Estate of Behringer v. Medical Center at Princeton.

Science.gov (United States)

1991-04-25

Dr. William Behringer, a staff member at the Medical Center at Princeton, was diagnosed with AIDS. Afterwards, Behringer received numerous phone calls from various people expressing awareness of his illness, and his surgical privileges at the Center were suspended. He sued the Medical Center, alleging a breach of confidentiality and discrimination. The Superior Court of New Jersey, Mercer County, held that the Medical Center had breached its duty of confidentiality when it failed to take reasonable precautions to prevent Behringer's AIDS diagnosis from becoming public knowledge. Nevertheless, although New Jersey's anti-discrimination statutes protected Dr. Behringer from having his surgical privileges revoked, the Medical Center demonstrated a reasonable risk to patients that justified suspending Dr. Behringer's privileges, or alternatively, requiring his patients' informed consent before operating. The court found that the risk included not only actual HIV transmission, but also the possibility of surgical accidents.

Johnson Space Center Health and Medical Technical Authority

Science.gov (United States)

Fogarty, Jennifer A.

2010-01-01

1.HMTA responsibilities: a) Assure program/project compliance with Agency health and medical requirements at identified key decision points. b) Certify that programs/projects comply with Agency health and medical requirements prior to spaceflight missions. c) Assure technical excellence. 2. Designation of applicable NASA Centers for HMTA implementation and Chief Medical Officer (CMO) appointment. 3. Center CMO responsible for HMTA implementation for programs and projects at the center. JSC HMTA captured in "JSC HMTA Implementation Plan". 4. Establishes specifics of dissenting opinion process consistent with NASA procedural requirements.

Holistic Health Care for the Medically Uninsured: The Church Health Center of Memphis

OpenAIRE

Morris, G. Scott

2015-01-01

The Church Health Center (CHC) in Memphis was founded in 1987 to provide quality, affordable health care for working, uninsured people and their families. With numerous, dedicated financial supporters and health care volunteers, CHC has become the largest faith-based health care organization of its type nationally, serving >61,000 patients. CHC embraces a holistic approach to health by promoting wellness in every dimension of life. It offers on-site services including medical care, dentistry,...

Medical waste management in Jordan: A study at the King Hussein Medical Center

International Nuclear Information System (INIS)

Oweis, Rami; Al-Widyan, Mohamad; Al-Limoon, Ohood

2005-01-01

As in many other developing countries, the generation of regulated medical waste (RMW) in Jordan has increased significantly over the last few decades. Despite the serious impacts of RMW on humans and the environment, only minor attention has been directed to its proper handling and disposal. This study was conducted in the form of a case study at one of Jordan's leading medical centers, namely, the King Hussein Medical Center (KHMC). Its purpose was to report on the current status of medical waste management at KHMC and propose possible measures to improve it. In general, it was found that the center's administration was reasonably aware of the importance of medical waste management and practiced some of the measures to adequately handle waste generated at the center. However, it was also found that significant voids were present that need to be addressed in the future including efficient segregation, the use of coded and colored bags, better handling and transfer means, and better monitoring and tracking techniques, as well as the need for training and awareness programs for the personnel

Nutrient offerings from the meals and snacks served in four daycare centers in Guatemala City.

NARCIS (Netherlands)

Vossenaar, M.; Panday, B.; Hamelinck, V.; Soto-Méndez, M.J.; Doak, C.M.; Solomons, N.W.

2011-01-01

Objective: To assess the nutritional content and contribution to recommended nutrient intakes of the menu offerings in diverse daycare centers serving low-income urban families in Guatemala City. Methods: An observational study design was used to record all food and drink items offered to children

An Artist in the University Medical Center. Review.

Science.gov (United States)

James, A. Everette, Jr.

1991-01-01

Reviews "An Artist in the University Medical Center" (M. Lesser, New Orleans: Tulane University Press, 1989), in which the artist captures the human side of the complex Tulane Medical Center in New Orleans (Louisiana). The interplay of drawings, etchings, watercolors, and prose conveys traditions of nurturing in the hospital. (SLD)

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.

An academic medical center under prolonged rocket attack--organizational, medical, and financial considerations.

Science.gov (United States)

Bar-El, Yaron; Michaelson, Moshe; Hyames, Gila; Skorecki, Karl; Reisner, Shimon A; Beyar, Rafael

2009-09-01

The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams' work schedules, and providing needed services for the families of employees. The Rambam Medical Center's Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams.

[NEURO-ONCOLOGY A NEW FIELD IN DAVIDOFF CANCER CENTER AT RABIN MEDICAL CENTER].

Science.gov (United States)

Yust-Katz, Shlomit; Limon, Dror; Abu-Shkara, Ramez; Siegal, Tali

2017-08-01

Neuro-oncology is a subspecialty attracting physicians from medical disciplines such as neurology, neurosurgery, pediatrics, oncology, and radiotherapy. It deals with diagnosis and management of primary brain tumors, as well as metastatic and non-metastatic neurological manifestations that frequently affect cancer patients including brain metastases, paraneoplastic syndromes and neurological complications of cancer treatment. A neuro-oncology unit was established in Davidoff Cancer Center at Rabin Medical Center. It provides a multidisciplinary team approach for management of brain tumors and services, such as expert outpatient clinics and inpatient consultations for the departments of oncology, hematology, bone marrow transplantation and other departments in the Rabin Medical Center. In addition, expert consultation is frequently provided to other hospitals that treat cancer patients with neurological manifestations. The medical disciplines that closely collaborate for the daily management of neuro-oncology patients include radiotherapy, hematology, oncology, neuro-surgery, neuro-radiology and neuro-pathology. The neuro-oncology center is also involved in clinical and laboratory research conducted in collaboration with researchers in Israel and abroad. The new service contributes substantially to the improved care of cancer patients and to the advance of research topics in the field of neuro-oncology.

A 40-Year History of End-of-Life Offerings in US Medical Schools: 1975-2015.

Science.gov (United States)

Dickinson, George E

2017-07-01

The purpose of this longitudinal study of US medical schools over a 40-year period was to ascertain their offerings on end-of-life (EOL) issues. At 5-year intervals, beginning in 1975, US medical schools were surveyed via a questionnaire to determine their EOL offerings. Data were reported with frequency distributions. The Institute of Medicine has encouraged more emphasis on EOL issues over the past 2 decades. Findings revealed that undergraduate medical students in the United States are now exposed to death and dying, palliative care, and geriatric medicine. The inclusion of EOL topics has definitely expanded over the 40-year period as findings reveal that US undergraduate medical students are currently exposed in over 90% of programs to death and dying, palliative care, and geriatric medicine, with the emphasis on these topics varying with the medical programs. Such inclusion should produce future favorable outcomes for undergraduate medical students, patients, and their families.

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.

Analysis of the drug formulary and the purchasing process at a Moroccan university medical center.

Science.gov (United States)

Lachhab, Z; Serragui, S; Hassar, M; Cherrah, Y; Errougani, A; Ahid, S

2018-05-31

To give an overview of the pharmaceutical policy in the largest medical center in Morocco, a developing country in socio-economic transition. This is an analytical descriptive study of the drug formulary and the purchasing process carried out at the Ibn Sina University Medical Center. Our formulary included 830 drugs belonging to 14 classes according to the Anatomical, Therapeutic and Chemical (ATC) Classification System. There was a respective predominance of class N (21.8%), class B (13.5%), and class J (12.6%). Injectable route was dominant (46%). Drugs had a significant actual benefit in 70% (according to the French Data), reimbursable in 42.8%, essential in 29.2% according to World Health Organization (WHO) list, and in 36.9% according to the Moroccan list. The calls for tenders included 542 drugs representing 65% of the formulary, and the attribution rate was 71%. The main reason for non-attribution was the lack of offers. Generics accounted for 45% by volume and 26.5% by value. With this first study, we were able to identify key indicators on drugs used in the largest medical center in Morocco. The current challenge is to introduce pharmacoeconomics in decision making concerning the updates of the drug formulary.

Community pharmacist collaboration with a patient-centered medical home: Establishment of a patient-centered medical neighborhood and payment model.

Science.gov (United States)

Luder, Heidi R; Shannon, Pam; Kirby, James; Frede, Stacey M

To determine the feasibility of a partnership between a community pharmacy and a patient-centered medical home (PCMH) by measuring the impact on office- and patient-level clinical outcomes. Kroger Pharmacy and a PCMH practice in Cincinnati, OH. The Kroger Co. is a large grocery store chain that operates 102 pharmacies in the Cincinnati-Dayton marketing area. The PCMH practice is an accredited PCMH office serving more than 9000 patients in the Cincinnati area. In a medical neighborhood, a PCMH coordinates care with other local specialty practices or partners. A partnership between the community pharmacy chain and the PCMH was established to create a medical neighborhood. The pharmacist spent 2 half-days per week at the PCMH. The pharmacist provided initial medication therapy management appointments in the PCMH and offered follow-up services in the office, the pharmacy, or both, depending on patient preference. The pharmacy received a capitated payment per patient per month for a predetermined number of 1000 high-risk patients. Office-level changes in clinical outcomes such as A1C, blood pressure, and lipid measures were collected and compared with those of a similar control office. In addition, patient-level outcomes such as change in A1C, blood pressure, lipids, and weight were measured. One hundred five patients were seen by the pharmacist during the study period, with 1.5% of the total managed at the office. There was a statistically significant increase in influenza vaccinations received. On a patient level, A1C and systolic blood pressure significantly improved. This project represents an exciting opportunity for community pharmacists to expand their scope of services through direct partnership with PCMHs and maintain a sustainable reimbursement structure. Copyright © 2018. Published by Elsevier Inc.

