trials, controlled before

Improving care planning and coordination for service users with medical co-morbidity transitioning between tertiary medical and primary care services.

Science.gov (United States)

Cranwell, K; Polacsek, M; McCann, T V

2017-08-01

WHAT IS KNOWN ON THE SUBJECT?: Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments. Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services. Little is known about mental health nurses' perspectives about how to address these problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive. The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation. Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity. Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments. Introduction Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim To explore mental health nurses

Primary health care facility infrastructure and services and the ...

African Journals Online (AJOL)

... Research Council ae Currently from Cape Peninsula University of Technology ... Keywords: primary health care facilities; nutritional status; children; caregivers' rural; South Africa ... underlying causes of malnutrition in children, while poor food quality, .... Information on PHC facility infrastructure and services was obtained.

Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa.

Science.gov (United States)

Sokhela, Dudu G; Makhanya, Nonhlanhla J; Sibiya, Nokuthula M; Nokes, Kathleen M

2013-07-05

Comprehensive Primary Health Care (PHC), based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients' experiences led to satisfaction or dissatisfaction with the Fast Queue service. A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources. Effective health communication strategies contribute to positive

Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

Directory of Open Access Journals (Sweden)

Dudu G. Sokhela

2013-07-01

Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service. Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

Medications Associated with Geriatric Syndromes (MAGS) and their Prevalence in Older Hospitalized Adults Discharged to Skilled Nursing Facilities

Science.gov (United States)

Saraf, Avantika A.; Peterson, Alec W.; Simmons, Sandra F.; Schnelle, John F.; Bell, Susan P.; Kripalani, Sunil; Myers, Amy P.; Mixon, Amanda S.; Long, Emily A.; Jacobsen, J. Mary Lou; Vasilevskis, Eduard E.

2016-01-01

Background More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than three geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. Objectives Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to skilled nursing facilities (SNFs) Design Literature review and multidisciplinary expert panel discussion, followed by cross-sectional analysis. Setting Academic Medical Center in the United States Participants 154 hospitalized Medicare beneficiaries discharged to SNFs Measurements Development of a list of medications that are associated with six geriatric syndromes. Prevalence of the medications associated with geriatric syndromes was examined in the hospital discharge sample. Results A list of 513 medications was developed as potentially contributing to 6 geriatric syndromes: cognitive impairment, delirium, falls, reduced appetite or weight loss, urinary incontinence, and depression. Medications included 18 categories. Antiepileptics were associated with all syndromes while antipsychotics, antidepressants, antiparkinsonism and opioid agonists were associated with 5 geriatric syndromes. In the prevalence sample, patients were discharged to SNFs with an overall average of 14.0 (±4.7) medications, including an average of 5.9 (±2.2) medications that could contribute to geriatric syndromes, with falls having the most associated medications at discharge, 5.5 (±2.2). Conclusions Many commonly prescribed medications are associated with geriatric syndromes. Over 40% of all medications ordered upon discharge to SNFs were associated with geriatric syndromes and could be contributing to the high prevalence of geriatric syndromes experienced by this population. PMID:27255830

Medical Care Cost Recovery National Database (MCCR NDB)

Data.gov (United States)

Department of Veterans Affairs — The Medical Care Cost Recovery National Database (MCCR NDB) provides a repository of summary Medical Care Collections Fund (MCCF) billing and collection information...

[Medication errors in Spanish intensive care units].

Science.gov (United States)

Merino, P; Martín, M C; Alonso, A; Gutiérrez, I; Alvarez, J; Becerril, F

2013-01-01

To estimate the incidence of medication errors in Spanish intensive care units. Post hoc study of the SYREC trial. A longitudinal observational study carried out during 24 hours in patients admitted to the ICU. Spanish intensive care units. Patients admitted to the intensive care unit participating in the SYREC during the period of study. Risk, individual risk, and rate of medication errors. The final study sample consisted of 1017 patients from 79 intensive care units; 591 (58%) were affected by one or more incidents. Of these, 253 (43%) had at least one medication-related incident. The total number of incidents reported was 1424, of which 350 (25%) were medication errors. The risk of suffering at least one incident was 22% (IQR: 8-50%) while the individual risk was 21% (IQR: 8-42%). The medication error rate was 1.13 medication errors per 100 patient-days of stay. Most incidents occurred in the prescription (34%) and administration (28%) phases, 16% resulted in patient harm, and 82% were considered "totally avoidable". Medication errors are among the most frequent types of incidents in critically ill patients, and are more common in the prescription and administration stages. Although most such incidents have no clinical consequences, a significant percentage prove harmful for the patient, and a large proportion are avoidable. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Informal caregiving burden and perceived social support in an acute stroke care facility.

Science.gov (United States)

Akosile, Christopher Olusanjo; Banjo, Tosin Olamilekan; Okoye, Emmanuel Chiebuka; Ibikunle, Peter Olanrewaju; Odole, Adesola Christiana

2018-04-05

Providing informal caregiving in the acute in-patient and post-hospital discharge phases places enormous burden on the caregivers who often require some form of social support. However, it appears there are few published studies about informal caregiving in the acute in-patient phase of individuals with stroke particularly in poor-resource countries. This study was designed to evaluate the prevalence of caregiving burden and its association with patient and caregiver-related variables and also level of perceived social support in a sample of informal caregivers of stroke survivors at an acute stroke-care facility in Nigeria. Ethical approval was sought and obtained. Fifty-six (21 males, 35 females) consecutively recruited informal caregivers of stroke survivors at the medical ward of a tertiary health facility in South-Southern Nigeria participated in this cross-sectional survey. Participants' level of care-giving strain/burden and perceived social support were assessed using the Caregiver Strain Index and the Multidimensional Scale of Perceived Social Support respectively. Caregivers' and stroke survivors' socio-demographics were also obtained. Data was analysed using frequency count and percentages, independent t-test, analysis of variance (ANOVA) and partial correlation at α =0.05. The prevalence of care-giving burden among caregivers is 96.7% with a high level of strain while 17.9% perceived social support as low. No significant association was found between caregiver burden and any of the caregiver- or survivor-related socio-demographics aside primary level education. Only the family domain of the Multidimensional Scale of Perceived Social Support was significantly correlated with burden (r = - 0.295). Informal care-giving burden was highly prevalent in this acute stroke caregiver sample and about one in every five of these caregivers rated social support low. This is a single center study. Healthcare managers and professionals in acute care facilities

Financial burden of medical care: a family perspective.

Science.gov (United States)

Cohen, Robin A; Kirzinger, Whitney K

2014-01-01

Data from the National Health Interview Survey, 2012. In 2012, more than one in four families experienced financial burdens of medical care. Families with incomes at or below 250% of the federal poverty level (FPL) were more likely to experience financial burdens of medical care than families with incomes above 250% of the FPL. Families with children aged 0-17 years were more likely than families without children to experience financial burdens of medical care. The presence of a family member who was uninsured increased the likelihood that a family would experience a financial burden of medical care. Recently published data from the National Health Interview Survey (NHIS) found that 1 in 5 persons was in a family having problems paying medical bills, and 1 in 10 persons was in a family with medical bills that they were unable to pay at all (1-3). NHIS defines "family" as an individual or a group of two or more related persons living together in the same housing unit. The family perspective is important to consider when examining financial risk because significant expenses for one family member may adversely affect the whole family. Health insurance coverage is one way for a family to mitigate financial risk associated with health care costs, although health insurance status may differ among family members. This report explores selected family demographic characteristics and their association with financial burdens of medical care (problems paying medical bills, paying medical bills over time, and having medical bills that cannot be paid) based on data from the 2012 NHIS. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Trauma treatment in a role 1 medical facility in Afghanistan

DEFF Research Database (Denmark)

Vedel, Pernille Nygaard; Helsø, I; Jørgensen, H L

2013-01-01

Most of the emergency care delivered in Afghanistan is currently provided by the military sector and non-governmental organisations. Main Operating Base (MOB) Price in Helmand Province has a small medical centre and due to its location provides critical care to civilians and military casualties a...... and this article describes the patterns in trauma patient care at the MOB Price medical centre regarding the types of patients and injuries....

Integrated Payment And Delivery Models Offer Opportunities And Challenges For Residential Care Facilities.

Science.gov (United States)

Grabowski, David C; Caudry, Daryl J; Dean, Katie M; Stevenson, David G

2015-10-01

Under health care reform, new financing and delivery models are being piloted to integrate health and long-term care services for older adults. Programs using these models generally have not included residential care facilities. Instead, most of them have focused on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with matched individuals in the community and nursing home, and rates of functional dependency that fall between those of their counterparts in the other two settings. These results suggest that the residential care facility population could benefit greatly from models that coordinated health and long-term care services. However, few providers have invested in the infrastructure needed to support integrated delivery models. Challenges to greater care integration include the private-pay basis for residential care facility services, which precludes shared savings from reduced Medicare costs, and residents' preference for living in a home-like, noninstitutional environment. Project HOPE—The People-to-People Health Foundation, Inc.

A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care-Preliminary Data.

Science.gov (United States)

Chodosh, Joshua; Price, Rachel M; Cadogan, Mary P; Damron-Rodriguez, JoAnn; Osterweil, Dan; Czerwinski, Alfredo; Tan, Zaldy S; Merkin, Sharon S; Gans, Daphna; Frank, Janet C

2015-11-01

Depression is common in nursing facility residents. Depression data obtained using the Minimum Data Set (MDS) 3.0 offer opportunities for improving diagnostic accuracy and care quality. How best to integrate MDS 3.0 and other data into quality improvement (QI) activity is untested. The objective was to increase nursing home (NH) capability in using QI processes and to improve depression assessment and management through focused mentorship and team building. This was a 6-month intervention with five components: facilitated collection of MDS 3.0 nine-item Patient Health Questionnaire (PHQ-9) and medication data for diagnostic interpretation; education and modeling on QI approaches, team building, and nonpharmacological depression care; mentored team meetings; educational webinars; and technical assistance. PHQ-9 and medication data were collected at baseline and 6 and 9 months. Progress was measured using team participation measures, attitude and care process self-appraisal, mentor assessments, and resident depression outcomes. Five NHs established interprofessional teams that included nursing (44.1%), social work (20.6%), physicians (8.8%), and other disciplines (26.5%). Members participated in 61% of eight offered educational meetings (three onsite mentored team meetings and five webinars). Competency self-ratings improved on four depression care measures (P = .05 to depression scores did not change while medication use declined, from 37.2% of residents at baseline to 31.0% at 9 months (P care processes, achieved medication reductions, and was well received. Application to other NH-prevalent syndromes is possible. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Differences in essential newborn care at birth between private and public health facilities in eastern Uganda.

Science.gov (United States)

Waiswa, Peter; Akuze, Joseph; Peterson, Stefan; Kerber, Kate; Tetui, Moses; Forsberg, Birger C; Hanson, Claudia

2015-01-01

In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007). Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (pprivate facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was slightly lower in private compared to public facilities, calling for quality improvement in both

Differences in essential newborn care at birth between private and public health facilities in eastern Uganda

Directory of Open Access Journals (Sweden)

Peter Waiswa

2015-03-01

Full Text Available Background: In Uganda and elsewhere, the private sector provides an increasing and significant proportion of maternal and child health services. However, little is known whether private care results in better quality services and improved outcomes compared to the public sector, especially regarding care at the time of birth. Objective: To describe the characteristics of care-seekers and assess newborn care practices and services received at public and private facilities in rural eastern Uganda. Design: Within a community-based maternal and newborn care intervention with health systems strengthening, we collected data from mothers with infants at baseline and endline using a structured questionnaire. Descriptive, bivariate, and multivariate data analysis comparing nine newborn care practices and three composite newborn care indicators among private and public health facilities was conducted. Results: The proportion of women giving birth at private facilities decreased from 25% at baseline to 17% at endline, whereas overall facility births increased. Private health facilities did not perform significantly better than public health facilities in terms of coverage of any essential newborn care interventions, and babies were more likely to receive thermal care practices in public facilities compared to private (68% compared to 60%, p=0.007. Babies born at public health facilities received an average of 7.0 essential newborn care interventions compared to 6.2 at private facilities (p<0.001. Women delivering in private facilities were more likely to have higher parity, lower socio-economic status, less education, to seek antenatal care later in pregnancy, and to have a normal delivery compared to women delivering in public facilities. Conclusions: In this setting, private health facilities serve a vulnerable population and provide access to service for those who might not otherwise have it. However, provision of essential newborn care practices was

Stress and Coping among Owners and Managers of Residential Care Facilities.

Science.gov (United States)

Walker, Hollie; And Others

Stress and burnout are common in the caregiving professions. Stress negatively affects both the caregivers and patients. In order to help caregivers deal with stress effectively and to improve the care in residential care facilities, it is essential to learn more about the particular stressors that managers of such facilities experience. In this…

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.

"Best care on home ground" versus "elitist healthcare": concerns and competing expectations for medical tourism development in Barbados.

Science.gov (United States)

Johnston, Rory; Adams, Krystyna; Bishop, Lisa; Crooks, Valorie A; Snyder, Jeremy

2015-02-03

Many countries have demonstrated interest in expanding their medical tourism sectors because of its potential economic and health system benefits. However, medical tourism poses challenges to the equitable distribution of health resources between international and local patients and private and public medical facilities. Currently, very little is known about how medical tourism is perceived among front line workers and users of health systems in medical tourism 'destinations'. Barbados is one such country currently seeking to expand its medical tourism sector. Barbadian nurses and health care users were consulted about the challenges and benefits posed by ongoing medical tourism development there. Focus groups were held with two stakeholder groups in May, 2013. Nine (n = 9) citizens who use the public health system participated in the first focus group and seven (n = 7) nurses participated in the second. Each focus group ran for 1.5 hours and was digitally recorded. Following transcription, thematic analysis of the digitally coded focus group data was conducted to identify cross-cutting themes and issues. Three core concerns regarding medical tourism's health equity impacts were raised; its potential to 1) incentivize migration of health workers from public to private facilities, 2) burden Barbados' lone tertiary health care centre, and 3) produce different tiers of quality of care within the same health system. These concerns were informed and tempered by the existing a) health system structure that incorporates both universal public healthcare and a significant private medical sector, b) international mobility among patients and health workers, and c) Barbados' large recreational tourism sector, which served as the main reference in discussions about medical tourism's impacts. Incorporating these concerns and contextual influences, participants' shared their expectations of how medical tourism should locally develop and operate. By engaging with local

MEDICAL SERVICES OR MEDICAL CARE – AN URGENT ISSUE FOR PUBLIC HEALTH INSTITUTIONS

Directory of Open Access Journals (Sweden)

E. V. Pesennikova

2017-01-01

Full Text Available Purpose. To consider the relationship between the concepts of “medical service” and “medical care” in the work of public medical institutions, based on the analysis of normative legal documents of the modern period.Materials and methods. In the course of the research, more than 18 legal and regulatory documents that were published during the period from 1990 to 2017 were analyzed, an analysis of judicial practice and related literature sources (periodicals was carried out.Results. The analysis made it possible to distinguish the stages in the development of the organizational and legal framework for the provision of paid medical services in the Russian Federation and the dynamics of the relationship between the terms “medical care” and “medical service”. It was revealed that the concept of “medical services” appeared much later and was associated with the development of paid medical services and the need to establish legal aspects of health care. The provision of medical assistance is regulated mainly by public law, and the provision of medical services is governed by private law. The term “medical care” is broader than the “medical service” from the standpoint of the social aspect. At the same time, the concept of “medical service” can be considered more widely than medical care in cases when it is not only about measures aimed at treating the patient, but also about providing additional services to the patient in the process of receiving medical care.Conclusion. Thus, we concluded that the categories of medical care and medical services should not be identified, but also not completely different concepts, but rather enter into a partial intersection relationship. The need to distinguish between the concepts of “medical care” and “medical service” is dictated not only by the category relations or opinion of the population and the medical community, but also by the need for legal support for the process of

Leveraging new information technology to monitor medicine use in 71 residential aged care facilities: variation in polypharmacy and antipsychotic use.

Science.gov (United States)

Pont, Lisa G; Raban, Magda Z; Jorgensen, Mikaela L; Georgiou, Andrew; Westbrook, Johanna I

2018-06-08

The aim of this study was to use routinely collected electronic medicines administration (eMAR) data in residential aged care (RAC) to investigate the quality use of medicines. A cross-sectional analysis of eMAR data. 71 RAC facilities in New South Wales and the Australian Capital Territory, Australia. Permanent residents living in a participating facility on 1 October 2015. None. Variation in polypharmacy (≥5 medications), hyper-polypharmacy (≥10 medications) and antipsychotic use across facilities was examined using funnel plot analysis. The study dataset included 4775 long-term residents. The mean resident age was 85.3 years and 70.6% of residents were female. The median facility size was 60 residents and 74.3% were in metropolitan locations. 84.3% of residents had polypharmacy, 41.2% hyper-polypharmacy and 21.0% were using an antipsychotic. The extent of polypharmacy (69.75-100% of residents), hyper-polypharmacy (38.81-76.19%) and use of antipsychotic medicines (0-75.6%) varied considerably across the 71 facilities. Using eMAR data we found substantial variation in polypharmacy, hyper-polypharmacy and antipsychotic medicine use across 71 RAC facilities. Further investigation into the policies and practices of facilities performing above or below expected levels is warranted to understand variation and drive quality improvement.

National Hospital Ambulatory Medical Care Survey

Data.gov (United States)

U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...

Physicians′ professionalism at primary care facilities from patients′ perspective: The importance of doctors′ communication skills

Directory of Open Access Journals (Sweden)

Merry Indah Sari

2016-01-01

Full Text Available Background: Professionalism is the core duty of a doctor to be responsible to the society. Doctors′ professionalism depicts an internalization of values and mastery of professionals′ standards as an important part in shaping the trust between doctors and patients. Professionalism consists of various attributes in which current literature focused more on the perspective of the health professionals. Doctors′ professionalism may influence patients′ satisfaction, and therefore, it is important to know from the patients′ perspectives what was expected of medical doctors′ professionalism. Objective: This study was conducted to determine the attributes of physician professionalism from the patient′s perspective. Materials and Methods: This was a qualitative research using a phenomenology study design. In-depth interviews were conducted with 18 patients with hypertension and diabetes who had been treated for at least 1 year in primary care facilities in the city of Yogyakarta, Indonesia. The results of the interview were transcribed, encoded, and then classified into categories. Results: Communication skills were considered as the top priority of medical doctors′ attributes of professionalism in the perspectives of the patients. Conclusion: This study revealed that communication skill is the most important aspects of professionalism which greatly affected in the process of health care provided by the primary care doctors. Doctor-patient communication skills should be intensively trained during both basic and postgraduate medical education.

Serum biochemistry and morbidity among runners presenting for medical care after an Australian mountain ultramarathon.

Science.gov (United States)

Reid, Stephen A; King, M Jonathan

2007-07-01

To determine if exercise-associated hyponatremia (EAH) was a cause of morbidity among runners requiring medical care at an Australian mountain ultramarathon. Case series. Six Foot Track mountain ultramarathon, New South Wales, Australia, March 2006. Runners presenting to the medical facility. Serum biochemistry. No cases of exercise-associated hyponatremia were identified among 9 athletes (from 775 starters) who were treated with intravenous fluid therapy. Unwell runners had a mean serum (Na) of 143 mmol/L (range 138-147 mmol/L). All runners tested had elevated serum urea and creatinine concentrations. In this setting, EAH was not a significant cause of morbidity.

Residential care : Dutch and Italian residents of residential care facilities compared

NARCIS (Netherlands)

de Heer-Wunderink, Charlotte; Caro-Nienhuis, Annemarie D.; Sytema, Sjoerd; Wiersma, Durk

2008-01-01

Aims - Characteristics of patients living in residential care facilities and the availability of mental hospital- and residential beds in Italy and The Netherlands were compared to assess whether differences in the process of deinstitutionalisation have influenced the composition of their

42 CFR 431.105 - Consultation to medical facilities.

Science.gov (United States)

2010-10-01

... State agencies furnish consultative services to hospitals, nursing homes, home health agencies, clinics... 42 Public Health 4 2010-10-01 2010-10-01 false Consultation to medical facilities. 431.105 Section 431.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

29 CFR 825.114 - Inpatient care.

Science.gov (United States)

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Inpatient care. 825.114 Section 825.114 Labor Regulations... LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility, including...

Patient education and emotional support practices in abortion care facilities in the United States.

Science.gov (United States)

Gould, Heather; Perrucci, Alissa; Barar, Rana; Sinkford, Danielle; Foster, Diana Greene

2012-01-01

Little is known about how patient education and emotional support is provided at abortion facilities. This pilot study documents 27 facilities' practices in this aspect of abortion care. We conducted confidential telephone interviews with staff from 27 abortion facilities about their practices. The majority of facilities reported they rely primarily on trained nonclinician staff to educate patients and provide emotional support. As part of their informed consent and counseling processes, facilities reported that staff always provide patients with information about the procedure (96%), assess the certainty of their abortion decisions (92%), assess their feelings and provide emotional support (74%), and provide contraceptive health education (92%). Time spent providing these components of care varied across facilities and patients. When describing their facility's care philosophy, many respondents expressed support for "patient-centered," "supportive," "nonjudgmental" care. Eighty-two percent agreed that it is the facility's role to provide counseling for emotional issues related to abortion. All facilities valued informed consent, patient education, and emotional support. Although the majority of facilities considered counseling for emotional issues to be a part of their role, some did not. Future research should examine patients' preferences regarding abortion care and counseling and how different approaches to care affect women's emotional well-being after having an abortion. This information is important in light of current, widespread legislative efforts that aim to regulate abortion counseling, which are being proposed without an understanding of patient needs or facility practices. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

76 FR 59167 - Siemens Medical Solutions USA, Inc., Oncology Care Systems Division, Concord, CA; Siemens Medical...

Science.gov (United States)

2011-09-23

... Medical Solutions USA, Inc., Oncology Care Systems Division, Concord, CA; Siemens Medical Solutions USA... Solutions USA, Inc. (Siemens), Oncology Care Systems Division, Concord, California (subject firm). The...., Oncology Care Systems Division, Concord, California (TA-W-73,158) and Siemens Medical Solutions USA, Inc...

Post-cold war United Nations peacekeeping operations: a review of the case for a hybrid level 2+ medical treatment facility.

Science.gov (United States)

Johnson, Ralph Jay

2015-01-01

Post-Cold War, UN peacekeeping operations (UN PKOs) have become larger, more mobile, multi-faceted and conducted over vast areas of remote, rugged, and harsh geography. They have been increasingly involved in dangerous areas with ill-defined boundaries, simmering internecine armed conflict, and disregard on the part of some local parties for peacekeepers' security and role. Yet progressively there have been expectations of financial restraint and austerity. Additionally, UN PKOs have become more "robust," that is, engaged in preemptive, assertive operations. A statistically positive and significant relationship exists between missions' size, complexity, remoteness, and aggressive tenor and a higher probability of trauma or death, especially as a result of hostile actions or disease. Therefore, in the interest of "force protection" and optimizing operations, a key component of UN PKOs is health care and medical treatment. The expectation is that UN PKO medical support must conform to the general intent and structure of current UN PKOs to become more streamlined, portable, mobile, compartmentalized, and specialized, but also more varied and complex to address the medical aspects of these missions cost-efficiently. This article contends that establishing a hybrid level 2-a level 2 with level 3 modules and components (i.e., level 2+)-is a viable course of action when considering trends in the medical aspects of Post-Cold War UN PKOs. A level 2 medical treatment facility has the potential to provide needed forward mobile medical treatment, especially trauma care, for extended, complex, large-scale, and comprehensive UN PKOs. This is particularly the case for missions that include humanitarian outreach, preventive medicine, and psychiatry. The level 2 treatment facility is flexible enough to expand into a hybrid level 2+ with augmentation of modules based on changes in mission requirements and variation in medical aspects.

Find Ryan White HIV/AIDS Medical Care Providers

Data.gov (United States)

U.S. Department of Health & Human Services — The Find Ryan White HIV/AIDS Medical Care Providers tool is a locator that helps people living with HIV/AIDS access medical care and related services. Users can...

42 CFR 34.7 - Medical and other care; death.

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Medical and other care; death. 34.7 Section 34.7... EXAMINATIONS MEDICAL EXAMINATION OF ALIENS § 34.7 Medical and other care; death. (a) An alien detained by or in... further care. (b) In case of the death of an alien, the body shall be delivered to the consular or...

Medical Assistant-based care management for high risk patients in small primary care practices

DEFF Research Database (Denmark)

Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

2016-01-01

Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2......, and monitoring delivered by medical assistants with usual care. Measurements: All-cause hospitalizations at 12 months (primary outcome) and quality of life scores (Short Form 12 Health Questionnaire [SF-12] and the Euroqol instrument [EQ-5D]). Results: Included patients had, on average, four co-occurring chronic...

Quantitative Properties of the Macro Supply and Demand Structure for Care Facilities for Elderly in Japan.

Science.gov (United States)

Nishino, Tatsuya

2017-12-01

As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly's care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan's Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize 'Ageing in Place'. When considering households' tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia.

Quantitative Properties of the Macro Supply and Demand Structure for Care Facilities for Elderly in Japan

Science.gov (United States)

Nishino, Tatsuya

2017-01-01

As the Asian country with the most aged population, Japan, has been modifying its social welfare system. In 2000, the Japanese social care vision turned towards meeting the elderly’s care needs in their own homes with proper formal care services. This study aims to understand the quantitative properties of the macro supply and demand structure for facilities for the elderly who require support or long-term care throughout Japan and present them as index values. Additionally, this study compares the targets for establishing long-term care facilities set by Japan’s Ministry of Health, Labor and Welfare for 2025. In 2014, approximately 90% of all the people who were certified as requiring support and long-term care and those receiving preventive long-term care or long-term care services, were 75 years or older. The target increases in the number of established facilities by 2025 (for the 75-years-or-older population) were calculated to be 3.3% for nursing homes; 2.71% for long-term-care health facilities; 1.7% for group living facilities; and, 1.84% for community-based multi-care facilities. It was revealed that the establishment targets for 2025 also increase over current projections with the expected increase of the absolute number of users of group living facilities and community-based multi-care facilities. On the other hand, the establishment target for nursing homes remains almost the same as the current projection, whereas that for long-term-care health facilities decreases. These changes of facility ratios reveal that the Japanese social care system is shifting to realize ‘Ageing in Place’. When considering households’ tendencies, the target ratios for established facilities are expected to be applied to the other countries in Asia. PMID:29194405

Antimicrobial stewardship in long term care facilities: what is effective?

Science.gov (United States)

Nicolle, Lindsay E

2014-02-12

Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicrobial stewardship programs for long term care facilities were identified through a systematic literature search. Interventions included education, guidelines development, feedback to practitioners, and infectious disease consultation. The studies reviewed varied in types of facilities, interventions used, implementation, and evaluation. Comprehensive programs addressing all infections were reported to have improved antimicrobial use for at least some outcomes. Targeted programs for treatment of pneumonia were minimally effective, and only for indicators of uncertain relevance for stewardship. Programs focusing on specific aspects of treatment of urinary infection - limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection - were reported to be effective. There were no reports of cost-effectiveness, and the sustainability of most of the programs is unclear. There is a need for further evaluation to characterize effective antimicrobial stewardship for long term care facilities.

32 CFR 732.13 - Sources of care.

Science.gov (United States)

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Sources of care. 732.13 Section 732.13 National... CARE Medical and Dental Care From Nonnaval Sources § 732.13 Sources of care. (a) Initial application. If a member requires maternity, medical, or dental care and naval facilities are unavailable, make...

Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility?

Science.gov (United States)

Tian, Wenqiang; DeJong, Gerben; Horn, Susan D; Putman, Koen; Hsieh, Ching-Hui; DaVanzo, Joan E

2012-01-01

There has been lengthy debate as to which setting, skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), is more efficient in treating joint replacement patients. This study aims to determine the efficiency of rehabilitation care provided by SNF and IRF to joint replacement patients with respect to both payment and length of stay (LOS). This study used a prospective multisite observational cohort design. Tobit models were used to examine the association between setting of care and efficiency. The study enrolled 948 knee replacement patients and 618 hip replacement patients from 11 IRFs and 7 SNFs between February 2006 and February 2007. Output was measured by motor functional independence measure (FIM) score at discharge. Efficiency was measured in 3 ways: payment efficiency, LOS efficiency, and stochastic frontier analysis efficiency. IRF patients incurred higher expenditures per case but also achieved larger motor FIM gains in shorter LOS than did SNF patients. Setting of care was not a strong predictor of overall efficiency of rehabilitation care. Great variation in characteristics existed within IRFs or SNFs and severity groups. Medium-volume facilities among both SNFs and IRFs were most efficient. Early rehabilitation was consistently predictive of efficient treatment. The advantage of either setting is not clear-cut. Definition of efficiency depends in part on preference between cost and time. SNFs are more payment efficient; IRFs are more LOS efficient. Variation within SNFs and IRFs blurred setting differences; a simple comparison between SNF and IRF may not be appropriate.

High-cost users of medical care

OpenAIRE

Garfinkel, Steven A.; Riley, Gerald F.; Iannacchione, Vincent G.

1988-01-01

Based on data from the National Medical Care Utilization and Expenditure Survey, the 10 percent of the noninstitutionalized U.S. population that incurred the highest medical care charges was responsible for 75 percent of all incurred charges. Health status was the strongest predictor of high-cost use, followed by economic factors. Persons 65 years of age or over incurred far higher costs than younger persons and had higher out-of-pocket costs, absolutely and as a percentage of income, althoug...

Proposed medical applications of the National Accelerator Centre facilities

International Nuclear Information System (INIS)

Jones, D.T.L.

1982-01-01

The National Accelerator Centre is at present under construction at Faure, near Cape Town. The complex will house a 200 MeV separated-sector cyclotron which will provide high quality beams for nuclear physics and related diciplines as well as high intensity beams for medical use. The medical aspects catered for will include particle radiotherapy, isotope production and possibly proton radiography. A 30-bed hospital is to be constructed on the site. Building operations are well advanced and the medical facilities should be available for use by the end of 1984

Current status of collaborative relationships between dialysis facilities and dental facilities in Japan: results of a nationwide survey.

Science.gov (United States)

Yoshioka, Masami; Shirayama, Yasuhiko; Imoto, Issei; Hinode, Daisuke; Yanagisawa, Shizuko; Takeuchi, Yuko

2015-02-12

Recent studies have reported an association between periodontal disease and mortality among dialysis patients. Therefore, preventive dental care should be considered very important for this population. In Japan, no systematic education has been undertaken regarding the importance of preventive dental care for hemodialysis patients--even though these individuals tend to have oral and dental problems. The aim of this study was to investigate the current state of collaborative relationships between hemodialysis facilities and dental services in Japan and also to identify strategies to encourage preventive dental visits among hemodialysis outpatients. A nationwide questionnaire on the collaborative relationship between dialysis facilities and dental facilities was sent by mail to all medical facilities in Japan offering outpatient hemodialysis treatment. Responses were obtained from 1414 of 4014 facilities (35.2%). Among the 1414 facilities, 272 (19.2%) had a dental service department. Approximately 100,000 dialysis outpatients were receiving treatment at these participating facilities, which amounts to one-third of all dialysis patients in Japan. Of those patients, 82.9% received hemodialysis at medical facilities without dental departments. Only 87 of 454 small clinics without in-house dental departments (19.2%) had collaborative registered dental clinics. Medical facilities with registered dental clinics demonstrated a significantly more proactive attitude to routine collaboration on dental matters than facilities lacking such clinics. Our nationwide survey revealed that most dialysis facilities in Japan have neither an in-house dental department nor a collaborative relationship with a registered dental clinic. Registration of dental clinics appears to promote collaboration with dental facilities on a routine basis, which would be beneficial for oral health management in hemodialysis patients.