Development of a Hospital-based Massage Therapy Course at an Academic Medical Center.

Science.gov (United States)

Dion, Liza J; Cutshall, Susanne M; Rodgers, Nancy J; Hauschulz, Jennifer L; Dreyer, Nikol E; Thomley, Barbara S; Bauer, Brent

2015-03-01

Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment.

Lessons learned: mobile device encryption in the academic medical center.

Science.gov (United States)

Kusche, Kristopher P

2009-01-01

The academic medical center is faced with the unique challenge of meeting the multi-faceted needs of both a modern healthcare organization and an academic institution, The need for security to protect patient information must be balanced by the academic freedoms expected in the college setting. The Albany Medical Center, consisting of the Albany Medical College and the Albany Medical Center Hospital, was challenged with implementing a solution that would preserve the availability, integrity and confidentiality of business, patient and research data stored on mobile devices. To solve this problem, Albany Medical Center implemented a mobile encryption suite across the enterprise. Such an implementation comes with complexities, from performance across multiple generations of computers and operating systems, to diversity of application use mode and end user adoption, all of which requires thoughtful policy and standards creation, understanding of regulations, and a willingness and ability to work through such diverse needs.

Implementation of epic beaker anatomic pathology at an academic medical center

Directory of Open Access Journals (Sweden)

John Larry Blau

2017-01-01

Full Text Available Background: Beaker is a relatively new laboratory information system (LIS offered by Epic Systems Corporation as part of its suite of health-care software and bundled with its electronic medical record, EpicCare. It is divided into two modules, Beaker anatomic pathology (Beaker AP and Beaker Clinical Pathology. In this report, we describe our experience implementing Beaker AP version 2014 at an academic medical center with a go-live date of October 2015. Methods: This report covers preimplementation preparations and challenges beginning in September 2014, issues discovered soon after go-live in October 2015, and some post go-live optimizations using data from meetings, debriefings, and the project closure document. Results: We share specific issues that we encountered during implementation, including difficulties with the proposed frozen section workflow, developing a shared specimen source dictionary, and implementation of the standard Beaker workflow in large institution with trainees. We share specific strategies that we used to overcome these issues for a successful Beaker AP implementation. Several areas of the laboratory-required adaptation of the default Beaker build parameters to meet the needs of the workflow in a busy academic medical center. In a few areas, our laboratory was unable to use the Beaker functionality to support our workflow, and we have continued to use paper or have altered our workflow. In spite of several difficulties that required creative solutions before go-live, the implementation has been successful based on satisfaction surveys completed by pathologists and others who use the software. However, optimization of Beaker workflows has continued to be an ongoing process after go-live to the present time. Conclusions: The Beaker AP LIS can be successfully implemented at an academic medical center but requires significant forethought, creative adaptation, and continued shared management of the ongoing product by

Characteristics of medical teachers using student-centered teaching methods.

Science.gov (United States)

Kim, Kyong-Jee; Hwang, Jee-Young

2017-09-01

This study investigated characteristics of medical teachers who have adopted student-centered teaching methods into their teaching. A 24-item questionnaire consisted of respondent backgrounds, his or her use of student-centered teaching methods, and awareness of the school's educational objectives and curricular principles was administered of faculty members at a private medical school in Korea. Descriptive statistics and chi-square analysis were conducted to compare faculty use of student-centered approaches across different backgrounds and awareness of curricular principles. Overall response rate was 70% (N=140/200), approximately 25% (n=34) of whom were using student-centered teaching methods. Distributions in the faculty use of student-centered teaching methods were significantly higher among basic sciences faculty (versus clinical sciences faculty), with teaching experiences of over 10 years (versus less than 10 years), and who were aware of the school's educational objectives and curricular principles. Our study indicates differences in medical faculty's practice of student-centered teaching across disciplines, teaching experiences, and their understanding of the school's educational objectives curricular principles. These findings have implications for faculty development and institutional support to better promote faculty use of student-centered teaching approaches.

Measuring the efficiency of dental departments in medical centers: a nonparametric analysis approach.

Science.gov (United States)

Wang, Su-Chen; Tsai, Chi-Cheng; Huang, Shun-Te; Hong, Yu-Jue

2002-12-01

Data envelopment analysis (DEA), a cross-sectional study design based on secondary data analysis, was used to evaluate the relative operational efficiency of 16 dental departments in medical centers in Taiwan in 1999. The results indicated that 68.7% of all dental departments in medical centers had poor performance in terms of overall efficiency and scale efficiency. All relatively efficient dental departments were in private medical centers. Half of these dental departments were unable to fully utilize available medical resources. 75.0% of public medical centers did not take full advantage of medical resources at their disposal. In the returns to scale, 56.3% of dental departments in medical centers exhibited increasing returns to scale, due to the insufficient scale influencing overall hospital operational efficiency. Public medical centers accounted for 77.8% of the institutions affected. The scale of dental departments in private medical centers was more appropriate than those in public medical centers. In the sensitivity analysis, the numbers of residents, interns, and published papers were used to assess teaching and research. Greater emphasis on teaching and research in medical centers has a large effect on the relative inefficiency of hospital operation. Dental departments in private medical centers had a higher mean overall efficiency score than those in public medical centers, and the overall efficiency of dental departments in non-university hospitals was greater than those in university hospitals. There was no information to evaluate the long-term efficiency of each dental department in all hospitals. A different combination of input and output variables, using common multipliers for efficiency value measurements in DEA, may help establish different pioneering dental departments in hospitals.

Opportunity for Collaboration Between Radiation Injury Treatment Network Centers and Medical Toxicology Specialists.

Science.gov (United States)

Davlantes, Elizabeth; Shartar, Samuel; Venero, Jennifer; Steck, Alaina; Langston, Amelia; Kazzi, Ziad N

2017-08-01

The Radiation Injury Treatment Network (RITN) comprises >50 centers across the United States that are poised to care for victims of a radiation emergency. The network is organized around bone marrow transplant centers because these facilities excel in both radiation medicine and the care of patients with severe bone marrow depression. A radiation emergency may cause not only irradiation from an external source but also internal contamination with radioactive material. Because medical toxicologists are trained in radiation injury management and have expertise in the management of internal contamination, RITN centers may benefit from partnerships with medical toxicology resources, which may be located at academic medical centers, hospital inpatient clinical services, outpatient clinics, or poison control centers. We determined the locations of existing RITN centers and assessed their proximity to various medical toxicology resources, including medical toxicology fellowship programs, inpatient toxicology services, outpatient toxicology clinics, and poison control centers. Data were derived from publicly available Internet sources in March 2015. The majority of RITN centers do not have a medical toxicology fellowship, an inpatient toxicology service, or an outpatient toxicology clinic within the same institution. Fifty-seven percent of RITN centers have at least one of these resources located in the same city, however, and 73% of centers have at least one of these resources or a poison control center within the same city. Ninety-five percent of RITN centers have at least one medical toxicology resource within the state. Most RITN centers are located in the same city as at least one medical toxicology resource. Establishing relationships between RITN centers and medical toxicologists needs to be explored further.

Academic medical center libraries on the Web.

Science.gov (United States)

Tannery, N H; Wessel, C B

1998-10-01

Academic medical center libraries are moving towards publishing electronically, utilizing networked technologies, and creating digital libraries. The catalyst for this movement has been the Web. An analysis of academic medical center library Web pages was undertaken to assess the information created and communicated in early 1997. A summary of present uses and suggestions for future applications is provided. A method for evaluating and describing the content of library Web sites was designed. The evaluation included categorizing basic information such as description and access to library services, access to commercial databases, and use of interactive forms. The main goal of the evaluation was to assess original resources produced by these libraries.

St. Luke's Medical Center: technologizing health care

International Nuclear Information System (INIS)

Tumanguil, S.S.

1994-01-01

The computerization of the St. Luke's Medical Center improved the hospital administration and management, particularly in nuclear medicine department. The use of computer-aided X-ray simulator machine and computerized linear accelerator machine in diagnosing and treating cancer are the most recent medical technological breakthroughs that benefited thousands of Filipino cancer patients. 4 photos

Melanoma in the shopping mall: A utilitarian argument for offering unsolicited medical opinions in informal settings.

Science.gov (United States)

Preller, Gustav; Salloch, Sabine

2018-03-01

Doctors occasionally make diagnoses in strangers outside of formal medical settings by using the medical skill of visual inspection, such as noticing signs of melanoma or the symptoms of hyperthyroidism. This may cause considerable moral unease and doubts on the side of the diagnosing physician. Such encounters force physicians to consider whether or not to intervene by introducing themselves to the stranger and offering an unsolicited medical opinion despite the absence of a formal doctor-patient relationship. A small body of literature has addressed the topic of the unsolicited medical opinion, often with a primary focus on practical advice. This article seeks to establish an ethical-theoretical basis for physicians' ethical obligation to offer an unsolicited medical opinion when they make a diagnosis by visual inspection in a stranger outside of the formal medical context. Using a utilitarian approach, it is argued that, if it is in the physicians' power to prevent a possible loss of well-being, without thereby sacrificing anything of equal value, physicians have an ethical obligation to intervene. © 2018 John Wiley & Sons Ltd.

A decade of building massage therapy services at an academic medical center as part of a healing enhancement program.

Science.gov (United States)

Rodgers, Nancy J; Cutshall, Susanne M; Dion, Liza J; Dreyer, Nikol E; Hauschulz, Jennifer L; Ristau, Crystal R; Thomley, Barb S; Bauer, Brent A

2015-02-01

The use of complementary and integrative medicine therapies is steadily becoming an integral part of health care. Massage therapy is increasingly offered to hospitalized patients for various conditions to assist with the management of common symptoms such as pain, anxiety, and tension. This article summarizes a decade of building the massage therapy service at a large tertiary care medical center, from the early pilot studies and research to the current program offerings, and the hopes and dreams for the future. Copyright © 2014 Elsevier Ltd. All rights reserved.