Cost recovery of NGO primary health care facilities: a case study in Bangladesh

Directory of Open Access Journals (Sweden)

Alam Khurshid

2010-06-01

Full Text Available Abstract Background Little is known about the cost recovery of primary health care facilities in Bangladesh. This study estimated the cost recovery of a primary health care facility run by Building Resources Across Community (BRAC, a large NGO in Bangladesh, for the period of July 2004 - June 2005. This health facility is one of the seven upgraded BRAC facilities providing emergency obstetric care and is typical of the government and private primary health care facilities in Bangladesh. Given the current maternal and child mortality in Bangladesh and the challenges to addressing health-related Millennium Development Goal (MDG targets the financial sustainability of such facilities is crucial. Methods The study was designed as a case study covering a single facility. The methodology was based on the 'ingredient approach' using the allocation techniques by inpatient and outpatient services. Cost recovery of the facility was estimated from the provider's perspective. The value of capital items was annualized using 5% discount rate and its market price of 2004 (replacement value. Sensitivity analysis was done using 3% discount rate. Results The cost recovery ratio of the BRAC primary care facility was 59%, and if excluding all capital costs, it increased to 72%. Of the total costs, 32% was for personnel while drugs absorbed 18%. Capital items were17% of total costs while operational cost absorbed 12%. Three-quarters of the total cost was variable costs. Inpatient services contributed 74% of total revenue in exchange of 10% of total utilization. An average cost per patient was US$ 10 while it was US$ 67 for inpatient and US$ 4 for outpatient. Conclusion The cost recovery of this NGO primary care facility is important for increasing its financial sustainability and decreasing donor dependency, and achieving universal health coverage in a developing country setting. However, for improving the cost recovery of the health facility, it needs to increase

[Home care and place of death for elderly people living in the remote islands of Japan. An examination on the presence of inpatient facilities].

Science.gov (United States)

Horikoshi, Naoko; Kuwahara, Yuki; Taguchi, Atsuko; Nagata, Tomoko; Murashima, Sachiyo

2013-07-01

The purpose of this study was to clarify the actual status of end-of-life care for elderly people living in the remote islands of Japan, and whether the presence of inpatient facilities was related to the place of death, so as to obtain suggestions for constructing a system of end-of-life care. The survey targeted caregivers (85 people) who cared for elderly people (aged 65 and over), who had been legally certified for long-term care, and who had died between April 2009 and July 2011 in five islands of Japan. Islands were selected from a list of remote islands specified in the Remote Islands Development Act and related laws. Using a mixed method embedded design, we conducted semi-structured interviews using a questionnaire that assessed the place and cause of the elderly patient's death, age at death, gender, and whether the patient or family members had requested that the patient be allowed to die at home. The proportion of elderly people who died at home in the group living on remote islands with no inpatient facilities was 39.0% (16 of 41 people), compared with 18.2% (8 of 44 people) living on islands with inpatient facilities. The difference was significant (P=0.029). Among the 24 elderly people who died at home, 6 died of cancer. Terminally ill cancer patients were released to die at home under three conditions: the caregivers could provide sufficient care, the visiting physician was present, and pain control was provided. It was also possible for elderly cancer patients to receive end-of-life care in remote islands that did not have inpatient facilities. In addition, among the elderly people who died at home in the remote islands, home care had been recommended by medical staff. It is important for professionals coordinating home care to understand the characteristics of diseases, perform early assessment of caregiver situations, and collaborate with medical staff.

Antimicrobial use in long-term-care facilities

NARCIS (Netherlands)

Nicolle, LE; Bentley, DW; Garibaldi, R; Neuhaus, EG; Smith, PW

There is intense antimicrobial use in long-term-care facilities (LTCFs), and studies repeatedly document that much of this use is inappropriate. The current crisis in antimicrobial resistance, which encompasses the LTCF, heightens concerns of antimicrobial use. Attempts to improve antimicrobial use

A national medical cyclotron facility: report to the Minister of Health by the Medical Cyclotron Committee

International Nuclear Information System (INIS)

1985-01-01

Research and training in nuclear medicine in Australia are both limited by the lack of a medical cyclotron facility. The Committee recommends the establishment of a national medical cyclotron to provide a supply of short-lived radioisotopes for research in relevant fields of medicine, and for diagnostic use in nuclear medicine

Stoicism, the physician, and care of medical outliers

Directory of Open Access Journals (Sweden)

Papadimos Thomas J

2004-12-01

Full Text Available Abstract Background Medical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them. The determinism of Stoic thought is explored as an intellectual basis for the pursuit of a correct mental attitude that will provide aid and comfort to physicians who care for medical outliers, thus fostering continued physician engagement in their care. Discussion The Stoic topics of good, the preferable, the morally indifferent, living consistently, and appropriate actions are reviewed. Furthermore, Zeno's cardinal virtues of Justice, Temperance, Bravery, and Wisdom are addressed, as are the Stoic passions of fear, lust, mental pain, and mental pleasure. These concepts must be understood by physicians if they are to comprehend and accept the Stoic view as it relates to having the proper attitude when caring for those with long-term and/or costly illnesses. Summary Practicing physicians, especially those that are hospital based, and most assuredly those practicing critical care medicine, will be emotionally challenged by the medical outlier. A Stoic approach to such a social and psychological burden may be of benefit.

The guidelines for the humanisation of care facilities

Directory of Open Access Journals (Sweden)

Daniela Bosia

2015-04-01

Full Text Available This article outlines the structure and contents of the guidelines for the humanisation of care facilities, which were produced from the research project The Humanisation of Healthcare Facilities: the new Dimension of Hospital Architecture conducted by the Tesis Inter-university Research Centre at the University of Florence and by the DINSE Department of the Politecnico di Torino for the Ministry of Health. The research work used a requirement-based approach that analysed the activities and requirements expressed by certain different users. For example, the guidelines on certain areas of the analysed healthcare facilities have been outlined.

Questionnaire survey and technical guideline of blood irradiation on medical facilities

International Nuclear Information System (INIS)

Matsumoto, Mitsuhiro; Hasegawa, Hironori; Okumura, Masahiko; Sonoda, Tatsuo; Osada, Koji.

1997-01-01

We know that transfusion-associated graft versus host disease (TA-GVHD) is a serious side effect associated with blood transfusion and the onset is independent on the immunological conditions of patients. We have only prophylactic treatment against TA-GVHD. The most reliable method is to irradiate the blood for transfusion. In Japanese medical facilities, however, the risk of TA-GVHD is poorly understood and actual conditions of the blood irradiation are unclear. We sent a questionnaire to randomly selected 426 medical facilities in Japan, which had the department of radiology, to investigate the actual conditions of blood irradiation for transfusion and the problems on the irradiation dose measurement of the external apparatus for blood irradiation. The questionnaire involved 19 questions about the blood irradiation for transfusion. The survey took place for one month (June 1-June 30, 1995). Replies were obtained from a total of 306 medical facilities (72%). The results showed that blood irradiation was done by several methods in the 75% of the medical facilities, and the external irradiation apparatus was used in 83%. Some problems were shown, including irradiation period, cost of the irradiation, the operating procedure of the apparatus, requested number of the irradiation, and the request after usual hours. There was no significant problem on the irradiation dose, irradiation method, etc. We also sent a questionnaire to 74 facilities of the Red Cross Blood Center, in which the frequency of blood irradiation have increased since May, 1976. The X-ray apparatus as the external irradiation apparatus has practical advantages; lower cost, compact and out of the legal control on the ionizing radiation, however, it has some problems on the uniformity of the absorption dose when a single X-ray tube-type apparatus is used. We discuss about the possible onset of TA-GVHD or other accidents by the incorrect irradiation of the blood preparations. (K.H.)

Integrated Payment and Delivery Models Offer Opportunities and Challenges for Residential Care Facilities

OpenAIRE

Grabowski, David C.; Caudry, Daryl J.; Dean, Katie M.; Stevenson, David G.

2015-01-01

Under health care reform, a series of new financing and delivery models are being piloted to integrate health and long-term care services for older adults. To date, these programs have not encompassed residential care facilities, with most programs focusing on long-term care recipients in the community or the nursing home. Our analyses indicate that individuals living in residential care facilities have similarly high rates of chronic illness and Medicare utilization when compared with simila...

The use of music in aged care facilities: A mixed-methods study.

Science.gov (United States)

Garrido, Sandra; Dunne, Laura; Perz, Janette; Chang, Esther; Stevens, Catherine J

2018-02-01

Music is frequently used in aged care, being easily accessible and cost-effective. Research indicates that certain types of musical engagement hold greater benefits than others. However, it is not clear how effectively music is utilized in aged care facilities and what the barriers are to its further use. This study used a mixed-methods paradigm, surveying 46 aged care workers and conducting in-depth interviews with 5, to explore how music is used in aged care facilities in Australia, staff perceptions of the impact of music on residents, and the barriers to more effective implementation of music in aged care settings.

Management challenges faced by managers of New Zealand long-term care facilities.

Science.gov (United States)

Madas, E; North, N

2000-01-01

This article reports on a postal survey of 78 long-term care managers in one region of New Zealand, of whom 45 (58%) responded. Most long-term care managers (73.2%) were middle-aged females holding nursing but not management qualifications. Most long-term care facilities (69%) tended to be stand-alone facilities providing a single type of care (rest home or continuing care hospital). The most prominent issues facing managers were considered to be inadequate funding to match the growing costs of providing long-term care and occupancy levels. Managers believed that political/regulatory, economic and social factors influenced these issues. Despite a turbulent health care environment and the challenges facing managers, long-term care managers reported they were coping well and valued networking.

In Connecticut: improving patient medication management in primary care.

Science.gov (United States)

Smith, Marie; Giuliano, Margherita R; Starkowski, Michael P

2011-04-01

Medications are a cornerstone of the management of most chronic conditions. However, medication discrepancies and medication-related problems-some of which can cause serious harm-are common. Pharmacists have the expertise to identify, resolve, monitor, and prevent these problems. We present findings from a Centers for Medicare and Medicaid Services demonstration project in Connecticut, in which nine pharmacists worked closely with eighty-eight Medicaid patients from July 2009 through May 2010. The pharmacists identified 917 drug therapy problems and resolved nearly 80 [corrected] percent of them after four encounters. The result was an estimated annual saving of $1,123 per patient on medication claims and $472 per patient on medical, hospital, and emergency department expenses-more than enough to pay for the contracted pharmacist services. We recommend that the Center for Medicare and Medicaid Innovation support the evaluation of pharmacist-provided medication management services in primary care medical homes, accountable care organizations, and community health and care transition teams, as well as research to explore how to enhance team-based care.

42 CFR 456.243 - Content of medical care evaluation studies.

Science.gov (United States)

2010-10-01

... 42 Public Health 4 2010-10-01 2010-10-01 false Content of medical care evaluation studies. 456.243 Section 456.243 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... Ur Plan: Medical Care Evaluation Studies § 456.243 Content of medical care evaluation studies. Each...

Referral of children seeking care at private health facilities in Uganda.

Science.gov (United States)

Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus; Clarke, Siân E; Lal, Sham; Hansen, Kristian S; Magnussen, Pascal; LaRussa, Philip

2017-02-14

In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health facilities in order to explore ways of improving treatment and referral of sick children in this sector. A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant interviews with private providers and community members. A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick children to higher levels of care in the two weeks prior to the survey. The main constraints to follow referral advice as perceived by caretakers were: not appreciating the importance of referral, gender-related decision-making and negotiations at household level, poor quality of care at referral facilities, inadequate finances at household level; while the perception that referral leads to loss of prestige and profit was a major constraint to private providers. In conclusion, the results show that referral of sick children at private health facilities faces many challenges at provider, caretaker, household and community levels. Thus, interventions to address constraints to referral of sick children are urgently needed.

Coverage and quality of antenatal care provided at primary health care facilities in the 'Punjab' province of 'Pakistan'.

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Muhammad Ashraf Majrooh

Full Text Available BACKGROUND: Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'. METHODS: Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers. RESULTS: The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage. CONCLUSION: The coverage and quality of the antenatal care services in 'Punjab' are extremely compromised. Only half of the expected pregnancies are enrolled and

Medical and radiological aspects of emergency preparedness and response at SevRAO facilities.

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Savkin, M N; Sneve, M K; Grachev, M I; Frolov, G P; Shinkarev, S M; Jaworska, A

2008-12-01

Regulatory cooperation between the Norwegian Radiation Protection Authority and the Federal Medical Biological Agency (FMBA) of the Russian Federation has the overall goal of promoting improvements in radiation protection in Northwest Russia. One of the projects in this programme has the objectives to review and improve the existing medical emergency preparedness capabilities at the sites for temporary storage of spent nuclear fuel and radioactive waste. These are operated by SevRAO at Andreeva Bay and in Gremikha village on the Kola Peninsula. The work is also intended to provide a better basis for regulation of emergency response and medical emergency preparedness at similar facilities elsewhere in Russia. The purpose of this paper is to present the main results of that project, implemented by the Burnasyan Federal Medical Biophysical Centre. The first task was an analysis of the regulatory requirements and the current state of preparedness for medical emergency response at the SevRAO facilities. Although Russian regulatory documents are mostly consistent with international recommendations, some distinctions lead to numerical differences in operational intervention criteria under otherwise similar conditions. Radiological threats relating to possible accidents, and related gaps in the regulation of SevRAO facilities, were also identified. As part of the project, a special exercise on emergency medical response on-site at Andreeva Bay was prepared and carried out, and recommendations were proposed after the exercise. Following fruitful dialogue among regulators, designers and operators, special regulatory guidance has been issued by FMBA to account for the specific and unusual features of the SevRAO facilities. Detailed sections relate to the prevention of accidents, and emergency preparedness and response, supplementing the basic Russian regulatory requirements. Overall it is concluded that (a) the provision of medical and sanitary components of emergency

Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service.

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Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren

2017-01-13

Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care

Community-level football injury epidemiology: traumatic injuries treated at Swedish emergency medical facilities.

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Timpka, Toomas; Schyllander, Jan; Stark Ekman, Diana; Ekman, Robert; Dahlström, Örjan; Hägglund, Martin; Kristenson, Karolina; Jacobsson, Jenny

2018-02-01

Despite the popularity of the sport, few studies have investigated community-level football injury patterns. This study examines football injuries treated at emergency medical facilities using data from three Swedish counties. An open-cohort design was used based on residents aged 0-59 years in three Swedish counties (pop. 645 520). Data were collected from emergency medical facilities in the study counties between 1 January 2007 and 31 December 2010. Injury frequencies and proportions for age groups stratified by sex were calculated with 95% confidence intervals (95% CIs) and displayed per diagnostic group and body location. Each year, more than 1/200 person aged 0-59 years sustained at least one injury during football play that required emergency medical care. The highest injury incidence was observed among adolescent boys [2009 injuries per 100 000 population years (95% CI 1914-2108)] and adolescent girls [1413 injuries per 100 000 population years (95% CI 1333-1498)]. For female adolescents and adults, knee joint/ligament injury was the outstanding injury type (20% in ages 13-17 years and 34% in ages 18-29 years). For children aged 7-12 years, more than half of the treated injuries involved the upper extremity; fractures constituted about one-third of these injuries. One of every 200 residents aged 0-59 years in typical Swedish counties each year sustained a traumatic football injury that required treatment in emergency healthcare. Further research on community-level patterns of overuse syndromes sustained by participation in football play is warranted. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

[The forensic medical aspects of the inappropriate medical care in the modern-day Ukraine].

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Franchuk, V V

2018-01-01

Despite the fact that the ever growing relevance of the problem of the inappropriate medical care was long ago brought to the worldwide attention, it has not been practically addressed in the Ukraine since the country gained independence in 1991. The objective of the present study was to consider the specific features of expert examination of the cases of inappropriate medical care as exemplified by the materials of the legal actions and lawsuits instituted against healthcare specialists violating their occupational duties. The results of forensic medical examination by the local Bureaux of forensic medical expertise concerning the 350 so-called malpractice suits instituted in the Ternopol, Zhitomir, and Chernovtsy regions during the period from 207 to 2016 were available for the analysis. The facts of inadequate and inappropriate medical care were documented in 245 (72.0%) cases. The frequency of diagnostic and therapeutic errors amounted to 29.7% and 26.9% respectively while the improper formulation of the medical documentation was recorded in 21.3% of the cases. The cases of poor organization of the diagnostic and treatment process accounted for 14.6% of the total whereas the improper behaviour of the medical personnel was reported in 7.5% of all the known cases of provision of the healthcare services. It is concluded that in the majority of the cases, the citizens of the modern-day Ukraine receive the inappropriate (insufficient and untimely) medical care. Over 80% of the cases of the inappropriate medical care currently provided in the country can be accounted for by the objective reasons, with each fifths case being due to the violation of professional responsibilities by the healthcare providers.

Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities.

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Daneman, Nick; Campitelli, Michael A; Giannakeas, Vasily; Morris, Andrew M; Bell, Chaim M; Maxwell, Colleen J; Jeffs, Lianne; Austin, Peter C; Bronskill, Susan E

2017-06-26

, use of prolonged treatment duration and class selection. Prescriber audit and feedback may be a promising tool to optimize antibiotic use in long-term care facilities. © 2017 Canadian Medical Association or its licensors.

Quality of antenatal care service provision in health facilities across sub-Saharan Africa: Evidence from nationally representative health facility assessments.

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Kanyangarara, Mufaro; Munos, Melinda K; Walker, Neff

2017-12-01

Utilization of antenatal care (ANC) services has increased over the past two decades. Continued gains in maternal and newborn health will require an understanding of both access and quality of ANC services. We linked health facility and household survey data to examine the quality of service provision for five ANC interventions across health facilities in sub-Saharan Africa. Using data from 20 nationally representative health facility assessments - the Service Provision Assessment (SPA) and the Service Availability and Readiness Assessment (SARA), we estimated facility level readiness to deliver five ANC interventions: tetanus toxoid vaccine for pregnant women, intermittent preventive treatment for malaria in pregnancy (IPTp), syphilis detection and treatment in pregnancy, iron supplementation and hypertensive disease case management. Facility level indicators were stratified by health facility type, managing authority and location, then linked to estimates of ANC utilization in that stratum from the corresponding Demographic and Health Surveys (DHS) to generate population level estimates of the 'likelihood of appropriate care'. Finally, the association between estimates of the 'likelihood of appropriate care' from the linking approach and estimates of coverage levels from the DHS were assessed. A total of 10 534 health facilities were surveyed in the 20 health facility assessments, of which 8742 reported offering ANC services and were included in the analysis. Health facility readiness to deliver IPTp, iron supplementation, and tetanus toxoid vaccination was higher (median: 84.1%, 84.9% and 82.8% respectively) than readiness to deliver hypertensive disease case management and syphilis detection and treatment (median: 23.0% and 19.9% respectively). Coverage of at least 4 ANC visits ranged from 24.8% to 75.8%. Estimates of the likelihood of appropriate care derived from linking health facility and household survey data showed marked gaps for all interventions

Nursing delegation and medication administration in assisted living.

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Mitty, Ethel; Resnick, Barbara; Allen, Josh; Bakerjian, Debra; Hertz, Judith; Gardner, Wendi; Rapp, Mary Pat; Reinhard, Susan; Young, Heather; Mezey, Mathy

2010-01-01

Assisted living (AL) residences are residential long-term care settings that provide housing, 24-hour oversight, personal care services, health-related services, or a combination of these on an as-needed basis. Most residents require some assistance with activities of daily living and instrumental activities of daily living, such as medication management. A resident plan of care (ie, service agreement) is developed to address the health and psychosocial needs of the resident. The amount and type of care provided, and the individual who provides that care, vary on the basis of state regulations and what services are provided within the facility. Some states require that an RN hold a leadership position to oversee medication management and other aspects of care within the facility. A licensed practical nurse/licensed vocational nurse can supervise the day-to-day direct care within the facility. The majority of direct care in AL settings is provided by direct care workers (DCWs), including certified nursing assistants or unlicensed providers. The scope of practice of a DCW varies by state and the legal structure within that state. In some states, the DCW is exempt from the nurse practice act, and in some states, the DCW may practice within a specific scope such as being a medication aide. In most states, however, the DCW scope of practice is conscribed, in part, by the delegation of responsibilities (such as medication administration) by a supervising RN. The issue of RN delegation has become the subject of ongoing discussion for AL residents, facilities, and regulators and for the nursing profession. The purpose of this article is to review delegation in AL and to provide recommendations for future practice and research in this area.

The Context of Religious and Spiritual Care at the End of Life in Long-term Care Facilities.

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Hamilton, V Lee; Daaleman, Timothy P; Williams, Christianna S; Zimmerman, Sheryl

2009-01-01

Despite the increasing numbers of Americans who die in nursing homes (NHs) and residential care/assisted living (RC/AL) facilities, and the importance of religious and spiritual needs as one approaches death, little is known about how these needs are met for dying individuals in long-term care (LTC) institutional settings. This study compared receipt of religious and spiritual help in four types of LTC settings: NHs, smaller (facilities, traditional RC/AL facilities, and new-model RC/AL facilities. Data were also available for religious affiliation of the facilities, size, and provision of religious and hospice services. Controlling for such factors, the importance of religion/spirituality to the decedent was the strongest predictor of the decedent's receipt of spiritual help. In addition, new-model RC/AL facilities were significantly more likely to provide help for religious and spiritual needs of decedent residents than other RC/AL types, but did not differ significantly from NHs.

2001 survey on primary medical care in Singapore.

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Emmanuel, S C; Phua, H P; Cheong, P Y

2004-05-01

The 2001 survey on primary medical care was undertaken to compare updated primary healthcare practices such as workload and working hours in the public and private sectors; determine private and public sector market shares in primary medical care provision; and gather the biographical profile and morbidity profile of patients seeking primary medical care from both sectors in Singapore. This is the third survey in its series, the earlier two having been carried out in 1988 and 1993, respectively. The survey questionnaire was sent out to all the 1480 family doctors in private primary health outpatient practice, the 89 community-based paediatricians in the private sector who were registered with the Singapore Medical Council and also to all 152 family doctors working in the public sector primary medical care clinics. The latter comprised the polyclinics under the two health clusters in Singapore, namely the Singapore Health Services and National Healthcare Group, and to a very much smaller extent, the School Health Service's (SHS) outpatient clinics. The survey was conducted on 21 August 2001, and repeated on 25 September 2001 to enable those who had not responded to the original survey date to participate. Subjects consisted of all outpatients who sought treatment at the private family practice clinics (including the clinics of the community-based paediatricians), and the public sector primary medical care clinics, on the survey day. The response rate from the family doctors in private practice was 36 percent. Owing to the structured administrative organisation of the polyclinics and SHS outpatient clinics, all returns were completed and submitted to the respective headquarters. Response from the community-based paediatricians was poor, so their findings were omitted in the survey analysis. The survey showed that the average daily patient-load of a family doctor in private practice was 33 patients per day, which was lower than the 40 patients a day recorded in 1993

National Medical Care System May Impede Fostering of True Specialization of Radiation Oncologists: Study Based on Structure Survey in Japan

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Numasaki, Hodaka [Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Osaka (Japan); Shibuya, Hitoshi [Department of Radiology, Tokyo Medical and Dental University, Tokyo (Japan); Nishio, Masamichi [Department of Radiology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido (Japan); Ikeda, Hiroshi [Department of Radiology, Sakai Municipal Hospital, Sakai, Osaka (Japan); Sekiguchi, Kenji [Department of Radiation Oncology, St. Luke' s International Hospital, Tokyo (Japan); Kamikonya, Norihiko [Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo (Japan); Koizumi, Masahiko [Oncology Center, Osaka University Hospital, Suita, Osaka (Japan); Tago, Masao [Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, Kawasaki, Kanagawa (Japan); Ando, Yutaka [Department of Medical Informatics, Heavy Ion Medical Center, National Institute of Radiological Sciences, Chiba (Japan); Tsukamoto, Nobuhiro [Department of Radiation Oncology, Saitama Medical University International Medical Center, Saitama (Japan); Terahara, Atsuro [Department of Radiology, Toho University Omori Medical Center, Tokyo (Japan); Nakamura, Katsumasa [Department of Radiology, Kyushu University Hospital at Beppu, Oita (Japan); Mitsumori, Michihide [Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine Kyoto University, Kyoto (Japan); Nishimura, Tetsuo [Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka (Japan); Hareyama, Masato [Department of Radiology, Sapporo Medical University, Hokkaido (Japan); Teshima, Teruki, E-mail: teshima@sahs.med.osaka-u.ac.jp [Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Suita, Osaka (Japan)

2012-01-01

Purpose: To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. Methods and Materials: In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO). Results: The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p < 0.0001). There were also significant differences in the average practice index for patients by ROs working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p < 0.0001). Conclusions: ROs working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists.

National medical care system may impede fostering of true specialization of radiation oncologists: study based on structure survey in Japan.

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Numasaki, Hodaka; Shibuya, Hitoshi; Nishio, Masamichi; Ikeda, Hiroshi; Sekiguchi, Kenji; Kamikonya, Norihiko; Koizumi, Masahiko; Tago, Masao; Ando, Yutaka; Tsukamoto, Nobuhiro; Terahara, Atsuro; Nakamura, Katsumasa; Mitsumori, Michihide; Nishimura, Tetsuo; Hareyama, Masato; Teshima, Teruki

2012-01-01

To evaluate the actual work environment of radiation oncologists (ROs) in Japan in terms of working pattern, patient load, and quality of cancer care based on the relative time spent on patient care. In 2008, the Japanese Society of Therapeutic Radiology and Oncology produced a questionnaire for a national structure survey of radiation oncology in 2007. Data for full-time ROs were crosschecked with data for part-time ROs by using their identification data. Data of 954 ROs were analyzed. The relative practice index for patients was calculated as the relative value of care time per patient on the basis of Japanese Blue Book guidelines (200 patients per RO). The working patterns of RO varied widely among facility categories. ROs working mainly at university hospitals treated 189.2 patients per year on average, with those working in university hospitals and their affiliated facilities treating 249.1 and those working in university hospitals only treating 144.0 patients per year on average. The corresponding data were 256.6 for cancer centers and 176.6 for other facilities. Geographically, the mean annual number of patients per RO per quarter was significantly associated with population size, varying from 143.1 to 203.4 (p working mainly in university hospitals between those in main and affiliated facilities (1.07 vs 0.71: p working in university hospitals and their affiliated facilities treated more patients than the other ROs. In terms of patient care time only, the quality of cancer care in affiliated facilities might be worse than that in university hospitals. Under the current national medical system, working patterns of ROs of academic facilities in Japan appear to be problematic for fostering true specialization of radiation oncologists. Copyright © 2012 Elsevier Inc. All rights reserved.

PALLIATIVE CARE AND MEDICAL COMMUNICATION

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Cristina Anca COLIBABA

2015-06-01

Full Text Available This article outlines learners’ difficulty in acquiring and practicing palliative medical skills necessary in medical procedures due to limited technologically state-of-the art language learning support to facilitate optimum access for medical students to the European medicine sector and offers as a potential solution the Palliative Care MOOC project (2014-1-RO01-KA203-002940. The project is co-financed by the European Union under the Erasmus+ program and coordinated by the Gr.T.Popa University of Medicine and Pharmacy Iasi, Romania. The article describes the project idea and main objectives, highlighting its focus and activities on developing innovative guidelines on standardized fundamental medical procedures, as well as clinical language and communication skills. The project thus helps not only medical lecturers and language teachers who teach medical students, but also the medical students themselves and the lay people involved in causalities.

Medical care at mass gatherings: emergency medical services at large-scale rave events.

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Krul, Jan; Sanou, Björn; Swart, Eleonara L; Girbes, Armand R J

2012-02-01

The objective of this study was to develop comprehensive guidelines for medical care during mass gatherings based on the experience of providing medical support during rave parties. Study design was a prospective, observational study of self-referred patients who reported to First Aid Stations (FASs) during Dutch rave parties. All users of medical care were registered on an existing standard questionnaire. Health problems were categorized as medical, trauma, psychological, or miscellaneous. Severity was assessed based on the Emergency Severity Index. Qualified nurses, paramedics, and doctors conducted the study after training in the use of the study questionnaire. Total number of visitors was reported by type of event. During the 2006-2010 study period, 7,089 persons presented to FASs for medical aid during rave parties. Most of the problems (91.1%) were categorized as medical or trauma, and classified as mild. The most common medical complaints were general unwell-being, nausea, dizziness, and vomiting. Contusions, strains and sprains, wounds, lacerations, and blisters were the most common traumas. A small portion (2.4%) of the emergency aid was classified as moderate (professional medical care required), including two cases (0.03%) that were considered life-threatening. Hospital admission occurred in 2.2% of the patients. Fewer than half of all patients presenting for aid were transported by ambulance. More than a quarter of all cases (27.4%) were related to recreational drugs. During a five-year field research period at rave dance parties, most presentations on-site for medical evaluation were for mild conditions. A medical team of six healthcare workers for every 10,000 rave party visitors is recommended. On-site medical staff should consist primarily of first aid providers, along with nurses who have event-specific training on advanced life support, event-specific injuries and incidents, health education related to self-care deficits, interventions for

Development of an integrated medical supply information system

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Xu, Eric; Wermus, Marek; Blythe Bauman, Deborah

2011-08-01

The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.

Effects of person-centered care on residents and staff in aged-care facilities: a systematic review

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Brownie S

2013-01-01

Full Text Available Sonya Brownie, Susan NancarrowSchool of Health and Human Sciences, Southern Cross University, Lismore, NSW, AustraliaBackground: Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff.Methods: We searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes.Results: The search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4. The studies in this review incorporated a range of different outcome measures (ie, dependent variables to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents' levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses' sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an

Predictors associated with unplanned hospital readmission of medical and surgical intensive care unit survivors within 30 days of discharge.

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Ohnuma, Tetsu; Shinjo, Daisuke; Brookhart, Alan M; Fushimi, Kiyohide

2018-01-01

Reducing the 30-day unplanned hospital readmission rate is a goal for physicians and policymakers in order to improve quality of care. However, data on the readmission rate of critically ill patients in Japan and knowledge of the predictors associated with readmission are lacking. We investigated predictors associated with 30-day rehospitalization for medical and surgical adult patients separately. Patient data from 502 acute care hospitals with intensive care unit (ICU) facilities in Japan were retrospectively extracted from the Japanese Diagnosis Procedure Combination (DPC) database between April 2012 and February 2014. Factors associated with unplanned hospital readmission within 30 days of hospital discharge among medical and surgical ICU survivors were identified using multivariable logistic regression analysis. Of 486,651 ICU survivors, we identified 5583 unplanned hospital readmissions within 30 days of discharge following 147,423 medical hospitalizations (3.8% readmitted) and 11,142 unplanned readmissions after 339,228 surgical hospitalizations (3.3% readmitted). The majority of unplanned hospital readmissions, 60.9% of medical and 63.1% of surgical case readmissions, occurred within 15 days of discharge. For both medical and surgical patients, the Charlson comorbidity index score; category of primary diagnosis during the index admission (respiratory, gastrointestinal, and metabolic and renal); hospital length of stay; discharge to skilled nursing facilities; and having received a packed red blood cell transfusion, low-dose steroids, or renal replacement therapy were significantly associated with higher unplanned hospital readmission rates. From patient data extracted from a large Japanese national database, the 30-day unplanned hospital readmission rate after ICU stay was 3.4%. Further studies are required to improve readmission prediction models and to develop targeted interventions for high-risk patients.