Assessing the Academic Medical Center as a Supportive Learning Community

Science.gov (United States)

Gannon, Sam C.

2011-01-01

Academic medical centers are well-known for their emphasis on teaching, research and public service; however, like most large, bureaucratic organizations, they oftentimes suffer from an inability to learn as an organization. The role of the research administrator in the academic medical center has grown over time as the profession itself has…

["AGAINST ALL ODDS" - PROMOTING RESEARCH, CLINICAL DEVELOPMENT AND MEDICAL SERVICES OF THE CONFLICT IN THE GALILEE MEDICAL CENTER].

Science.gov (United States)

Bornstein, Jacob

2017-05-01

The Galilee Medical Center (GMC) is unique in several aspects. Firstly, in the clinical aspect: In recent years, led by the Director of Medical Center, Dr. Masad Barhoum, a considerable momentum of development has taken place to reduce health discrepancies between the center and the periphery. Despite the under- financing of the health system in the Galilee, the GMC opened new clinical departments, introduced advanced medical technology and key staff members were added. This approach is depicted in publications presented in the current issue. Secondly, the aspect of medicine standoff: The GMC is the nearest hospital to the border with neighboring countries. It is also a tertiary center for trauma, due to the establishment of the Department of Neurosurgery, Department of Oral and Maxillofacial Surgery and the Departments of Orthopedic Surgery, general invasive radiology and invasive radiology of the brain. In recent years, the medical center treated hundreds of victims of the civil war in Syria, a third of them - women and children. The injured patients presented unique medical problems that are described in the papers in this issue. Thirdly, the research aspect: The medical center is the main teaching facility of medical students of the Faculty of Medicine in the Galilee of Bar-Ilan University. The Faculty of Medicine, led by the Dean, Prof. Ran Tur-Kaspa, promotes research and teaching in the medical center. Even before the establishment of the Faculty of Medicine, former hospital director, Prof. Shaul Shasha, not only extolled the importance of research, but established a research laboratory years ago. The laboratory continues to pursue translational research by the physicians of the medical center, led by Dr. Shifra Sela and Prof. Batya Kristal, and supported by the current medical center director, Dr. Masad Barhoum. Several studies conducted in this research laboratory are published herewith. With these unique aspects and despite the discrimination in funding

[Patient-centered care. Improvement of communication between university medical centers and general practitioners for patients in neuro-oncology].

Science.gov (United States)

Renovanz, M; Keric, N; Richter, C; Gutenberg, A; Giese, A

2015-12-01

Communication between university medical centers and general practitioners (GP) is becoming increasingly more important in supportive patient care. A survey among GPs was performed with the primary objective to assess their opinion on current workflow and communication between GPs and the university medical center. The GPs were asked to score (grades 1-6) their opinion on the current interdisciplinary workflow in the care of patients with brain tumors, thereby rating communication between a university medical center in general and the neuro-oncology outpatient center in particular. Questionnaires were sent to1000 GPs and the response rate was 15 %. The mean scored evaluation of the university medical center in general was 2.62 and of the neuro-oncological outpatient clinic 2.28 (range 1-6). The most often mentioned issues to be improved were easier/early telephone information (44 %) and a constantly available contact person (49 %). Interestingly, > 60 % of the GPs indicated they would support web-based tumor boards for interdisciplinary and palliative neuro-oncological care. As interdisciplinary care for neuro-oncology patients is an essential part of therapy, improvement of communication between GPs and university medical centers is indispensable. Integrating currently available electronic platforms under data protection aspects into neuro-oncological palliative care could be an interesting tool in order to establish healthcare networks and could find acceptance with GPs.

Supply chain optimization at an academic medical center.

Science.gov (United States)

Labuhn, Jonathan; Almeter, Philip; McLaughlin, Christopher; Fields, Philip; Turner, Benjamin

2017-08-01

A successful supply chain optimization project that leveraged technology, engineering principles, and a technician workflow redesign in the setting of a growing health system is described. With continued rises in medication costs, medication inventory management is increasingly important. Proper management of central pharmacy inventory and floor-stock inventory in automated dispensing cabinets (ADCs) can be challenging. In an effort to improve control of inventory costs in the central pharmacy of a large academic medical center, the pharmacy department implemented a supply chain optimization project in collaboration with the medical center's inhouse team of experts on process improvement and industrial engineering. The project had 2 main components: (1) upgrading and reconfiguring carousel technology within an expanded central pharmacy footprint to generate accurate floor-stock inventory replenishment reports, which resulted in efficiencies within the medication-use system, and (2) implementing a technician workflow redesign and algorithm to right-size the ADC inventory, which decreased inventory stockouts (i.e., incidents of depletion of medication stock) and improved ADC user satisfaction. Through a multifaceted approach to inventory management, the number of stockouts per month was decreased and ADC inventory was optimized, resulting in a one-time inventory cost savings of $220,500. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

DEVELOPMENT OF SIMULATION CENTER AND TRAINING PROGRAMMES IN IVANO-FRANKIVSK PERINATAL CENTER

Directory of Open Access Journals (Sweden)

Zoryana Kocherga

2017-06-01

Full Text Available Current system of medical education in Ukraine needs improvement and reforms in order to enhance the proficiency of doctors and paramedics. Training of practical/technical skills, communication, as well as teamwork skills is considerably important.The use of simulation techniques and methods in medical education is called simulation training in medicine. Medical skills are acquired through cognitive (knowledge and psychomotor (practice skills. The first medical simulation centers appeared in Ukraine in 2006 according to the order of the Ministry of Health Care of Ukraine.On June 20, 2013, a new simulation training center was opened in Ivano-Frankivsk on the base of Regional Perinatal Center. Similar medical simulation centers were opened in the second half of 2013 in Volyn and Vinnytsia regions under the Ukrainian-Swiss Mother and Child Health Programme, which started in the area of perinatology. Their goal is to improve the teamwork of all specialists involved in the process of delivery and neonatal intensive care,as well as to engage internship doctors and senior medical students in clinical skills training programmes.The use of simulation techniques and training programs offers a powerful platform to study and practice clinical reasoning behaviors and patterns.

The Manned Spacecraft Center and medical technology

Science.gov (United States)

Johnston, R. S.; Pool, S. L.

1974-01-01

A number of medically oriented research and hardware development programs in support of manned space flights have been sponsored by NASA. Blood pressure measuring systems for use in spacecraft are considered. In some cases, complete new bioinstrumentation systems were necessary to accomplish a specific physiological study. Plans for medical research during the Skylab program are discussed along with general questions regarding space-borne health service systems and details concerning the Health Services Support Control Center.

Connecticut Children's Medical Center multi-year branding campaign.

Science.gov (United States)

Botvin, J

2000-01-01

As the only children's hospital in the state, Connecticut Children's Medical Center was challenged by the inherent complacency of parents. It met the challenge through a multi-level marketing effort which included television and radio, community outreach and strong media relations. By emphasizing the unique nature of children, the campaign affirms the need for a specialized children's health center.

Patient-Centered Tools for Medication Information Search.

Science.gov (United States)

Wilcox, Lauren; Feiner, Steven; Elhadad, Noémie; Vawdrey, David; Tran, Tran H

2014-05-20

Recent research focused on online health information seeking highlights a heavy reliance on general-purpose search engines. However, current general-purpose search interfaces do not necessarily provide adequate support for non-experts in identifying suitable sources of health information. Popular search engines have recently introduced search tools in their user interfaces for a range of topics. In this work, we explore how such tools can support non-expert, patient-centered health information search. Scoping the current work to medication-related search, we report on findings from a formative study focused on the design of patient-centered, medication-information search tools. Our study included qualitative interviews with patients, family members, and domain experts, as well as observations of their use of Remedy, a technology probe embodying a set of search tools. Post-operative cardiothoracic surgery patients and their visiting family members used the tools to find information about their hospital medications and were interviewed before and after their use. Domain experts conducted similar search tasks and provided qualitative feedback on their preferences and recommendations for designing these tools. Findings from our study suggest the importance of four valuation principles underlying our tools: credibility, readability, consumer perspective, and topical relevance.

Military Construction: Renovation Plans at the Portsmouth Naval Medical Center

National Research Council Canada - National Science Library

1997-01-01

The Portsmouth Naval Medical Center is a teaching hospital that provides comprehensive health care services to active duty forces and, when space is available, provides medical services to other DOD beneficiaries (i.e...

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Staff Association

2012-01-01

proposes the following offer: 15% discount for the Staff Association members who enroll their children in summer FUTUREKIDS activities. Extracurricular Activities For Your Children The FUTUREKIDS Geneva Learning Center is open 6 days a week and offers a selection of after-school extracurricular activities for children and teenagers (ages 5 to 16). In addition to teaching in its Learning Centers, Futurekids collaborates with many private schools in Suisse Romande (Florimont, Moser, Champittet, Ecole Nouvelle, etc.) and with the Département de l'Instruction Publique (DIP) Genève. Courses and camps are usually in French but English groups can be set up on demand. FUTUREKIDS Computer Camps (during school holidays) FUTUREKIDS Computer Camps are a way of having a great time during vacations while learning something useful, possibly discovering a new hobby or even, why not, a future profession. Our computer camps are at the forefront of technology. Themes are diverse and suit all ...