Cost Effectiveness of Falls and Injury Prevention Strategies for Older Adults Living in Residential Aged Care Facilities.

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Church, Jody L; Haas, Marion R; Goodall, Stephen

2015-12-01

To evaluate the cost effectiveness of interventions designed to prevent falls and fall-related injuries among older people living in residential aged care facilities (RACFs) from an Australian health care perspective. A decision analytic Markov model was developed that stratified individuals according to their risk of falling and accounted for the risk of injury following a fall. The effectiveness of the interventions was derived from two Cochrane reviews of randomized controlled trials for falls/fall-related injury prevention in RACFs. Interventions were considered effective if they reduced the risk of falling or reduced the risk of injury following a fall. The interventions that were modelled included vitamin D supplementation, annual medication review, multifactorial intervention (a combination of risk assessment, medication review, vision assessment and exercise) and hip protectors. The cost effectiveness was calculated as the incremental cost relative to the incremental benefit, in which the benefit was estimated using quality-adjusted life-years (QALYs). Uncertainty was explored using univariate and probabilistic sensitivity analysis. Vitamin D supplementation and medication review both dominated 'no intervention', as these interventions were both more effective and cost saving (because of healthcare costs avoided). Hip protectors are dominated (less effective and more costly) by vitamin D and medication review. The incremental cost-effectiveness ratio (ICER) for medication review relative to vitamin D supplementation is AU$2442 per QALY gained, and the ICER for multifactorial intervention relative to medication review is AU$1,112,500 per QALY gained. The model is most sensitive to the fear of falling and the cost of the interventions. The model suggests that vitamin D supplementation and medication review are cost-effective interventions that reduce falls, provide health benefits and reduce health care costs in older adults living in RACFs.

Medical liability and health care reform.

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Nelson, Leonard J; Morrisey, Michael A; Becker, David J

2011-01-01

We examine the impact of the Affordable Care Act (ACA) on medical liability and the controversy over whether federal medical reform including a damages cap could make a useful contribution to health care reform. By providing guaranteed access to health care insurance at community rates, the ACA could reduce the problem of under-compensation resulting from damages caps. However, it may also exacerbate the problem of under-claiming in the malpractice system, thereby reducing incentives to invest in loss prevention activities. Shifting losses from liability insurers to health insurers could further undermine the already weak deterrent effect of the medical liability system. Republicans in Congress and physician groups both pushed for the adoption of a federal damages cap as part of health care reform. Physician support for damages caps could be explained by concerns about the insurance cycle and the consequent instability of the market. Our own study presented here suggests that there is greater insurance market stability in states with caps on non-economic damages. Republicans in Congress argued that the enactment of damages caps would reduce aggregate health care costs. The Congressional Budget Office included savings from reduced health care utilization in its estimates of cost savings that would result from the enactment of a federal damages cap. But notwithstanding recent opinions offered by the CBO, it is not clear that caps will significantly reduce health care costs or that any savings will be passed on to consumers. The ACA included funding for state level demonstration projects for promising reforms such as offer and disclosure and health courts, but at this time the benefits of these reforms are also uncertain. There is a need for further studies on these issues.

The costs of caring: medical costs of Alzheimer's disease and the managed care environment.

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Murman, D L

2001-01-01

This review summarizes the medical costs associated with Alzheimer's disease (AD) and related dementias, as well as the payers responsible for these medical costs in the US health care system. It is clear from this review that AD and related dementias are associated with substantial medical costs. The payers responsible for a majority of these costs are families of patients with AD and the US government through the Medicare and Medicaid programs. In an attempt to control expenditures, Medicare and Medicaid have turned to managed care principles and managed care organizations. The increase in "managed" dementia care gives rise to several potential problems for patients with AD, along with many opportunities for systematic improvement in the quality of dementia care. Evidence-based disease management programs provide the greatest opportunities for improving managed dementia care but will require the development of dementia-specific quality of care measures to evaluate and continually improve them.

Integrating advanced practice providers into medical critical care teams.

Science.gov (United States)

McCarthy, Christine; O'Rourke, Nancy C; Madison, J Mark

2013-03-01

Because there is increasing demand for critical care providers in the United States, many medical ICUs for adults have begun to integrate nurse practitioners and physician assistants into their medical teams. Studies suggest that such advanced practice providers (APPs), when appropriately trained in acute care, can be highly effective in helping to deliver high-quality medical critical care and can be important elements of teams with multiple providers, including those with medical house staff. One aspect of building an integrated team is a practice model that features appropriate coding and billing of services by all providers. Therefore, it is important to understand an APP's scope of practice, when they are qualified for reimbursement, and how they may appropriately coordinate coding and billing with other team providers. In particular, understanding when and how to appropriately code for critical care services (Current Procedural Terminology [CPT] code 99291, critical care, evaluation and management of the critically ill or critically injured patient, first 30-74 min; CPT code 99292, critical care, each additional 30 min) and procedures is vital for creating a sustainable program. Because APPs will likely play a growing role in medical critical care units in the future, more studies are needed to compare different practice models and to determine the best way to deploy this talent in specific ICU settings.

Production of medical radioactive isotopes using KIPT electron driven subcritical facility

International Nuclear Information System (INIS)

Talamo, Alberto; Gohar, Yousry

2008-01-01

Kharkov Institute of Physics and Technology (KIPT) of Ukraine in collaboration with Argonne National Laboratory (ANL) has a plan to construct an electron accelerator driven subcritical assembly. One of the facility objectives is the production of medical radioactive isotopes. This paper presents the ANL collaborative work performed for characterizing the facility performance for producing medical radioactive isotopes. First, a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Then, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes have been considered and all transmutation channels are used including (n, γ), (n, 2n), (n, p), and (γ, n). In the second part, the parent isotopes with high reaction rate were explicitly modeled in the calculations. Four irradiation locations were considered in the analyses to study the medical isotope production rate. The results show the self-shielding effect not only reduces the specific activity but it also changes the irradiation location that maximizes the specific activity. The axial and radial distributions of the parent capture rates have been examined to define the irradiation sample size of each parent isotope

Production of medical radioactive isotopes using KIPT electron driven subcritical facility

Energy Technology Data Exchange (ETDEWEB)

Talamo, Alberto [Nuclear Engineering Division, Argonne National Laboratory, 9700 South Cass Avenue, Argonne, IL 60439 (United States)], E-mail: alby@anl.gov; Gohar, Yousry [Nuclear Engineering Division, Argonne National Laboratory, 9700 South Cass Avenue, Argonne, IL 60439 (United States)

2008-05-15

Kharkov Institute of Physics and Technology (KIPT) of Ukraine in collaboration with Argonne National Laboratory (ANL) has a plan to construct an electron accelerator driven subcritical assembly. One of the facility objectives is the production of medical radioactive isotopes. This paper presents the ANL collaborative work performed for characterizing the facility performance for producing medical radioactive isotopes. First, a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Then, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes have been considered and all transmutation channels are used including (n, {gamma}), (n, 2n), (n, p), and ({gamma}, n). In the second part, the parent isotopes with high reaction rate were explicitly modeled in the calculations. Four irradiation locations were considered in the analyses to study the medical isotope production rate. The results show the self-shielding effect not only reduces the specific activity but it also changes the irradiation location that maximizes the specific activity. The axial and radial distributions of the parent capture rates have been examined to define the irradiation sample size of each parent isotope.

Production of medical radioactive isotopes using KIPT electron driven subcritical facility.

Science.gov (United States)

Talamo, Alberto; Gohar, Yousry

2008-05-01

Kharkov Institute of Physics and Technology (KIPT) of Ukraine in collaboration with Argonne National Laboratory (ANL) has a plan to construct an electron accelerator driven subcritical assembly. One of the facility objectives is the production of medical radioactive isotopes. This paper presents the ANL collaborative work performed for characterizing the facility performance for producing medical radioactive isotopes. First, a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Then, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes have been considered and all transmutation channels are used including (n, gamma), (n, 2n), (n, p), and (gamma, n). In the second part, the parent isotopes with high reaction rate were explicitly modeled in the calculations. Four irradiation locations were considered in the analyses to study the medical isotope production rate. The results show the self-shielding effect not only reduces the specific activity but it also changes the irradiation location that maximizes the specific activity. The axial and radial distributions of the parent capture rates have been examined to define the irradiation sample size of each parent isotope.

Resident challenges with daily life in Chinese long-term care facilities: A qualitative pilot study.

Science.gov (United States)

Song, Yuting; Scales, Kezia; Anderson, Ruth A; Wu, Bei; Corazzini, Kirsten N

As traditional family-based care in China declines, the demand for residential care increases. Knowledge of residents' experiences with long-term care (LTC) facilities is essential to improving quality of care. This pilot study aimed to describe residents' experiences in LTC facilities, particularly as it related to physical function. Semi-structured open-ended interviews were conducted in two facilities with residents stratified by three functional levels (n = 5). Directed content analysis was guided by the Adaptive Leadership Framework. A two-cycle coding approach was used with a first-cycle descriptive coding and second-cycle dramaturgical coding. Interviews provided examples of challenges faced by residents in meeting their daily care needs. Five themes emerged: staff care, care from family members, physical environment, other residents in the facility, and personal strategies. Findings demonstrate the significance of organizational context for care quality and reveal foci for future research. Copyright © 2017 Elsevier Inc. All rights reserved.

Health insurance and the demand for medical care.

Science.gov (United States)

de Meza, D

1983-03-01

With rare exceptions the provision of actuarially fair health insurance tends to substantially increase the demand for medical care by redistributing income from the healthy to the sick. This suggests that previous studies which attribute all the extra demand for medical care to moral hazard effects may overestimate the efficiency costs of health insurance.

U.S. academic medical centers under the managed health care environment.

Science.gov (United States)

Guo, K

1999-06-01

This research investigates the impact of managed health care on academic medical centers in the United States. Academic medical centers hold a unique position in the U.S. health care system through their missions of conducting cutting-edge biomedical research, pursuing clinical and technological innovations, providing state-of-the-art medical care and producing highly qualified health professionals. However, policies to control costs through the use of managed care and limiting resources are detrimental to academic medical centers and impede the advancement of medical science. To survive the threats of managed care in the health care environment, academic medical centers must rely on their upper level managers to derive successful strategies. The methods used in this study include qualitative approaches in the form of key informants and case studies. In addition, a survey questionnaire was sent to 108 CEOs in all the academic medical centers in the U.S. The findings revealed that managers who perform the liaison, monitor, entrepreneur and resource allocator roles are crucial to ensure the survival of academic medical centers, so that academic medical centers can continue their missions to serve the general public and promote their well-being.

Smoke-Free Medical Facility Campus Legislation: Support, Resistance, Difficulties and Cost

Directory of Open Access Journals (Sweden)

J. Gary Wheeler

2009-01-01

Full Text Available Although medical facilities restrict smoking inside, many people continue to smoke outside, creating problems with second-hand smoke, litter, fire risks, and negative role modeling. In 2005, Arkansas passed legislation prohibiting smoking on medical facility campuses. Hospital administrators (N=113 were surveyed pre- and post-implementation. Administrators reported more support and less difficulty than anticipated. Actual cost was 10-50% of anticipated cost. Few negative effects and numerous positive effects on employee performance and retention were reported. The results may be of interest to hospital administrators and demonstrate that state legislation can play a positive role in facilitating broad health-related policy change.

They receive antenatal care in health facilities, yet do not deliver there: predictors of health facility delivery by women in rural Ghana.

Science.gov (United States)

Boah, Michael; Mahama, Abraham B; Ayamga, Emmanuel A

2018-05-03

Research has shown that use of antenatal services by pregnant women and delivery in health facilities with skilled birth attendants contribute to better delivery outcomes. However, a gap exists in Ghana between the use of antenatal care provided by health facilities and delivery in health facilities with skilled birth attendants by pregnant women. This study sought to identify the predictors of health facility delivery by women in a rural district in Ghana. This was a cross-sectional study conducted in June 2016. Women who delivered in the past 6 months preceding the study were interviewed. Data on socio-demographic characteristics, use of antenatal care, place of delivery and reasons for home delivery were collected from study participants. Chi-square test and multiple logistic regression analysis were used to assess an association between women's socio-demographic and obstetric characteristics and place of delivery at 95% confidence interval. The study found that 98.8% of women received antenatal care services at least once during their recent pregnancy, and 67.9% attended antenatal care at least four times before delivery. However, 61.9% of the women delivered in a health facility with a skilled attendant. The frequently mentioned reason for home delivery was "unaware of onset of labour and delivery". The odds for delivery at a health facility were reduced among women with four living children [(AOR = 0.07, CI = 0.15-0.36, p = 0.001)], with no exposure to delivery care information [(AOR = 0.06, CI = 0.01-0.34, p = 0.002), who started their first ANC visit from the second trimester of pregnancy[(AOR = 0.003, CI = 0.01-0.15, p facilities although visits to antenatal care sessions were high, an indication that there was the need to intensify health education on early initiation of antenatal care, signs of labour and delivery, and importance of health facility delivery.

Does health facility service environment matter for the receipt of essential newborn care? Linking health facility and household survey data in Malawi.

Science.gov (United States)

Carvajal-Aguirre, Liliana; Mehra, Vrinda; Amouzou, Agbessi; Khan, Shane M; Vaz, Lara; Guenther, Tanya; Kalino, Maggie; Zaka, Nabila

2017-12-01

Health facility service environment is an important factor for newborns survival and well-being in general and in particular in high mortality settings such as Malawi where despite high coverage of essential interventions, neonatal mortality remains high. The aim of this study is to assess whether the quality of the health service environment at birth is associated with quality of care received by the newborn. We used data from the Malawi Millennium Development Goals Endline household survey conducted as part of MICS survey program and Service Provision Assessment Survey carried out in 2014. The analysis is based on 6218 facility births that occurred during the past 2 years. Descriptive statistics, bivariate and multivariate random effect models are used to assess the association of health facility service readiness score for normal deliveries and newborn care with newborns receiving appropriate newborn care, defined for this analysis as receiving 5 out of 6 recommended interventions during the first 2 days after birth. Newborns in districts with top facility service readiness score have 1.5 higher odds of receiving appropriate newborn care (adjusted odds ratio (aOR) = 1.52, 95% confidence interval CI = 1.19-1.95, P  = 0.001), as compared to newborns in districts with a lower facility score after adjusting for potential confounders. Newborns in the Northern region were two times more likely to receive 5 newborn care interventions as compared to newborns in the Southern region (aOR = 2.06, 95% CI = 1.50-2.83, P  < 0.001). Living in urban or rural areas did not have an impact on receiving appropriate newborn care. There is need to increase the level of service readiness across all facilities, so that all newborns irrespective of the health facility, district or region of delivery are able to receive all recommended essential interventions. Investments in health systems in Malawi should concentrate on increasing training and availability of

Pediatric сlinic of Odessa National Medical University: the quality of emergency medical care for children

Directory of Open Access Journals (Sweden)

E.A. Starets

2017-04-01

Full Text Available Background. The purpose of the article is to discuss the issue of improving the quality of emergency care for children with the most common diseases. Materials and methods. The quality of medical care includes 6 characteristics: 1 effectiveness — evidencebased health care results in improved health outcomes; 2 relevancy: health care is delivered in a manner that maximizes resource use and avoids wasting and provided in a setting where skills and resources are appropriate to medical need; 3 accessibility: health care is provided timely, reasonable and affordable; 4 acceptability/patient-centered: health care provided takes into account the preferences and aspirations of individual service users; 5 equity: health care provided does not vary in quality because of personal characteristics or socioeconomic status; 6 safety: health care provided minimizes risks and harm to service users and providers. Results. The Intensive Care Unit (ICU started working in the Pediatric Clinic of the Odessa National Medical University on February 1, 2017. The main task of ICU is the treatment of children with emergency conditions (who needs monitoring of breathing and cardiac activity, oxygen therapy, large-volume rehydration therapy, etc. The patients admit to the ICU according the results of triage. Triage is the process of rapidly screening of sick children soon after their addmission to hospital and in ICU, in order to identify those with emergency signs — obstruc-ted breathing or severe respiratory distress; central cyanosis; signs of shock; signs of severe dehydration; those with priority signs — very high temperature, severe pallor, respiratory distress etc. The local guidelines for the most common diseases in children have been developed in the Pediatric Clinic. These local guidelines are based on: 1 modern national guidelines; 2 WHO: Pocket book of hospital care for children: guidelines for the management of common childhood illnesses (2013; clinical

Effectively marketing prepaid medical care with decision support systems.