Die Ärztliche Zentralbibliothek des Universitätsklinikums Hamburg-Eppendorf / The Medical Library of the University Medical Center Hamburg-Eppendorf

Directory of Open Access Journals (Sweden)

Kintzel, Melanie

2009-12-01

Full Text Available This article introduces the Medical Library of the University Medical Center Hamburg-Eppendorf. Firstly, history, role and status of the library within the University Medical Center are illustrated, followed by a description of the library’s facilities and services. Finally, recent projects are presented as well as a selection of key figures.

Using Technology to Enhance Teaching of Patient-Centered Interviewing for Early Medical Students.

Science.gov (United States)

Kaltman, Stacey; Talisman, Nicholas; Pennestri, Susan; Syverson, Eleri; Arthur, Paige; Vovides, Yianna

2018-06-01

Effective strategies for teaching communication skills to health professions students are needed. This article describes the design and evaluation of immersive and interactive video simulations for medical students to practice basic communication skills. Three simulations were developed, focusing on patient-centered interviewing techniques such as using open-ended questions, reflections, and empathic responses while assessing a patient's history of present illness. First-year medical students were randomized to simulation or education-as-usual arms. Students in the simulation arm were given access to three interactive video simulations developed using Articulate Storyline, an e-learning authoring tool, to practice and receive feedback on patient-centered interviewing techniques to prepare for their Observed Structured Clinical Examination (OSCE). Trained raters evaluated videos of two OSCE cases for each participant to assess specific communication skills used during the history of present illness component of the interview. Eighty-seven percent of the students in the simulation arm interacted with at least one simulation during the history of present illness. For both OSCE cases, students in the simulation arm asked significantly more open-ended questions. Students in the simulation arm asked significantly fewer closed-ended questions and offered significantly more empathic responses in one OSCE case. No differences were found for reflections. Students reported that the simulations helped improve their communication skills. The use of interactive video simulations was found to be feasible to incorporate into the curriculum and was appealing to students. In addition, students in the simulation arm displayed more behaviors consistent with the patient-centered interviewing model practiced in the simulations. Continued development and research are warranted.

Marketing the academic medical center group practice.

Science.gov (United States)

Eudes, J A; Divis, K L

1992-01-01

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

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

Science.gov (United States)

2011-01-01

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

An Analysis of Medication Errors at the Military Medical Center: Implications for a Systems Approach for Error Reduction

National Research Council Canada - National Science Library

Scheirman, Katherine

2001-01-01

An analysis was accomplished of all inpatient medication errors at a military academic medical center during the year 2000, based on the causes of medication errors as described by current research in the field...

A model for training medical student innovators: the Harvard Medical School Center for Primary Care Abundance Agents of Change program.

Science.gov (United States)

Duong, David B; Sullivan, Erin E; Minter-Jordan, Myechia; Giesen, Lindsay; Ellner, Andrew L

2016-01-01

In 2013, the Harvard Medical School Center for Primary Care established the Abundance Agents of Change (AoC) program to promote interprofessional learning and innovation, increase partnership between 15 academic and community health centers (CHCs) in Boston's most under-served communities, and increase medical student interest in primary care careers. The AoC is modeled in the form of a 'grants challenge', offering $20,000 to interprofessional student teams to develop an innovative solution that addresses a healthcare delivery need identified by CHCs. The program's initial two years were characterized by a four-stage process which included working with CHCs and crafting a request for proposals, forming interprofessional 20 student teams comprising students from across and outside of Harvard University, training students using a systems-based innovation curriculum, and performing program evaluation. Our evaluation data from cohorts 1 and 2 of the AoC program demonstrate that we succeeded in training students as innovators and members of interprofessional teams. We also learned valuable lessons regarding creating better alignment with CHC priorities, extending the program cycle from 12 to 18 months, and changing the way funding is disbursed to 25 students, which will be incorporated in later versions of the program. Based on our experience and evaluation data, we believe that this program is a replicable way to train students as innovators and members of interprofessional teams to address the current complex healthcare environment.

Investigating Medication Errors in Educational Health Centers of Kermanshah

Directory of Open Access Journals (Sweden)

Mohsen Mohammadi

2015-08-01

Full Text Available Background and objectives : Medication errors can be a threat to the safety of patients. Preventing medication errors requires reporting and investigating such errors. The present study was conducted with the purpose of investigating medication errors in educational health centers of Kermanshah. Material and Methods: The present research is an applied, descriptive-analytical study and is done as a survey. Error Report of Ministry of Health and Medical Education was used for data collection. The population of the study included all the personnel (nurses, doctors, paramedics of educational health centers of Kermanshah. Among them, those who reported the committed errors were selected as the sample of the study. The data analysis was done using descriptive statistics and Chi 2 Test using SPSS version 18. Results: The findings of the study showed that most errors were related to not using medication properly, the least number of errors were related to improper dose, and the majority of errors occurred in the morning. The most frequent reason for errors was staff negligence and the least frequent was the lack of knowledge. Conclusion: The health care system should create an environment for detecting and reporting errors by the personnel, recognizing related factors causing errors, training the personnel and create a good working environment and standard workload.

Operation of medical accelerator PATRO at Hyogo Ion Beam Medical Center

International Nuclear Information System (INIS)

Itano, A.; Akagi, T.; Higashi, A.; Fukushima, S.; Fujita, A.; Honda, Y.; Isa, H.; Nishikigouri, K.

2004-01-01

PATRO (Particle Accelerator for Therapy, Radiology and Oncology) is a medical accelerator facility for hadrontherapy of cancer at Hyogo Ion Beam Medical Center (HIBMC). Beam particles are proton (230 MeV) and carbon (320 MeV/u). After the beam commissioning and the tuning of irradiation system in 2000, we performed the clinical trials with proton and carbon beams from May 2001 until July 2002. We operated the accelerator for about 11,000 hours since the beginning of the beam tuning until the end of the clinical trials and for about 5,000 hours during the clinical trials. No serious troubles happened during the clinical trials. The stability and the reproducibility of the beams were well proved. (author)

The house of gastrointestinal medicine: how academic medical centers can build a sustainable economic clinical model.

Science.gov (United States)

Rustgi, Anil K; Allen, John I

2013-11-01

Academic Medical Centers (AMCs) have been given unique responsibilities to care for patients, educate future clinicians, and bring innovative research to the bedside. Over the last few decades, this tripartite mission has served the United States well, and payers (Federal, State, and commercial) have been willing to underwrite these missions with overt and covert financial subsidies. As cost containment efforts have escalated, the traditional business model of AMCs has been challenged. In this issue, Dr Anil Rustgi and I offer some insights into how AMCs must alter their business model to be sustainable in our new world of accountable care, cost containment, and clinical integration.

A management plan for hospitals and medical centers facing radiation incidents.

Science.gov (United States)

Davari, Fereshteh; Zahed, Arash

2015-09-01

Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

Early experiences with big data at an academic medical center.

Science.gov (United States)

Halamka, John D

2014-07-01

Beth Israel Deaconess Medical Center (BIDMC), an academic health care institution affiliated with Harvard University, has been an early adopter of electronic applications since the 1970s. Various departments of the medical center and the physician practice groups affiliated with it have implemented electronic health records, filmless imaging, and networked medical devices to such an extent that data storage at BIDMC now amounts to three petabytes and continues to grow at a rate of 25 percent a year. Initially, the greatest technical challenge was the cost and complexity of data storage. However, today the major focus is on transforming raw data into information, knowledge, and wisdom. This article discusses the data growth, increasing importance of analytics, and changing user requirements that have shaped the management of big data at BIDMC. Project HOPE—The People-to-People Health Foundation, Inc.

Attitudes of medical students towards incentives offered by pharmaceutical companies- perspective from a developing nation- a cross sectional study

Science.gov (United States)

2014-01-01

Background A training physician has his first interaction with a pharmaceutical representative during medical school. Medical students are often provided with small gifts such as pens, calendars and books, as well as free lunches as part of drug promotion offers. Ethical impact of these transactions as perceived by young medical students has not been investigated in Pakistan before. This study aimed to assess the association of socio-demographic variables with the attitudes of medical students towards pharmaceutical companies and their incentives. Methods As part of a cross-sectional survey, a validated questionnaire previously used for assessing attitude of medical students towards pharmaceutical industry, was modified, pre-tested and distributed among consenting clinical year students at DUHS and AKU. Questions included acceptability of pharmaceutically sponsored gifts, events and tuition fee, and their impact on future prescription. Responses were graded as agree, disagree or neutral which were then scored according to the AMSA guidelines of ethical conduct. Results Out of a total of 353 targeted students 303 responded, corresponding to a response rate of 85.8%. Responses indicated that 42.7% students believed in no interaction with drug companies during medical school. However, 81% of students favored pharmaceutical sponsorship of student-body events/seminars at medical colleges. More than one-third of the students were comfortable receiving gifts from drug companies. Overall, the results of this study offer an interesting comparison between the students of a private medical school (AKU) and a public medical school (DUHS); AKU students exhibited a greater degree of mistrust towards drug information provided by pharmaceutical companies compared to DUHS students (p = 0.040). Furthermore, when asked if there was a need to incorporate guidelines in the undergraduate curriculum with regard to interaction with drug companies, 84.2% students at AKU agreed

Attitudes of medical students towards incentives offered by pharmaceutical companies -- perspective from a developing nation -- a cross-sectional study.

Science.gov (United States)

Siddiqui, Usman Tariq; Shakoor, Amarah; Kiani, Sarah; Ali, Farwa; Sharif, Maryam; Kumar, Arun; Raza, Qasim; Khan, Naseer; Alamzaib, Sardar Mohammed; Farid-ul-Husnain, Syed

2014-05-05

A training physician has his first interaction with a pharmaceutical representative during medical school. Medical students are often provided with small gifts such as pens, calendars and books, as well as free lunches as part of drug promotion offers. Ethical impact of these transactions as perceived by young medical students has not been investigated in Pakistan before. This study aimed to assess the association of socio-demographic variables with the attitudes of medical students towards pharmaceutical companies and their incentives. As part of a cross-sectional survey, a validated questionnaire previously used for assessing attitude of medical students towards pharmaceutical industry, was modified, pre-tested and distributed among consenting clinical year students at DUHS and AKU. Questions included acceptability of pharmaceutically sponsored gifts, events and tuition fee, and their impact on future prescription. Responses were graded as agree, disagree or neutral which were then scored according to the AMSA guidelines of ethical conduct. Out of a total of 353 targeted students 303 responded, corresponding to a response rate of 85.8%. Responses indicated that 42.7% students believed in no interaction with drug companies during medical school. However, 81% of students favored pharmaceutical sponsorship of student-body events/seminars at medical colleges. More than one-third of the students were comfortable receiving gifts from drug companies. Overall, the results of this study offer an interesting comparison between the students of a private medical school (AKU) and a public medical school (DUHS); AKU students exhibited a greater degree of mistrust towards drug information provided by pharmaceutical companies compared to DUHS students (p = 0.040). Furthermore, when asked if there was a need to incorporate guidelines in the undergraduate curriculum with regard to interaction with drug companies, 84.2% students at AKU agreed, compared to 54.9% at DUHS. Medical

Trends in the Use of Medical Imaging to Diagnose Appendicitis at an Academic Medical Center.

Science.gov (United States)

Repplinger, Michael D; Weber, Andrew C; Pickhardt, Perry J; Rajamanickam, Victoria P; Svenson, James E; Ehlenbach, William J; Westergaard, Ryan P; Reeder, Scott B; Jacobs, Elizabeth A

2016-09-01

To quantify the trends in imaging use for the diagnosis of appendicitis. A retrospective study covering a 22-year period was conducted at an academic medical center. Patients were identified by International Classification of Diseases-9 diagnosis code for appendicitis. Medical record data extraction of these patients included imaging test used (ultrasound, CT, or MRI), gender, age, and body mass index (BMI). The proportion of patients undergoing each scan was calculated by year. Regression analysis was performed to determine whether age, gender, or BMI affected imaging choice. The study included a total of 2,108 patients, including 967 (43.5%) females and 599 (27%) children (imaging used for the diagnosis of appendicitis decreased over time (P medical center, CT use increased more than 20-fold. However, no statistically significant trend was found for increased use of ultrasound or MRI. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Moral dilemmas faced by hospitals in time of war: the Rambam Medical Center during the second Lebanon war.

Science.gov (United States)

Bar-El, Yaron; Reisner, Shimon; Beyar, Rafael

2014-02-01

Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to follow, and offer a retrospective critical reflection in this paper. The hospital's first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats.

Governing Academic Medical Center Systems: Evaluating and Choosing Among Alternative Governance Approaches.

Science.gov (United States)

Chari, Ramya; O'Hanlon, Claire; Chen, Peggy; Leuschner, Kristin; Nelson, Christopher

2018-02-01

The ability of academic medical centers (AMCs) to fulfill their triple mission of patient care, medical education, and research is increasingly being threatened by rising financial pressures and resource constraints. Many AMCs are, therefore, looking to expand into academic medical systems, increasing their scale through consolidation or affiliation with other health care systems. As clinical operations grow, though, the need for effective governance becomes even more critical to ensure that the business of patient care does not compromise the rest of the triple mission. Multi-AMC systems, a model in which multiple AMCs are governed by a single body, pose a particular challenge in balancing unity with the needs of component AMCs, and therefore offer lessons for designing AMC governance approaches. This article describes the development and application of a set of criteria to evaluate governance options for one multi-AMC system-the University of California (UC) and its five AMCs. Based on a literature review and key informant interviews, the authors identified criteria for evaluating governance approaches (structures and processes), assessed current governance approaches using the criteria, identified alternative governance options, and assessed each option using the identified criteria. The assessment aided UC in streamlining governance operations to enhance their ability to respond efficiently to change and to act collectively. Although designed for UC and a multi-AMC model, the criteria may provide a systematic way for any AMC to assess the strengths and weaknesses of its governance approaches.

Patient-centered medical homes for patients with disabilities.

Science.gov (United States)

Hernandez, Brigida; Damiani, Marco; Wang, T Arthur; Driscoll, Carolyn; Dellabella, Peter; LePera, Nicole; Mentari, Michael

2015-01-01

The patient-centered medical home is an innovative approach to improve health care outcomes. To address the unique needs of patients with intellectual and developmental disabilities (IDDs), a large health care provider reevaluated the National Committee for Quality Assurance's 6 medical home standards: (a) enhance access and continuity, (b) identify and manage patient populations, (c) plan and manage care, (d) provide self-care and community support, (e) track and coordinate care, and (f) measure and improve performance. This article describes issues to consider when serving patients with IDDs.

97 Medical Apparatuses tested at the Academic Medical Center (AMC) Amsterdam for interference by WLAN/WiFi signals

NARCIS (Netherlands)

Hensbroek, R.

2009-01-01

This research describes the influence of WLAN 1 signals on medical apparatuses in the Academic Medical Center (AMC) Amsterdam. The results in this report were obtained by testing medical equipment with WLAN signals. A comparable research was reported earlier. See TNO report KvL/P&Z 2007.117 dated

Trends in the utilization of medical imaging from 2003 to 2011: clinical encounters offer a complementary patient-centered focus.

Science.gov (United States)

Dodoo, Martey S; Duszak, Richard; Hughes, Danny R

2013-07-01

The aim of this study was to investigate trends in utilization and spending for medical imaging, using medical visits resulting in imaging as a novel metric of utilization. Utilization and spending for medical imaging were examined using (1) Medicare Part B claims data from 2003 to 2011 to measure per-enrollee spending and (2) household component events data on the elderly Medicare-age population from the Medical Expenditure Panel Survey from 2003 to 2010 to measure utilization as a function of clinical encounters. Annual health spending and Medicare payments for imaging for the elderly population grew from $294 per enrollee in 2003 to $418 in 2006 and had declined to $390 by 2011. Over this entire time, however, annual medical visits by a similar Medicare-age (≥ 65 years old) population resulting in imaging trended consistently downward, from 12.8% in 2003 to 10.6% in 2011. Despite early growth and then more recent declines in average Medicare spending per enrollee since 2003, the percentage of patient encounters resulting in medical imaging has significantly and consistently declined nationwide. Spending alone is thus an incomplete measure of changes in the role and utilization of medical imaging in overall patient care. As policymakers focus on medical imaging, a thoughtful analysis of payment policy influencing imaging utilization, and its role in concurrent and downstream patient care, will be critical to ensure appropriate patient access. Copyright © 2013 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Improving access to care through the patient-centered medical home.

Science.gov (United States)

North, Stephen W; McElligot, James; Douglas, Gaye; Martin, Amanda

2014-02-01

School-based health centers (SBHCs) serve an essential role in providing access to high-quality, comprehensive care to underserved children and adolescents in more than 2,000 schools across the United States. SBHCs are an essential component of the health care safety net, and their role in the patient-centered medical home (PCMH) continues to evolve as both collaborating partners and, when fully functioning, independent PCMHs. The American Academy of Pediatrics (AAP) supports the use of SBHCs, citing the proven benefits and exciting potential as justification, but also offers caution and recommends a focus on communication within the community. Traditional "brick and mortar" SBHCs are more likely to be located in urban communities (54.2% urban versus 18.0% rural) and be in schools with more students, allowing for a greater return on investment. Current SBHCs are located in schools with an average population of 997 students. The need for a large school population to help an SBHC approach financial viability excludes children in rural communities who are more likely to attend a school with fewer than 500 students, be poor, and have difficulty accessing health care.2 The expansion of telehealth technologies allows the creation of solutions to decrease geographic barriers that have limited the growth of SBHCs in rural communities. Telehealth school-based health centers (tSBHCs) that exclusively provide services through telemedicine are operating and developing in communities where geographic barriers and financial challenges have prevented the establishment of brick and mortar SBHCs. TSBHCs are beginning to increase the number and variety of services they provide through the use of telehealth to include behavioral health, nutrition services, and pediatric specialists. Understanding the role of tSBHCs in the growth of the PCMH model is critical for using these tools to continue to improve child and adolescent health. Copyright 2014, SLACK Incorporated.

PASTE: patient-centered SMS text tagging in a medication management system.

Science.gov (United States)

Stenner, Shane P; Johnson, Kevin B; Denny, Joshua C

2012-01-01

To evaluate the performance of a system that extracts medication information and administration-related actions from patient short message service (SMS) messages. Mobile technologies provide a platform for electronic patient-centered medication management. MyMediHealth (MMH) is a medication management system that includes a medication scheduler, a medication administration record, and a reminder engine that sends text messages to cell phones. The object of this work was to extend MMH to allow two-way interaction using mobile phone-based SMS technology. Unprompted text-message communication with patients using natural language could engage patients in their healthcare, but presents unique natural language processing challenges. The authors developed a new functional component of MMH, the Patient-centered Automated SMS Tagging Engine (PASTE). The PASTE web service uses natural language processing methods, custom lexicons, and existing knowledge sources to extract and tag medication information from patient text messages. A pilot evaluation of PASTE was completed using 130 medication messages anonymously submitted by 16 volunteers via a website. System output was compared with manually tagged messages. Verified medication names, medication terms, and action terms reached high F-measures of 91.3%, 94.7%, and 90.4%, respectively. The overall medication name F-measure was 79.8%, and the medication action term F-measure was 90%. Other studies have demonstrated systems that successfully extract medication information from clinical documents using semantic tagging, regular expression-based approaches, or a combination of both approaches. This evaluation demonstrates the feasibility of extracting medication information from patient-generated medication messages.