Science.gov (United States)

Forgionne, G A

1991-01-01

The paper reports a decision support system (DSS) that enables health plan administrators to quickly and easily: (1) manage relevant medical care market (consumer preference and competitors' program) information and (2) convert the information into appropriate medical care delivery and/or payment policies. As the paper demonstrates, the DSS enables providers to design cost efficient and market effective medical care programs. The DSS provides knowledge about subscriber preferences, customer desires, and the program offerings of the competition. It then helps administrators structure a medical care plan in a way that best meets consumer needs in view of the competition. This market effective plan has the potential to generate substantial amounts of additional revenue for the program. Since the system's data base consists mainly of the provider's records, routine transactions, and other readily available documents, the DSS can be implemented at a nominal incremental cost. The paper also evaluates the impact of the information system on the general financial performance of existing dental and mental health plans. In addition, the paper examines how the system can help contain the cost of providing medical care while providing better services to more potential beneficiaries than current approaches.

Alcoholism treatment and medical care costs from Project MATCH.

Science.gov (United States)

Holder, H D; Cisler, R A; Longabaugh, R; Stout, R L; Treno, A J; Zweben, A

2000-07-01

This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality. Longitudinal study with pre- and post-treatment initiation. The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment. Three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI and Providence, RI). Two hundred and seventy-nine patients. Patients were randomly assigned to one of three treatment modalities: a 12-session cognitive behavioral therapy (CBT), a four-session motivational enhancement therapy (MET) or a 12-session Twelve-Step facilitation (TSF) treatment over 12 weeks. Total medical care costs declined from pre- to post-treatment overall and for each modality. Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings. However, patients with poor prognostic characteristics (alcohol dependence, psychiatric severity and/or social network support for drinking) have better cost-savings potential with CBT and/or TSF. Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment.

Nutritional care of medical inpatients: a health technology assessment

Directory of Open Access Journals (Sweden)

Kruse Filip

2006-02-01

Full Text Available Abstract Background The inspiration for the present assessment of the nutritional care of medical patients is puzzlement about the divide that exists between the theoretical knowledge about the importance of the diet for ill persons, and the common failure to incorporate nutritional aspects in the treatment and care of the patients. The purpose is to clarify existing problems in the nutritional care of Danish medical inpatients, to elucidate how the nutritional care for these inpatients can be improved, and to analyse the costs of this improvement. Methods Qualitative and quantitative methods are deployed to outline how nutritional care of medical inpatients is performed at three Danish hospitals. The practices observed are compared with official recommendations for nutritional care of inpatients. Factors extraneous and counterproductive to optimal nutritional care are identified from the perspectives of patients and professional staff. A review of the literature illustrates the potential for optimal nutritional care. A health economic analysis is performed to elucidate the savings potential of improved nutritional care. Results The prospects for improvements in nutritional care are ameliorated if hospital management clearly identifies nutritional care as a priority area, and enjoys access to management tools for quality assurance. The prospects are also improved if a committed professional at the ward has the necessary time resources to perform nutritional care in practice, and if the care staff can requisition patient meals rich in nutrients 24 hours a day. At the kitchen production level prospects benefit from a facilitator contact between care and kitchen staff, and if the kitchen staff controls the whole food path from the kitchen to the patient. At the patient level, prospects are improved if patients receive information about the choice of food and drink, and have a better nutrition dialogue with the care staff. Better nutritional care of

Exercise Interventions for Preventing Falls Among Older People in Care Facilities: A Meta-Analysis.

Science.gov (United States)

Lee, Seon Heui; Kim, Hee Sun

2017-02-01

Falls in older people are a common problem, often leading to considerable morbidity. However, the overall effect of exercise interventions on fall prevention in care facilities remains controversial. To evaluate the effectiveness of exercise interventions on the rate of falls and number of fallers in care facilities. A meta-analysis was conducted of randomized controlled trials published up to December 2014. Eight databases were searched including Ovid-Medline, Embase, CINAHL, Cochrane Library, KoreaMed, KMbase, KISS, and KisTi. Two investigators independently extracted data and assessed study quality. Twenty-one studies were selected, that included 5,540 participants. Fifteen studies included exercise as a single intervention, whereas the remaining six included exercise combined with two or more fall interventions tailored to each resident's fall risk (i.e., medication review, environmental modification or staff education). Meta-analysis showed that exercise had a preventive effect on the rate of falls (risk ratio [RR] 0.81, 95% CI 0.68-0.97). This effect was stronger when exercise combined with other fall interventions on the rate of falls (RR 0.61, 95% CI 0.52-0.72) and on the number of fallers (RR 0.85, 95% CI 0.77-0.95). Exercise interventions including balance training (i.e., gait, balance, and functional training; or balance and strength) resulted in reduced the rate of falls. Sensitivity analyses indicated that exercise interventions resulted in reduced numbers of recurrent fallers (RR 0.71, 95% CI 0.53-0.97). This review provides an important basis for developing evidence-based exercise intervention protocols for older people living in care facilities. Exercise programs, which are combined with tailored other fall interventions and challenge balance training to improve balance skills, should be applied to frail older people with functional limitations in institutional settings. © 2016 Sigma Theta Tau International.

Perception of quality of care in HIV/AIDS programmes among patients in a tertiary health care facility in Anambra State.

Science.gov (United States)

Nwabueze, S A; Adogu, P O U; Ilika, A L; Asuzu, M C; Adinma, E D

2011-01-01

Continuous quality improvement is linked to the use of timely and useful feedback from clients in Human Immuno-deficiency Virus (HIV) care. HIV experts and care professionals agree that consumer involvement, such as patient satisfaction survey, is an essential part of HIV care and policy making today. The introduction ofAnti-Retroviral Treatment (ART) services in Nigeria has significantly impacted positively on the overall well being of People Living with HIV and Acquired Immune Deficiency Syndrome (PLWHA). However, there is little understanding of their satisfaction and perception of quality of care provided. Consequently, this study was carried out to assess patients' satisfaction with ambulatory HIV/AIDS care in a tertiary health facility in Anambra State. The study design is cross-sectional. A total of 150 patients from Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi were selected using systematic sampling technique from the daily AntiRetroviral (ARV) clinic register obtained from the medical records department of the centre. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 13. The mean age of the respondents was 38.3 +/- 9.1. Majority (50.7%) of the patients was married, and most of them (74.7%) were semi-skilled workers. There was a statistically significant difference in the numbers of those who spent >240 naira for transportation to the clinic, compared to those who spent 30 minutes are significantly larger than the number that spent 750 naira than those who spend <750 naira on non-HIV related laboratory (20 versus 9) tests. PLWHAs in this facility were least satisfied with access to care, while they expressed greatest satisfaction with good patient care and quality of service by staff. The overall satisfaction score of the subjects was 4.04 +/- 0.33. HIV patients' overall satisfaction with the services provided to them was quite high. Therefore, there is need to sustain the current

Access to Medication Abortion Among California's Public University Students.

Science.gov (United States)

Upadhyay, Ushma D; Cartwright, Alice F; Johns, Nicole E

2018-06-09

A proposed California law will require student health centers at public universities to provide medication abortion. To understand its potential impact, we sought to describe current travel time, costs, and wait times to access care at the nearest abortion facilities. We projected total medication abortion use based on campus enrollment figures and age- and state-adjusted abortion rates. We calculated distance and public transit time from campuses to the nearest abortion facility. We contacted existing abortion-providing facilities to determine costs, insurance acceptance, and wait times. We estimate 322 to 519 California public university students seek medication abortions each month. As many as 62% of students at these universities were more than 30 minutes from the closest abortion facility via public transportation. Average cost of medication abortion was $604, and average wait time to the first available appointment was one week. College students face cost, scheduling, and travel barriers to abortion care. Offering medication abortion on campus could reduce these barriers. Copyright © 2018 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Natural course of care dependency in residents of long-term care facilities: prospective follow-up study.

Science.gov (United States)

Caljouw, Monique A A; Cools, Herman J M; Gussekloo, Jacobijn

2014-05-22

Insight in the natural course of care dependency of vulnerable older persons in long-term care facilities (LTCF) is essential to organize and optimize individual tailored care. We examined changes in care dependency in LTCF residents over two 6-month periods, explored the possible predictive factors of change and the effect of care dependency on mortality. A prospective follow-up study in 21 Dutch long-term care facilities. 890 LTCF residents, median age 84 (Interquartile range 79-88) years participated. At baseline, 6 and 12 months, care dependency was assessed by the nursing staff with the Care Dependency Scale (CDS), range 15-75 points. Since the median CDS score differed between men and women (47.5 vs. 43.0, P = 0.013), CDS groups (low, middle and high) were based on gender-specific 33% of CDS scores at baseline and 6 months. At baseline, the CDS groups differed in median length of stay on the ward, urine incontinence and dementia (all P dependency status, predicted an increase in care dependency over time. The majority of residents were stable in their care dependency status over two subsequent 6-month periods. Highly care dependent residents showed an increased mortality risk. Awareness of the natural course of care dependency is essential to residents and their formal and informal caregivers when considering therapeutic and end-of-life care options.

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries.

Directory of Open Access Journals (Sweden)

Hannah H Leslie

2017-12-01

Full Text Available It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs-the structural inputs to care-predicts the clinical quality of care provided to patients.Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC, sick-child care, and (in 2 countries labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers' adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from -0.03 for family planning in Senegal to 0.40 for ANC in Tanzania. Facilities with similar

Association between infrastructure and observed quality of care in 4 healthcare services: A cross-sectional study of 4,300 facilities in 8 countries.

Science.gov (United States)

Leslie, Hannah H; Sun, Zeye; Kruk, Margaret E

2017-12-01

It is increasingly apparent that access to healthcare without adequate quality of care is insufficient to improve population health outcomes. We assess whether the most commonly measured attribute of health facilities in low- and middle-income countries (LMICs)-the structural inputs to care-predicts the clinical quality of care provided to patients. Service Provision Assessments are nationally representative health facility surveys conducted by the Demographic and Health Survey Program with support from the US Agency for International Development. These surveys assess health system capacity in LMICs. We drew data from assessments conducted in 8 countries between 2007 and 2015: Haiti, Kenya, Malawi, Namibia, Rwanda, Senegal, Tanzania, and Uganda. The surveys included an audit of facility infrastructure and direct observation of family planning, antenatal care (ANC), sick-child care, and (in 2 countries) labor and delivery. To measure structural inputs, we constructed indices that measured World Health Organization-recommended amenities, equipment, and medications in each service. For clinical quality, we used data from direct observations of care to calculate providers' adherence to evidence-based care guidelines. We assessed the correlation between these metrics and used spline models to test for the presence of a minimum input threshold associated with good clinical quality. Inclusion criteria were met by 32,531 observations of care in 4,354 facilities. Facilities demonstrated moderate levels of infrastructure, ranging from 0.63 of 1 in sick-child care to 0.75 of 1 for family planning on average. Adherence to evidence-based guidelines was low, with an average of 37% adherence in sick-child care, 46% in family planning, 60% in labor and delivery, and 61% in ANC. Correlation between infrastructure and evidence-based care was low (median 0.20, range from -0.03 for family planning in Senegal to 0.40 for ANC in Tanzania). Facilities with similar infrastructure scores

Mental health care roles of non-medical primary health and social care services.

Science.gov (United States)

Mitchell, Penny

2009-02-01

Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

Adolf Hitler's medical care.

Science.gov (United States)

Doyle, D

2005-02-01

For the last nine years of his life Adolf Hitler, a lifelong hypochondriac had as his physician Dr Theodor Morell. Hitler's mood swings, Parkinson's disease, gastro-intestinal symptoms, skin problems and steady decline until his suicide in 1945 are documented by reliable observers and historians, and in Morell's diaries. The bizarre and unorthodox medications given to Hitler, often for undisclosed reasons, include topical cocaine, injected amphetamines, glucose, testosterone, estradiol, and corticosteroids. In addition, he was given a preparation made from a gun cleaner, a compound of strychnine and atropine, an extract of seminal vesicles, and numerous vitamins and 'tonics'. It seems possible that some of Hitler's behaviour, illnesses and suffering can be attributed to his medical care. Whether he blindly accepted such unorthodox medications or demanded them is unclear.

Medication safety programs in primary care: a scoping review.

Science.gov (United States)

Khalil, Hanan; Shahid, Monica; Roughead, Libby

2017-10-01

Medication safety plays an essential role in all healthcare organizations; improving this area is paramount to quality and safety of any wider healthcare program. While several medication safety programs in the hospital setting have been described and the associated impact on patient safety evaluated, no systematic reviews have described the impact of medication safety programs in the primary care setting. A preliminary search of the literature demonstrated that no systematic reviews, meta-analysis or scoping reviews have reported on medication safety programs in primary care; instead they have focused on specific interventions such as medication reconciliation or computerized physician order entry. This scoping review sought to map the current medication safety programs used in primary care. The current scoping review sought to examine the characteristics of medication safety programs in the primary care setting and to map evidence on the outcome measures used to assess the effectiveness of medication safety programs in improving patient safety. The current review considered participants of any age and any condition using care obtained from any primary care services. We considered studies that focussed on the characteristics of medication safety programs and the outcome measures used to measure the effectiveness of these programs on patient safety in the primary care setting. The context of this review was primary care settings, primary healthcare organizations, general practitioner clinics, outpatient clinics and any other clinics that do not classify patients as inpatients. We considered all quantitative studied published in English. A three-step search strategy was utilized in this review. Data were extracted from the included studies to address the review question. The data extracted included type of medication safety program, author, country of origin, aims and purpose of the study, study population, method, comparator, context, main findings and outcome

Population Health and Tailored Medical Care in the Home: the Roles of Home-Based Primary Care and Home-Based Palliative Care.