The Patient-Centered Medical Home Neighbor: A Critical Concept for a Redesigned Healthcare Delivery System

Science.gov (United States)

2011-01-25

Sharing Knowledge: Achieving Breakthrough Performance 2010 Military Health System Conference The Patient -Centered Medical Home Neighbor: A Critical...DATE 25 JAN 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE The Patient -Centered Medical Home Neighbor: A...Conference What is the Patient -Centered Medical Home?  …a vision of health care as it should be  …a framework for organizing systems of care at both the

5 CFR 339.302 - Authority to offer examinations.

Science.gov (United States)

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Authority to offer examinations. 339.302... QUALIFICATION DETERMINATIONS Medical Examinations § 339.302 Authority to offer examinations. An agency may, at its option, offer a medical examination (including a psychiatric evaluation) in any situation where...

Access to patient-centered medical home among Ohio's Children with Special Health Care Needs.

Science.gov (United States)

Conrey, Elizabeth J; Seidu, Dazar; Ryan, Norma J; Chapman, Dj Sam

2013-06-01

Medical homes deliver primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate and culturally effective. Children with special health care needs (CSHCN) require a wide range of support to maintain health, making medical home access particularly important. We sought to understand independent risk factors for lacking access. We analyzed Ohio, USA data from the National Survey of Children with Special Health Care Needs (2005-2006). Among CSHCN, 55.6% had medical home access. The proportion achieving each medical home component was highest for having a personal doctor/nurse and lowest for receiving coordinated care, family-centered care and referrals. Specific subsets of CSHCN were significantly and independently more likely to lack medical home access: Hispanic (AOR=3.08), moderate/high severity of difficulty (AOR=2.84), and any public insurance (AOR=1.60). Efforts to advance medical home access must give special attention to these CSHCN populations and improvements must be made to referral access, family-centered care, and care coordination.

A management plan for hospitals and medical centers facing radiation incidents

Directory of Open Access Journals (Sweden)

Fereshteh Davari

2015-01-01

Full Text Available Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

Holistic Health Care for the Medically Uninsured: The Church Health Center of Memphis.

Science.gov (United States)

Morris, G Scott

2015-11-05

The Church Health Center (CHC) in Memphis was founded in 1987 to provide quality, affordable health care for working, uninsured people and their families. With numerous, dedicated financial supporters and health care volunteers, CHC has become the largest faith-based health care organization of its type nationally, serving >61,000 patients. CHC embraces a holistic approach to health by promoting wellness in every dimension of life. It offers on-site services including medical care, dentistry, optometry, counseling, social work, and nutrition and fitness education, to promote wellness in every dimension of life. A 2012 economic analysis estimated that a $1 contribution to the CHC provided roughly $8 in health services. The CHC has trained >1200 Congregational Health Promoters to be health leaders and is conducting research on the effectiveness of faith community nurses partnering with congregations to assist in home care for patients recently discharged from Memphis hospitals. The MEMPHIS Plan, CHC's employer-sponsored health care plan for small business and the self-employed, offers uninsured people in lower-wage jobs access to quality, affordable health care. The CHC also conducts replications workshops several times a year to share their model with leaders in other communities. The Institute for Healthcare Improvement (IHI) recently completed a case study that concluded: "The CHC is one of a very few organizations successfully embodying all three components of the IHI Triple Aim by improving population health outcomes, enhancing the individual's health care experience, and controlling costs. All three have been part of the Center's DNA since its inception, and as a transforming force in the community, the model is well worth national attention."

The patient-centered medical home neighbor: A primary care physician's view.

Science.gov (United States)

Sinsky, Christine A

2011-01-04

The American College of Physicians' position paper on the patient-centered medical home neighbor (PCMH-N) extends the work of the patient-centered medical home (PCMH) as a means of improving the delivery of health care. Recognizing that the PCMH does not exist in isolation, the PCMH-N concept outlines expectations for comanagement, communication, and care coordination and broadens responsibility for safe, effective, and efficient care beyond primary care to include physicians of all specialties. As such, it is a fitting follow-up to the PCMH and moves further down the road toward improved care for complex patients. Yet, there is more work to be done. Truly transforming the U.S. health care system around personalized medical homes embedded in highly functional medical neighborhoods will require better staffing models; more robust electronic information tools; aligned incentives for quality and efficiency within payment and regulatory policies; and a culture of greater engagement of patients, their families, and communities.

76 FR 71045 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and...

Science.gov (United States)

2011-11-16

...] Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information... period for the notice on its report of scientific and medical literature and information concerning the... ``Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information...

Walter Reed Army Medical Center's Internet-based electronic health portal.

Science.gov (United States)

Abbott, Kevin C; Boocks, Carl E; Sun, Zhengyi; Boal, Thomas R; Poropatich, Ronald K

2003-12-01

Use of the World Wide Web (WWW) and electronic media to facilitate medical care has been the subject of many reports in the popular press. However, few reports have documented the results of implementing electronic health portals for essential medical tasks, such as prescription refills and appointments. At Walter Reed Army Medical Center, "Search & Learn" medical information, Internet-based prescription refills and patient appointments were established in January 2001. A multiphase retrospective analysis was conducted to determine the use of the "Search & Learn" medical information and the relative number of prescription refills and appointments conducted via the WWW compared with conventional methods. From January 2001 to May 2002, there were 34,741 refills and 819 appointments made over the Internet compared with 2,275,112 refills and approximately 500,000 appointments made conventionally. WWW activity accounted for 1.52% of refills and 0.16% of appointments. There was a steady increase in this percentage over the time of the analysis. In April of 2002, the monthly average of online refills had risen to 4.57% and online appointments were at 0.27%. Online refills were projected to account for 10% of all prescriptions in 2 years. The "Search & Learn" medical information portion of our web site received 147,429 unique visits during this same time frame, which was an average of 326 visitors per day. WWW-based methods of conducting essential medical tasks accounted for a small but rapidly increasing percentage of total activity at Walter Reed Army Medical Center. Subsequent phases of analysis will assess demographic and geographic factors and aid in the design of future systems to increase use of the Internet-based systems.

78 FR 74163 - Harrison Medical Center, a Subsidiary of Franciscan Health System Bremerton, Washington; Notice...

Science.gov (United States)

2013-12-10

... DEPARTMENT OF LABOR Employment and Training Administration [TA-W-83,070] Harrison Medical Center, a Subsidiary of Franciscan Health System Bremerton, Washington; Notice of Negative Determination... workers of Harrison Medical Center, a subsidiary of Franciscan Health System, Bremerton, Washington...

78 FR 10610 - TRICARE; Demonstration Project for Participation in Maryland Multi-Payer Patient Centered Medical...

Science.gov (United States)

2013-02-14

... National Committee on Quality Assurance Patient Centered Medical Home (PPC-PCMH) recognition criteria... quality improvements. TMA Defense Health Cost Assessment and Evaluation (DHCAPE) staff will calculate... Maryland Multi-Payer Patient Centered Medical Home Program (MMPCMHP) Demonstration AGENCY: Department of...

Roles of Medical Record and Statistic Staff on Research at the Tawanchai Center.

Science.gov (United States)

Pattaranit, Rumpan; Chantachum, Vasana; Lekboonyasin, Orathai; Pradubwong, Suteera

2015-08-01

The medical record and statistic staffs play a crucial role behind the achievements of treatment and research of physicians, nurses and other health care professionals. The medical record and statistic staff are in charge of keeping patient medical records; creating databases; presenting information; sorting patient's information; providing patient medical records and related information for various medical teams and researchers; Besides, the medical record and statistic staff have collaboration with the Center of Cleft Lip-Palate, Khon Kaen University in association with the Tawanchai Project. The Tawanchai Center is an organization, involving multidisciplinary team which aims to continuing provide care for patients with cleft lip and palate and craniofacial deformities who need a long term of treatment since newborns until the age of 19 years. With support and encouragement from the Tawanchai team, the medical record and statistic staff have involved in research under the Tawanchai Centre since then and produced a number of publications locally and internationally.

Critical Care Organizations in Academic Medical Centers in North America: A Descriptive Report.

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Pastores, Stephen M; Halpern, Neil A; Oropello, John M; Kostelecky, Natalie; Kvetan, Vladimir

2015-10-01

With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. A 46-item survey questionnaire was electronically distributed using Survey Monkey to the leadership of 27 identified critical care organizations in the United States and Canada between September 2014 and February 2015. A critical care organization had to be headed by a physician and have primary governance over the majority, if not all, of the ICUs in the medical center. We received 24 responses (89%). The majority of the critical care organizations (83%) were called departments, centers, systems, or operations committees. Approximately two thirds of respondents were from larger (> 500 beds) urban institutions, and nearly 80% were primary university medical centers. On average, there were six ICUs per academic medical center with a mean of four ICUs under critical care organization governance. In these ICUs, intensivists were present in-house 24/7 in 49%; advanced practice providers in 63%; hospitalists in 21%; and telemedicine coverage in 14%. Nearly 60% of respondents indicated that they had a separate hospital budget to support data management and reporting, oversight of their ICUs, and rapid response teams. The transition from the traditional model of ICUs within departmentally controlled services or divisions to a critical care organization was described as gradual in 50% and complete in only 25%. Nearly 90% indicated that their critical care organization governance structure was either moderately or highly effective; a similar number suggested that their critical care organizations were evolving with increasing domain and financial control of the ICUs at their respective institutions. Our survey of the very few critical care organizations in North American

Abortion misinformation from crisis pregnancy centers in North Carolina.

Science.gov (United States)

Bryant, Amy G; Levi, Erika E

2012-12-01

This study assessed the accuracy of medical information provided by crisis pregnancy centers in North Carolina. We performed a secondary data analysis of a "secret shopper survey" performed by a nonprofit organization. Reports from phone calls and visits to crisis pregnancy centers were analyzed for quality and content of medical information provided. Web sites of crisis pregnancy centers in the state were also reviewed. Thirty-two crisis pregnancy centers were contacted. Nineteen of these were visited. Fourteen centers (44%) offered that they "provide counseling on abortion and its risks." Inaccurate information provided included a link between abortion and breast cancer (16%), infertility (26%) and mental health problems (26%). Of the 36 Web sites identified, 31 (86%) provided false or misleading information, including 26 sites (72%) linking abortion to "post-abortion stress." Many crisis pregnancy centers give inaccurate medical information regarding the risks of abortion. Overstating risks stigmatizes abortion, seeks to intimidate women and is unethical. Copyright © 2012 Elsevier Inc. All rights reserved.

Development of a longitudinal integrated clerkship at an academic medical center.

Science.gov (United States)

Poncelet, Ann; Bokser, Seth; Calton, Brook; Hauer, Karen E; Kirsch, Heidi; Jones, Tracey; Lai, Cindy J; Mazotti, Lindsay; Shore, William; Teherani, Arianne; Tong, Lowell; Wamsley, Maria; Robertson, Patricia

2011-04-04

In 2005, medical educators at the University of California, San Francisco (UCSF), began developing the Parnassus Integrated Student Clinical Experiences (PISCES) program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants' career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

Nutrition education in Japanese medical schools: a follow-up survey.

Science.gov (United States)

Orimo, Hideo; Ueno, Takahiro; Yoshida, Hiroshi; Sone, Hirohito; Tanaka, Akira; Itakura, Hiroshige

2013-01-01

A questionnaire survey was used to determine the status of nutrition education in Japanese medical schools in 2009. A similar survey was conducted in 2004, at which time nutritional education was determined to be inadequate in Japanese medical schools. The current questionnaire was sent to the directors of Centers for Medical Education of 80 medical schools, who represented all medical schools in Japan. Sixty-seven medical schools (83.8%) responded, of which 25 schools (37.3%) offered dedicated nutrition courses and 36 schools (53.7%) did not offer dedicated nutrition courses but offered something related to nutrition in other courses; six schools (9.0%) did not offer any nutrition education. Overall, 61 schools (91.0%) offered at least some nutritional topics in their undergraduate education. Nevertheless, only 11 schools (16.4%) seem to dedicate more than 5 hours to substantial nutrition education as judged by their syllabi. Although the mean length of the course was 11 hours, substantial nutrition education accounted for only 4.2 hours. Of the 25 medical schools that offered dedicated nutrition courses, seven schools offered the nutrition course as a stand-alone course and 18 schools offered it as an integrated course. In conclusion, the status of nutrition education in Japan has improved slightly but is still inadequate.

Patient-Centered Medical Home in chronic obstructive pulmonary disease

Directory of Open Access Journals (Sweden)

Ortiz G

2011-10-01

Full Text Available Gabriel Ortiz1, Len Fromer21Pediatric Pulmonary Services, El Paso, TX; 2Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USAAbstract: Chronic obstructive pulmonary disease (COPD is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH, which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.Keywords: Patient-Centered Medical Home, chronic care model, chronic obstructive pulmonary disease, patient education, physician assistants, nurse practitioners

DOE Center of Excellence in Medical Laser Applications. Final report, December 1, 1994--November 30, 1997

Energy Technology Data Exchange (ETDEWEB)

Jacques, S.L.

1998-01-01

An engineering network of collaborating medical laser laboratories are developing laser and optical technologies for medical diagnosis and therapy and are translating the engineering into medical centers in Portland OR, Houston TX, and Galveston TX. The Center includes the University of Texas M.D. Anderson Cancer Center, the University of Texas-Austin, Texas A and M University, Rice University, the University Texas Medical Branch-Galveston, Oregon Medical Laser Center (Providence St. Vincent Medical Center, Oregon Health Sciences University, and Oregon Graduate Institute, Portland, OR), and the University of Oregon. Diagnostics include reflectance, fluorescence, Raman IR, laser photoacoustics, optical coherence tomography, and several new video techniques for spectroscopy and imaging. Therapies include photocoagulation therapy, laser welding, pulsed laser ablation, and light-activated chemotherapy of cancer (photodynamic therapy, or PDT). Medical applications reaching the clinic include optical monitoring of hyperbilirubinemia in newborns, fluorescence detection of cervical dysplasia, laser thrombolysis of blood clots in heart attack and brain stroke, photothermal coagulant of benign prostate hyperplasia, and PDT for both veterinary and human cancer. New technologies include laser optoacoustic imaging of breast tumors and hemorrhage in head trauma and brain stroke, quality control monitoring of dosimetry during PDT for esophageal and lung cancer, polarization video reflectometry of skin cancer, laser welding of artificial tissue replacements, and feedback control of laser welding.

Relating calls to US poison centers for potential exposures to medications to Centers for Disease Control and Prevention reporting of influenza-like illness.

Science.gov (United States)

Beauchamp, Gillian A; McKeown, Nathanael J; Rodriguez, Sergio; Spyker, Daniel A

2016-03-01

The Centers for Disease Control (CDC) monitors influenza like illness (ILI) and the National Poison Data System (NPDS) warehouses call data uploaded by US poison centers regarding reported exposures to medication. We examined the relationship between calls to poison centers regarding reported exposures to medications commonly used to treat ILI and weekly reports of ILI. The CDC reports ILI, by age group, for each of 10 Health and Human Services (HHS) regions. We examined NPDS summary data from calls reported to poison centers regarding reported exposures to acetaminophen, cough/cold medications, and promethazine, for the same weeks, age groups, and HHS regions for influenza seasons 2000-2013. ILI and NPDS exposures were examined using graphical plots, descriptive statistics, stepwise regression analysis, and Geographic Information Systems (GIS). About 5,101,841 influenza-like illness cases were reported to the CDC, and 2,122,940 calls regarding reported exposures to medications commonly used to treat ILI, were reported by poison centers to the NPDS over the 13 flu seasons. Analysis of stepwise models of the linear untransformed data involving 24 NPDS data groups and for 60 ILI measures, over the 13 influenza seasons, demonstrated that reported exposures to medications used to treat ILI correlated with reported cases of ILI with a median R(2 )=( )0.489 (min R(2 )=( )0.248, max R(2 )=( )0.717), with mean ± SD of R(2 )=( )0.494 ± 0.121. Median number of parameters used (degrees of freedom - 1) was 7. NPDS data regarding poison center calls for selected ILI medication exposures were highly correlated with CDC ILI data. Since NPDS data are available in real time, it provides complimentary ILI monitoring. This approach may provide public health value in predicting other illnesses which are not currently as thoroughly monitored.

Hospital CIO Explains Blockchain Potential: An Interview with Beth Israel Deaconess Medical Center's John Halamka.

Science.gov (United States)

Mertz, Leslie

2018-01-01

Work is already underway to bring blockchain technology to the healthcare industry, and hospital administrators are trying to figure out what it can do for them, their clinicians, and their patients. That includes administrators at Beth Israel Deaconess Medical Center, a leading academic medical center located in Boston.

A Study to Determine Patient Waiting Time at the Outpatient Pharmacy at Wilford Hall USAF Medical Center

Science.gov (United States)

1988-06-01

at Wilford Hall USAF Medical Center significantly reduced the patient wait time at the main outpatient pharmacy. Satellite pharmacies have been ).’l...PRESENTING TO WINDOW 1, 19 MAR 88. 47 C:. A’.’E-:A: -ESCRIRTIONS PER PATIENT ...........48 H. WILFORD HALL MEDICAL CENTER OUTPATIENT QUESTIONNAIRE...that wait times at tne outpatient pharmacy were excessive. It was this concern that motivated the Medical Center Administrator to request that patient

Development of a longitudinal integrated clerkship at an academic medical center

Directory of Open Access Journals (Sweden)

Ann Poncelet

2011-04-01

Full Text Available In 2005, medical educators at the University of California, San Francisco (UCSF, began developing the Parnassus Integrated Student Clinical Experiences (PISCES program, a year-long longitudinal integrated clerkship at its academic medical center. The principles guiding this new clerkship were continuity with faculty preceptors, patients, and peers; a developmentally progressive curriculum with an emphasis on interdisciplinary teaching; and exposure to undiagnosed illness in acute and chronic care settings. Innovative elements included quarterly student evaluation sessions with all preceptors together, peer-to-peer evaluation, and oversight advising with an assigned faculty member. PISCES launched with eight medical students for the 2007/2008 academic year and expanded to 15 students for 2008/2009. Compared to UCSF's traditional core clerkships, evaluations from PISCES indicated significantly higher student satisfaction with faculty teaching, formal didactics, direct observation of clinical skills, and feedback. Student performance on discipline-specific examinations and United States Medical Licensing Examination step 2 CK was equivalent to and on standardized patient examinations was slightly superior to that of traditional peers. Participants’ career interests ranged from primary care to surgical subspecialties. These results demonstrate that a longitudinal integrated clerkship can be implemented successfully at a tertiary care academic medical center.

Integration of pharmacists into a patient-centered medical home.

Science.gov (United States)

Scott, Mollie Ashe; Hitch, Bill; Ray, Lisa; Colvin, Gaye

2011-01-01

To define the joint principles of the patient-centered medical home (PCMH) and describe the integration of pharmacists into a PCMH. Family medicine residency training program in North Carolina from 2001 to 2011. Mountain Area Health Education Family Health Center is a family medicine residency training program that is part of the North Carolina Area Health Education Center system. The goal of the organization is to train and retain health care students and residents. The practice is recognized as a level III PCMH by the National Committee for Quality Assurance (NCQA) and seeks to provide quality, safe, patient-centered care according to the joint principles of PCMH. Pharmacists, nurses, nutritionists, care managers, Spanish translators, and behavioral medicine specialists work collaboratively with physicians to provide seamless, comprehensive care. The Department of Pharmacotherapy is embedded in the family medicine clinic. Three pharmacists and two pharmacy residents are involved in providing direct patient care services, ensuring access to community resources, assisting patients with transitions of care, providing interprofessional education, and participating in continuous quality improvement initiatives. The pharmacists serve as clinical pharmacist practitioners and provide medication therapy management services in a pharmacotherapy clinic, anticoagulation clinics, and an osteoporosis clinic and via an inpatient family medicine service. Multiple learners such as student pharmacists, pharmacy residents, and family medicine residents rotate through the various pharmacy clinics to learn about pharmacotherapeutic principles and the role of the pharmacist in PCMH. PCMH is a comprehensive, patient-centered, team-based approach to population management in the primary care setting. Pharmacists play a vital role in PCMH and make fundamental contributions to patient care across health care settings. Such innovations in the ambulatory care setting create a unique niche

Early Lessons on Bundled Payment at an Academic Medical Center.

Science.gov (United States)

Jubelt, Lindsay E; Goldfeld, Keith S; Blecker, Saul B; Chung, Wei-Yi; Bendo, John A; Bosco, Joseph A; Errico, Thomas J; Frempong-Boadu, Anthony K; Iorio, Richard; Slover, James D; Horwitz, Leora I

2017-09-01

Orthopaedic care is shifting to alternative payment models. We examined whether New York University Langone Medical Center achieved savings under the Centers for Medicare and Medicaid Services Bundled Payments for Care Improvement initiative. This study was a difference-in-differences study of Medicare fee-for-service patients hospitalized from April 2011 to June 2012 and October 2013 to December 2014 for lower extremity joint arthroplasty, cardiac valve procedures, or spine surgery (intervention groups), or for congestive heart failure, major bowel procedures, medical peripheral vascular disorders, medical noninfectious orthopaedic care, or stroke (control group). We examined total episode costs and costs by service category. We included 2,940 intervention episodes and 1,474 control episodes. Relative to the trend in the control group, lower extremity joint arthroplasty episodes achieved the greatest savings: adjusted average episode cost during the intervention period decreased by $3,017 (95% confidence interval [CI], -$6,066 to $31). For cardiac procedures, the adjusted average episode cost decreased by $2,999 (95% CI, -$8,103 to $2,105), and for spinal fusion, it increased by $8,291 (95% CI, $2,879 to $13,703). Savings were driven predominantly by shifting postdischarge care from inpatient rehabilitation facilities to home. Spinal fusion index admission costs increased because of changes in surgical technique. Under bundled payment, New York University Langone Medical Center decreased total episode costs in patients undergoing lower extremity joint arthroplasty. For patients undergoing cardiac valve procedures, evidence of savings was not as strong, and for patients undergoing spinal fusion, total episode costs increased. For all three conditions, the proportion of patients referred to inpatient rehabilitation facilities upon discharge decreased. These changes were not associated with an increase in index hospital length of stay or readmission rate

Ethical acceptability of offering financial incentives for taking antipsychotic depot medication: Patients' and clinicians' perspectives after a 12-month randomized controlled trial

NARCIS (Netherlands)

E.L. Noordraven (Ernst); M.H.N. Schermer (Maartje); P. Blanken (Peter); C.L. Mulder (Niels); A.I. Wierdsma (André)

2017-01-01

textabstractBackground: A randomized controlled trial 'Money for Medication'(M4M) was conducted in which patients were offered financial incentives for taking antipsychotic depot medication. This study assessed the attitudes and ethical considerations of patients and clinicians who participated in

Dealing With Deans and Academic Medical Center Leadership: Advice From Leaders.

Science.gov (United States)

Sanfilippo, Fred; Powell, Deborah; Folberg, Robert; Tykocinski, Mark

2018-01-01

The 2017 Association of Pathology Chairs Annual Meeting included a session for department chairs and other department leaders on "how to deal with deans and academic medical center leadership." The session was focused on discussing ways to foster positive relationships with university, medical school, and health system leaders, and productively address issues and opportunities with them. Presentations and a panel discussion were provided by 4 former pathology chairs who subsequently have served as medical deans and in other leadership positions including university provost, medical center CEO, and health system board chair. There was a strong consensus among the participants on how best to deal with superiors about problems, conflicts, and requests for additional resources and authority. The importance of teamwork and accountability in developing a constructive and collaborative relationship with leaders and peers was discussed in detail. Effectiveness in communication, negotiation, and departmental advocacy were highlighted as important skills. As limited resources and increased regulations have become growing problems for universities and health systems, internal stress and competition have increased. In this rapidly changing environment, advice on how chairs can interact most productively with institutional leaders is becoming increasingly important.

Call centers with a postponed callback offer

NARCIS (Netherlands)

B. Legros (Benjamin); S. Ding (Sihan); R.D. van der Mei (Rob); O. Jouini (Oualid)

2017-01-01

textabstractWe study a call center model with a postponed callback option. A customer at the head of the queue whose elapsed waiting time achieves a given threshold receives a voice message mentioning the option to be called back later. This callback option differs from the traditional ones found in

Physician Payment Methods and the Patient-Centered Medical Home: Comment on "A Troubled Asset Relief Program for the Patient-Centered Medical Home".

Science.gov (United States)

Quinn, Kevin

This commentary analyzes the patient-centered medical home (PCMH) model within a framework of the 8 basic payment methods in health care. PCMHs are firmly within the fee-for-service tradition. Changes to the process and structure of the Resource Based Relative Value Scale, which underlies almost all physician fee schedules, could make PCMHs more financially viable. Of the alternative payment methods being considered, shared savings models are unlikely to transform medical practice whereas capitation models place unrealistic expectations on providers to accept epidemiological risk. Episode payment may strike a feasible balance for PCMHs, with newly available episode definitions presenting opportunities not previously available.

Home medication support for childhood cancer: family-centered design and testing.

Science.gov (United States)

Walsh, Kathleen E; Biggins, Colleen; Blasko, Deb; Christiansen, Steven M; Fischer, Shira H; Keuker, Christopher; Klugman, Robert; Mazor, Kathleen M

2014-11-01

Errors in the use of medications at home by children with cancer are common, and interventions to support correct use are needed. We sought to (1) engage stakeholders in the design and development of an intervention to prevent errors in home medication use, and (2) evaluate the acceptability and usefulness of the intervention. We convened a multidisciplinary team of parents, clinicians, technology experts, and researchers to develop an intervention using a two-step user-centered design process. First, parents and oncologists provided input on the design. Second, a parent panel and two oncology nurses refined draft materials. In a feasibility study, we used questionnaires to assess usefulness and acceptability. Medication error rates were assessed via monthly telephone interviews with parents. We successfully partnered with parents, clinicians, and IT experts to develop Home Medication Support (HoMeS), a family-centered Web-based intervention. HoMeS includes a medication calendar with decision support, a communication tool, adverse effect information, a metric conversion chart, and other information. The 15 families in the feasibility study gave HoMeS high ratings for acceptability and usefulness. Half recorded information on the calendar to indicate to other caregivers that doses were given; 34% brought it to the clinic to communicate with their clinician about home medication use. There was no change in the rate of medication errors in this feasibility study. We created and tested a stakeholder-designed, Web-based intervention to support home chemotherapy use, which parents rated highly. This tool may prevent serious medication errors in a larger study. Copyright © 2014 by American Society of Clinical Oncology.

Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach.

Science.gov (United States)

McCoy, Lise; Pettit, Robin K; Kellar, Charlyn; Morgan, Christine

2018-01-01

Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions. Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction. Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component. The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction.

Results of an Institutional LGBT Climate Survey at an Academic Medical Center.

Science.gov (United States)

Chester, Sean D; Ehrenfeld, Jesse M; Eckstrand, Kristen L

2014-12-01

The purpose of this study was to characterize the climate and culture experienced by lesbian, gay, bisexual, and transgender (LGBT) employees and students at one large academic medical center. An anonymous, online institutional climate survey was used to assess the attitudes and experiences of LGBT employees and students. There were 42 LGBT and 14 non-LGBT survey participants. Results revealed that a surprisingly large percentage of LGBT individuals experienced pressure to remain "closeted" and were harassed despite medical center policies of non-discrimination. Continuing training, inclusive policies and practices, and the development of mechanisms to address LGBT-specific harassment are necessary for improving institutional climate.

Meeting changing conditoins at the Rhode Island Medical Center cogeneration plant

International Nuclear Information System (INIS)

Galamaga, D.P.; Bowen, P.T.

1993-01-01

The Rhode Island Department of Mental Health, Retardation and Hospitals is one state department in Rhode Island whose basic function is to provide services to seriously disabled individuals throughout the state. Savings in operating expenses from the Rhode Island Medical Center Central Power Plant have accruded to provide operating funds for the major programs. Operating under a Director who reports to the Governor of Rhode Island, the Department has three major divisions, approximately 2500 employees, and a budget of 200 million dollars. Its operations extend throughout the state and the major focus for hospital or institutional levels of care reside in three major locations, the