Science.gov (United States)

Ritchie, Christine S; Leff, Bruce

2018-03-01

With the growth of value-based care, payers and health systems have begun to appreciate the need to provide enhanced services to homebound adults. Recent studies have shown that home-based medical services for this high-cost, high-need population reduce costs and improve outcomes. Home-based medical care services have two flavors that are related to historical context and specialty background-home-based primary care (HBPC) and home-based palliative care (HBPalC). Although the type of services provided by HBPC and HBPalC (together termed "home-based medical care") overlap, HBPC tends to encompass longitudinal and preventive care, while HBPalC often provides services for shorter durations focused more on distress management and goals of care clarification. Given workforce constraints and growing demand, both HBPC and HBPalC will benefit from working together within a population health framework-where HBPC provides care to all patients who have trouble accessing traditional office practices and where HBPalC offers adjunctive care to patients with high symptom burden and those who need assistance with goals clarification. Policy changes that support provision of medical care in the home, population health strategies that tailor home-based medical care to the specific needs of the patients and their caregivers, and educational initiatives to assure basic palliative care competence for all home-based medical providers will improve access and reduce illness burden to this important and underrecognized population. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Reaching out to the forgotten: providing access to medical care for the homeless in Italy.

Science.gov (United States)

De Maio, Gianfranco; Van den Bergh, Rafael; Garelli, Silvia; Maccagno, Barbara; Raddi, Freja; Stefanizzi, Alice; Regazzo, Costantina; Zachariah, Rony

2014-06-01

A program for outpatient and intermediate inpatient care for the homeless was pioneered by the humanitarian organization Médecins Sans Frontières (MSF) in Milan, Italy, during the winter of 2012-2013. We aimed to document the characteristics and clinical management of inpatients and outpatients seen during this program. A clinic providing outpatient and intermediate inpatient care (24 bed capacity) was set up in an existing homeless hostel. Patients were admitted for post-hospitalization intermediate care or for illnesses not requiring secondary care. This study was a retrospective audit of the routine program data. Four hundred and fifty four individuals presented for outpatient care and 123 patients were admitted to inpatient intermediary care. On average one outpatient consultation was conducted per patient per month, most for acute respiratory tract infections (39.8%; 522/1311). Eleven percent of all outpatients suffered from an underlying chronic condition and 2.98% (38/1311) needed referral to emergency services or secondary care facilities. Most inpatients were ill patients referred through public reception centers (72.3%; 89/123), while 27.6% (34/123) were post-hospitalization patients requiring intermediate care. Out of all inpatients, 41.4% (51/123) required more than 1 week of care and 6.5% (8/123) needed counter-referral to secondary care. The observed service usage, morbidity patterns, relatively long lengths of stay, high referral completion and need for counter-referrals, all reflect the important gap-filling role played by an intermediate care facility for this vulnerable population. We recommend that in similar contexts, medical non-governmental organizations (NGOs) focus on the setup of inpatient intermediary care services; while outpatient services are covered by the public health system. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Emergency situation in a medical cyclotron facility

International Nuclear Information System (INIS)

Kumar, Rajeev; Bhat, M.K.; Singh, D.K.; Pthania, B.S.; Pandit, A.G.; Jacob, M.J.

2010-01-01

Full text: Medical cyclotron is a particle accelerator used in producing short lived radioisotopes such as 18 F, 11 C, 15 O, 13 N, 18 F-2 gas etc. Positron Emission Tomography (PET) is a nuclear imaging modality that has rapidly gained favour. 18 F-FDG is the most widely used radiopharmaceutical with a half-life of 109.8 min. Having more than five years experience in this field we face lots of emergency conditions in the medical cyclotron facility. On the basis of harm we have divided in to three categories i.e. Harm of (a) working personnel, (b) Equipment and (c) environment. Radioactive gas leak and Target foil rupture is considered as the major emergency situations during medical cyclotron operations because there is a potential of over exposure to the working personnel. Radiation protection survey of a self-shielded medical cyclotron installation was carried out during normal and emergency conditions. It is found that the induced activity in the target foil increases with its successive usages. Recommendations have also been made to reduce personal exposure while handling the radioactive gas leak and target foil rupture conditions

Trends in medical care cost--revisited.

Science.gov (United States)

Vincenzino, J V

1997-01-01

Market forces have had a greater influence on the health care sector than anticipated. The increased use of managed care, particularly HMOs, has been largely responsible for a sharp deceleration in the rise of medical care costs. After recording double-digit growth for much of the post-Medicare/Medicaid period, national health expenditures rose just 5.1 percent and 5.5 percent in 1994 and 1995, respectively. The medical care Consumer Price Index (CPI) rose 3.5 percent in 1996-just 0.5 percent above the overall CPI. The delivery and financing of health care continues to evolve within a framework of cost constraints. As such, mergers, acquisitions and provider alliance groups will remain an integral part of the health industry landscape. However, cost savings are likely to become more difficult to achieve, especially if the "quality of care" issue becomes more pronounced. National health expenditures, which surpassed the $1 trillion mark in 1996, are projected to rise to $1.4 trillion by the year 2000--representing a 7.2 percent growth rate from 1995. In any event, demographics and technological advances suggest that the health sector will demand a rising share of economic resources. The ratio of health care expenditures to gross domestic product is forecast to rise from 13.6 percent in 1995 to 15 percent by the year 2000.

The Impact of Bar Code Medication Administration Technology on Reported Medication Errors

Science.gov (United States)

Holecek, Andrea

2011-01-01

The use of bar-code medication administration technology is on the rise in acute care facilities in the United States. The technology is purported to decrease medication errors that occur at the point of administration. How significantly this technology affects actual rate and severity of error is unknown. This descriptive, longitudinal research…

[The characteristics of medical technologies in emergency medical care hospital].

Science.gov (United States)

Murakhovskiĭ, A G; Babenko, A I; Bravve, Iu I; Tataurova, E A

2013-01-01

The article analyzes the implementation of major 12 diagnostic and 17 treatment technologies applied during medical care of patients with 12 key nosology forms of diseases in departments of the emergency medical care hospital No 2 of Omsk. It is established that key groups of technologies in the implementation of diagnostic process are the laboratory clinical diagnostic analyses and common diagnostic activities at reception into hospital and corresponding departments. The percentage of this kind of activities is about 78.3% of all diagnostic technologies. During the realization of treatment process the priority technologies are common curative and rehabilitation activities, intensive therapy activities and clinical diagnostic monitoring activities. All of them consist 80.1% of all curative technologies.

Radioactive isotope production for medical applications using Kharkov electron driven subcritical assembly facility

International Nuclear Information System (INIS)

Talamo, A.; Gohar, Y.

2007-01-01

Kharkov Institute of Physics and Technology (KIPT) of Ukraine has a plan to construct an accelerator driven subcritical assembly. The main functions of the subcritical assembly are the medical isotope production, neutron thereby, and the support of the Ukraine nuclear industry. Reactor physics experiments and material research will be carried out using the capabilities of this facility. The United States of America and Ukraine have started collaboration activity for developing a conceptual design for this facility with low enrichment uranium (LEU) fuel. Different conceptual designs are being developed based on the facility mission and the engineering requirements including nuclear physics, neutronics, heat transfer, thermal hydraulics, structure, and material issues. Different fuel designs with LEU and reflector materials are considered in the design process. Safety, reliability, and environmental considerations are included in the facility conceptual design. The facility is configured to accommodate future design improvements and upgrades. This report is a part of the Argonne National Laboratory Activity within this collaboration for developing and characterizing the subcritical assembly conceptual design. In this study, the medical isotope production function of the Kharkov facility is defined. First, a review was carried out to identify the medical isotopes and its medical use. Then a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Finally, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and irradiation location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes were considered and all transmutation channels are used including (n,γ), (n,2n), (n,p), and (γ,n). In the second part, the parent

Radioactive isotope production for medical applications using Kharkov electron driven subcritical assembly facility.

Energy Technology Data Exchange (ETDEWEB)

Talamo, A.; Gohar, Y.; Nuclear Engineering Division

2007-05-15

Kharkov Institute of Physics and Technology (KIPT) of Ukraine has a plan to construct an accelerator driven subcritical assembly. The main functions of the subcritical assembly are the medical isotope production, neutron thereby, and the support of the Ukraine nuclear industry. Reactor physics experiments and material research will be carried out using the capabilities of this facility. The United States of America and Ukraine have started collaboration activity for developing a conceptual design for this facility with low enrichment uranium (LEU) fuel. Different conceptual designs are being developed based on the facility mission and the engineering requirements including nuclear physics, neutronics, heat transfer, thermal hydraulics, structure, and material issues. Different fuel designs with LEU and reflector materials are considered in the design process. Safety, reliability, and environmental considerations are included in the facility conceptual design. The facility is configured to accommodate future design improvements and upgrades. This report is a part of the Argonne National Laboratory Activity within this collaboration for developing and characterizing the subcritical assembly conceptual design. In this study, the medical isotope production function of the Kharkov facility is defined. First, a review was carried out to identify the medical isotopes and its medical use. Then a preliminary assessment was performed without including the self-shielding effect of the irradiated samples. Finally, more detailed investigation was carried out including the self-shielding effect, which defined the sample size and irradiation location for producing each medical isotope. In the first part, the reaction rates were calculated as the multiplication of the cross section with the unperturbed neutron flux of the facility. Over fifty isotopes were considered and all transmutation channels are used including (n,{gamma}), (n,2n), (n,p), and ({gamma},n). In the second part

New irradiation facilities at the Australian national medical cyclotron

International Nuclear Information System (INIS)

Parcell, S.K.; Arnott, D.W.; Conard, E.M.

1999-01-01

Two new irradiation facilities have been developed at the National Medical Cyclotron for radionuclide production. The first relocates PET irradiations from the cyclotron vault to a dedicated PET beam room, to improve accessibility and reduce radiation exposures associated with target maintenance. This new facility consists of a beam line to transport 16-30 MeV proton beams from the cyclotron to 1 of 8 PET targets mounted on a target rack. The target rack has increased the number of targets available for production and experimentation. The second is a completely independent solid target irradiation facility for SPECT. This facility consists of a beam line to transport 26-30 MeV proton beams from the cyclotron to a dedicated beam room containing one solid target station. A new pneumatic target transfer system was also developed to transport the solid target to and from the existing chemistry hot cells. The beam line and target components are operated under the control of a dedicated PLC with a PC based user interface. The development and some technical aspects of these new irradiation facilities are discussed here. (author)

A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

Directory of Open Access Journals (Sweden)

Daniel O Erim

Full Text Available BACKGROUND: As part of efforts to reduce maternal deaths in Nigeria, pregnant women are being encouraged to give birth in healthcare facilities. However, little is known about whether or not available healthcare facilities can cope with an increasing demand for obstetric care. We thus carried out this survey as a rapid and tactical assessment of facility quality. We visited 121 healthcare facilities, and used the opportunity to interview over 700 women seeking care at these facilities. FINDINGS: Most of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home. The crude risk of an adverse neonatal outcome did not significantly vary by delivery site or birth attendant, and the occurrence of such an outcome during an in-facility delivery may influence the mother to have her next delivery outside. Such an outcome during a home delivery may not prompt a subsequent in-facility delivery. CONCLUSIONS: In conclusion, reducing maternal deaths in Nigeria will require attention to both increasing the number of facilities with high-quality EmOC capability and also assuring Nigerian women have access to these facilities regardless of where they live.

A systematic review of topical skin care in aged care facilities.

Science.gov (United States)

Hodgkinson, Brent; Nay, Rhonda; Wilson, Jacinda

2007-01-01

This systematic review aimed to evaluate the best available evidence regarding the effectiveness of topical skin care interventions for residents of aged care facilities. Natural changes to skin, as well as increased predisposition to pressure sores and incontinence, means residents of aged care facilities readily require topical skin care. A range of interventions exist that aim to maintain or improve the integrity of skin of older adults. Pubmed, Embase, Current Contents, CINAHL and The Cochrane Library databases were searched, as well as Health Technology Assessment websites up to April 2003. Systematic reviews and randomized or non-randomized controlled trials were evaluated for quality and data were independently extracted by two reviewers. The effectiveness of topical skin interventions was variable and dependent on the skin condition being treated. Studies examined the effectiveness of washing products on incontinence irritated skin. Disposable bodyworns may prevent deterioration of skin condition better than non-disposable underpads or bodyworns. Clinisan, a no-rinse cleanser may reduce the incidence of incontinence associated pressure ulcers when compared with soap and water. In general the quality of evidence for interventions to improve or maintain the skin condition in the older person was poor and more research in this area is needed. Skin care is a major issue for nurses working with older people. On the basis of this review no clear recommendations can be made. This lack of strong evidence for nurses to base effective practice decisions is problematic. However, the 'best' evidence suggests that disposable bodyworns are a good investment in the fight against skin deterioration. No rinse cleansers are to be preferred over soap and the use of the bag bath appears to be a useful practice to reduce the risk of dry skin (a risk factor for breaches in skin integrity).

The Negative Impact of Stark Law Exemptions on Graduate Medical Education and Health Care Costs: The Example of Radiation Oncology

International Nuclear Information System (INIS)

Anscher, Mitchell S.; Anscher, Barbara M.; Bradley, Cathy J.

2010-01-01

Purpose: To survey radiation oncology training programs to determine the impact of ownership of radiation oncology facilities by non-radiation oncologists on these training programs and to place these findings in a health policy context based on data from the literature. Methods and Materials: A survey was designed and e-mailed to directors of all 81 U.S. radiation oncology training programs in this country. Also, the medical and health economic literature was reviewed to determine the impact that ownership of radiation oncology facilities by non-radiation oncologists may have on patient care and health care costs. Prostate cancer treatment is used to illustrate the primary findings. Results: Seventy-three percent of the surveyed programs responded. Ownership of radiation oncology facilities by non-radiation oncologists is a widespread phenomenon. More than 50% of survey respondents reported the existence of these arrangements in their communities, with a resultant reduction in patient volumes 87% of the time. Twenty-seven percent of programs in communities with these business arrangements reported a negative impact on residency training as a result of decreased referrals to their centers. Furthermore, the literature suggests that ownership of radiation oncology facilities by non-radiation oncologists is associated with both increased utilization and increased costs but is not associated with increased access to services in traditionally underserved areas. Conclusions: Ownership of radiation oncology facilities by non-radiation oncologists appears to have a negative impact on residency training by shifting patients away from training programs and into community practices. In addition, the literature supports the conclusion that self-referral results in overutilization of expensive services without benefit to patients. As a result of these findings, recommendations are made to study further how physician ownership of radiation oncology facilities influence graduate

Improving the Quality of Home Health Care for Children With Medical Complexity.

Science.gov (United States)

Nageswaran, Savithri; Golden, Shannon L

2017-08-01

The objectives of this study are to describe the quality of home health care services for children with medical complexity, identify barriers to delivering optimal home health care, and discuss potential solutions to improve home health care delivery. In this qualitative study, we conducted 20 semistructured in-depth interviews with primary caregivers of children with medical complexity, and 4 focus groups with 18 home health nurses. During an iterative analysis process, we identified themes related to quality of home health care. There is substantial variability between home health nurses in the delivery of home health care to children. Lack of skills in nurses is common and has serious negative health consequences for children with medical complexity, including hospitalizations, emergency room visits, and need for medical procedures. Inadequate home health care also contributes to caregiver burden. A major barrier to delivering optimal home health care is the lack of training of home health nurses in pediatric care and technology use. Potential solutions for improving care include home health agencies training nurses in the care of children with medical complexity, support for nurses in clinical problem solving, and reimbursement for training nurses in pediatric home care. Caregiver-level interventions includes preparation of caregivers about: providing medical care for their children at home and addressing problems with home health care services. There are problems in the quality of home health care delivered to children with medical complexity. Training nurses in the care of children with medical complexity and preparing caregivers about home care could improve home health care quality. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

MEDIC: medical embedded device for individualized care.

Science.gov (United States)

Wu, Winston H; Bui, Alex A T; Batalin, Maxim A; Au, Lawrence K; Binney, Jonathan D; Kaiser, William J

2008-02-01

Presented work highlights the development and initial validation of a medical embedded device for individualized care (MEDIC), which is based on a novel software architecture, enabling sensor management and disease prediction capabilities, and commercially available microelectronic components, sensors and conventional personal digital assistant (PDA) (or a cell phone). In this paper, we present a general architecture for a wearable sensor system that can be customized to an individual patient's needs. This architecture is based on embedded artificial intelligence that permits autonomous operation, sensor management and inference, and may be applied to a general purpose wearable medical diagnostics. A prototype of the system has been developed based on a standard PDA and wireless sensor nodes equipped with commercially available Bluetooth radio components, permitting real-time streaming of high-bandwidth data from various physiological and contextual sensors. We also present the results of abnormal gait diagnosis using the complete system from our evaluation, and illustrate how the wearable system and its operation can be remotely configured and managed by either enterprise systems or medical personnel at centralized locations. By using commercially available hardware components and software architecture presented in this paper, the MEDIC system can be rapidly configured, providing medical researchers with broadband sensor data from remote patients and platform access to best adapt operation for diagnostic operation objectives.

Consumerism: forcing medical practices toward patient-centered care.

Science.gov (United States)

Ozmon, Jeff

2007-01-01

Consumerism has been apart of many industries over the years; now consumerism may change the way many medical practices deliver healthcare. With the advent of consumer-driven healthcare, employers are shifting the decision-making power to their employees. Benefits strategies like health savings accounts and high-deductible insurance plans now allow the patients to control how and where they spend their money on medical care. Practices that seek to attract the more affluent and informed consumers are beginning to institute patient-centered systems designs that invite patients to actively participate in their healthcare. This article will outline the changes in the healthcare delivery system facing medical practices, the importance of patient-centered care, and six strategies to implement to change toward more patient-centered care.

Comparing the nutrition environment and practices of home- and centre-based child-care facilities.

Science.gov (United States)

Martyniuk, Olivia J M; Vanderloo, Leigh M; Irwin, Jennifer D; Burke, Shauna M; Tucker, Patricia

2016-03-01

To assess and compare the nutrition environment and practices (as they relate to pre-schoolers) of centre- and home-based child-care facilities. Using a cross-sectional study design, nineteen child-care facilities (ten centre-based, nine home-based) were assessed for one full day using the Environment and Policy Assessment and Observation (EPAO) tool (consisting of a day-long observation/review of the nutrition environment, practices and related documents). Specifically, eight nutrition-related subscales were considered. Child-care facilities in London, Ontario, Canada. Child-care facilities were recruited through directors at centre-based programmes and the providers of home-based programmes. The mean total nutrition environment EPAO scores for centre- and home-based facilities were 12·3 (sd 1·94) and 10·8 (sd 0·78) out of 20 (where a higher score indicates a more supportive environment with regard to nutrition), respectively. The difference between the total nutrition environment EPAO score for centre- and home-based facilities was approaching significance (P=0·055). For both types of facilities, the highest nutrition subscale score (out of 20) was achieved in the staff behaviours domain (centre mean=17·4; home mean=17·0) and the lowest was in the nutrition training and education domain (centre mean=3·6; home mean=2·0). Additional research is needed to confirm these findings. In order to better support child-care staff and enhance the overall nutrition environment in child care, modifications to food practices could be adopted. Specifically, the nutritional quality of foods/beverages provided to pre-schoolers could be improved, nutrition-related training for child-care staff could be provided, and a nutrition curriculum could be created to educate pre-schoolers about healthy food choices.

MEDICAL TOURISM IN INDIA: A NEW AVENUE

OpenAIRE

Badwe, Anand N.; Giri, Purushottam A; Latti, Ramchandra G.

2012-01-01

Medical tourism is attracting attention of travelers from all over the globe. It combines a travel at ease and availing medical health care facility at low cost as per traveler’s own choice. World class medical health care is available in some of the Asian countries, such as India, Philippines and Singapore etc. Medical tourism has become one of the major industries in recent times. Medical Tourism India (Health Tourism India) is a developing concept whereby people from world over visit Ind...

Availability of emergency obstetric care (EmOC) among public and private health facilities in rural northwest Bangladesh.

Science.gov (United States)

Sikder, Shegufta S; Labrique, Alain B; Ali, Hasmot; Hanif, Abu A M; Klemm, Rolf D W; Mehra, Sucheta; West, Keith P; Christian, Parul

2015-01-31

Although safe motherhood strategies recommend that women seek timely care from health facilities for obstetric complications, few studies have described facility availability of emergency obstetric care (EmOC). We sought to describe and compare availability and readiness to provide EmOC among public and private health facilities commonly visited for pregnancy-related complications in two districts of northwest Bangladesh. We also described aspects of financial and geographic access to healthcare and key constraints to EmOC provision. Using data from a large population-based community trial, we identified and surveyed the 14 health facilities (7 public, 7 private) most frequently visited for obstetric complications and near misses as reported by women. Availability of EmOC was based on provision of medical services, assessed through clinician interviews and record review. Levels of EmOC availability were defined as basic or comprehensive. Readiness for EmOC provision was based on scores in four categories: staffing, equipment, laboratory capacity, and medicines. Readiness scores were calculated using unweighted averages. Costs of C-section procedures and geographic locations of facilities were described. Textual analysis was used to identify key constraints. The seven surveyed private facilities offered comprehensive EmOC compared to four of the seven public facilities. With 100% representing full readiness, mean EmOC readiness was 81% (range: 63%-91%) among surveyed private facilities compared to 67% (range: 48%-91%) in public facilities (p = 0.040). Surveyed public clinics had low scores on staffing and laboratory capacity (69%; 50%). The mean cost of the C-section procedure in private clinics was $77 (standard deviation: $16) and free in public facilities. The public sub-district facilities were the only facilities located in rural areas, with none providing comprehensive EmOC. Shortages in specialized staff were listed as the main barrier to EmOC provision in

Medical Care Expenditure in Suicides From Non-illness-related Causes

Directory of Open Access Journals (Sweden)

Jungwoo Sohn

2014-11-01

Full Text Available Objectives: Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. Methods: Suicides motivated by non-illness-related factors were identified using the investigator’s note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. Results: Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. Conclusions: Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention

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Natalie A. DiPietro

2014-01-01

Full Text Available As medication therapy management (MTM continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.   Type: Idea Paper

Medical devices made into weapons by prisoners: an unrecognized risk.

Science.gov (United States)

Hayden, J W; Laney, C; Kellermann, A L

1995-12-01

The alteration of a knee immobilizer into a sharp weapon by a prisoner prompted us to survey neighboring penal institutions to determine the frequency of such events. We mailed a nine-item survey to all detention facilities in Tennessee, Arkansas, and Mississippi. A second survey was sent to nonresponding institutions 6 weeks after the initial mailing. The Regional Medical Center at Memphis, the designated facility for evaluation and treatment of prisoners from the county jail and state penitentiary. Survey respondents included 25 state penitentiaries, 31 county jails, 1 state minimum-security facility, 1 state maximum-security facility, 1 work-release center, 1 county detention center for drunken-driving offenders, and 1 federal penitentiary. Of the 81 institutions surveyed, 77% responded to one of the two mailings. Forty percent responded in the affirmative when asked whether stolen or unauthorized medical equipment from outside their institutions had been discovered among inmates. When respondents were questioned as to whether medical equipment, prescribed or not, had been used or altered in a criminal manner, 34% responded "yes." Medications and medical appliances were listed in the responses. A survey of 81 local and neighboring penal institutions in a three-state area revealed that the illicit use of medicine and medical devices by prisoners is a legitimate safety concern of prison personnel and health care workers when medical care for inmates must be sought outside the security of their institutions. The modification of medical equipment into weapons by incarcerated patients, although clearly recognized as a security and safety problem by police authorities, appears to be unappreciated by health care workers providing episodic care to inmates.

Well-being, the Decision making process in residential care facilities and accommodation in Denmark

DEFF Research Database (Denmark)

Knudstrup, Mary-Ann; Harder, Henrik

process. 3. Alternatives to "the living environments”. In general a discussion about “the living environments” as the only and right solution for organising the residential care facilities and accommodation in Denmark is recommended. Maybe there should be a possibility given to create more private...... for assisted living residential care facilities and accommodation for senior citizens selected from different parts of Denmark. The case study will provide important knowledge on municipal activities in the area of residential care facilities, as well as discuss the different actors’ roles in the decision......-based knowledge is needed: There is a need for research-based knowledge manuals among the actors involved in the planning and project design process which describe systematically the importance of working with the different aspects on well-being in residential care facilities and accommodation in Denmark. 2. More...

Implementing a Pharmacist-Led Medication Management Pilot to Improve Care Transitions

Directory of Open Access Journals (Sweden)

Rachel Root, PharmD, MS

2012-01-01

Full Text Available Purpose: The purpose of this project was to design and pilot a pharmacist-led process to address medication management across the continuum of care within a large integrated health-system.Summary: A care transitions pilot took place within a health-system which included a 150-bed community hospital. The pilot process expanded the pharmacist’s medication management responsibilities to include providing discharge medication reconciliation, a patient-friendly discharge medication list, discharge medication education, and medication therapy management (MTM follow-up.Adult patients with a predicted diagnosis-related group (DRG of congestive heart failure or chronic obstructive pulmonary disease admitted to the medical-surgical and intensive care units who utilized a primary care provider within the health-system were included in the pilot. Forty patients met the inclusion criteria and thirty-four (85% received an intervention from an inpatient or MTM pharmacist. Within this group of patients, 88 drug therapy problems (2.6 per patient were identified and 75% of the drug therapy recommendations made by the pharmacist were accepted by the care provider. The 30-day all-cause readmission rates for the intervention and comparison groups were 30.5% and 35.9%, respectively. The number of patients receiving follow-up care varied with 10 (25% receiving MTM follow-up, 26 (65% completing a primary care visit after their first hospital discharge, and 23 (58% receiving a home care visit.Conclusion: Implementation of a pharmacist-led medication management pilot across the continuum of care resulted in an improvement in the quality of care transitions within the health-system through increased identification and resolution of drug therapy problems and MTM follow-up. The lessons learned from the implementation of this pilot will be used to further refine pharmacy care transitions programs across the health-system.

Gerontological contributions to the care of elderly people in long-term care facilities

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Vanessa da Silva Antonio Coimbra

Full Text Available ABSTRACT Objective: To analyze Brazilian scientific productions from the last 11 years which show the contributions of nursing to elderly people in long-term care facilities. Method: This is an integrative literature review. The search took place in the Virtual Health Library (VHL in the BDENF and LILACS databases and the SCIELO virtual library, between June and October 2016, using the keyword long-term care facility and the descriptors nursing and geriatrics. Results: Eleven studies were selected, published 2005 and 2016, with various methodological approaches that enabled discussion of the proposed objective. Conclusion: The contributions of nursing to institutionalized elderly people were linked to health promotion measures, as well as simple interventions, such as listening, interacting, offering recreation and helping in psychoaffective relationships. These activities contributed to raising the self-esteem of the individuals.

Quality control of conventional radiographic facilities in Kinshasa

International Nuclear Information System (INIS)

Woto, M.L.; Lukanda, M.V.; Mulumba, L.C.P.; Palangu

2009-01-01

The continuous development of medical applications of ionizing radiation, due to the benefit derived by diagnostic or therapeutic patients, their diversity, ease of implementation, explains the importance of medical exposure. The latter is currently the leading cause of human exposure to artificial origin. The purpose of this study is to contribute to the optimization of radiographic facilities in the city of Kinshasa. This study has revealed that city of Kinshasa has an average of 122 medical training with conventional radiology facilities distributed in six districts of health. Of the 122 facilities, only 30 (or 24.59%) are controlled from the point of view of quality assurance. Some generators and X-ray tubes are respectively controlled adjustment and de centered, and other devices are cannibalized. So, nationally and particularly in Kinshasa, quality control equipment and diagnostic facilities is at a generally delayed compared with international recommendations of X W. Major efforts must be made at government level to raise awareness and establish a quality assurance program in diagnostic radiology. An awareness of the entire medical profession and the competent administrative authorities of medical devices could be beneficial to the quality of care delivered to patients, limiting radiation exposure and improving image quality and only the financial balance of the health sector. The delivery of quality care passes through the justification of acts, the development and dissemination of good practice references and the establishment of quality control radiological installations.

Implementing a psycho-educational intervention for care assistants working with people with dementia in aged-care facilities: facilitators and barriers.

Science.gov (United States)

Barbosa, Ana; Nolan, Mike; Sousa, Liliana; Figueiredo, Daniela

2017-06-01

Many intervention studies lack an investigation and description of the factors that are relevant to its success or failure, despite its relevance to inform future interventions. This study aimed to explore the facilitators and barriers to the implementation of a psycho-educational intervention for care assistants caring for people with dementia in aged-care facilities. A process evaluation was carried out alongside a pretest/post-test controlled study conducted in aged-care facilities. Seven focus-group interviews involving 21 care assistants (female; mean age 43.37 ± 10.0) and individual semi-structured interviews with two managers (female; mean age 45.5 ± 10.26) were conducted 2 weeks and 6 months after the intervention, in two aged-care facilities. Interviews were recorded, transcribed and submitted to content analysis by two independent researchers. Results were organised into implementer, participant and organisation level hindered and facilitator factors. Findings enable the interpretation of the experimental results and underscore the importance of collecting the perception of different grades of staff to obtain information relevant to plan effective interventions. © 2016 Nordic College of Caring Science.

Oral health care in older people in long term care facilities : A systematic review of implementation strategies

NARCIS (Netherlands)

Weening-Verbree, L.; Huisman-de Waal, G.; van Dusseldorp, L.; van Achterberg, T.; Schoonhoven, L.

Objectives: Oral hygiene is necessary to maintain oral health and quality of life. However, the oral hygiene and the oral health care of older people in long term care facilities are poor. This indicates that care is not in compliance with the available guidelines and protocols, and stresses the

Understanding Combat Casualty Care Statistics

National Research Council Canada - National Science Library

Holcomb, John B; Stansbury, Lynn G; Champion, Howard R; Wade, Charles; Bellamy, Ronald F

2006-01-01

.... The authors' objective was to arrive at terminology and equations that would produce the best insight into the effectiveness of care at different stages of treatment, either pre- or post-medical treatment facility care...

Referral of children seeking care at private health facilities in Uganda

DEFF Research Database (Denmark)

Mbonye, Anthony K.; Buregyeya, Esther; Rutebemberwa, Elizeus

2017-01-01

Background In Uganda, referral of sick children seeking care at public health facilities is poor and widely reported. However, studies focusing on the private health sector are scanty. The main objective of this study was to assess referral practices for sick children seeking care at private health...... facilities in order to explore ways of improving treatment and referral of sick children in this sector. Methods A survey was conducted from August to October 2014 in Mukono district, central Uganda. Data was collected using a structured questionnaire supplemented by Focus Group Discussions and Key Informant...... interviews with private providers and community members. Results A total of 241 private health facilities were surveyed; 170 (70.5%) were registered drug shops, 59 (24.5%) private clinics and 12 (5.0%) pharmacies. Overall, 104/241 (43.2%) of the private health facilities reported that they had referred sick...

Medical Malpractice Phenomena: Signals for Changing Medical and Health Care Values

DEFF Research Database (Denmark)

Brødsgaard, I.; Moore, R.

1990-01-01

Excellent discussion of the economic factors such as medical malpractice and corporate medicine that have begun to interfere with the doctor-patient relationship and why this relationship is so essential in order to prevent medical malpractice. Issues of quality assurance are relevant to the doctor-patient...... relationship and the quality of health care....

Working on reform. How workers' compensation medical care is affected by health care reform.

Science.gov (United States)

Himmelstein, J; Rest, K

1996-01-01

The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?

Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform.

Science.gov (United States)

Ormond, Meghann

2011-01-01

"Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers.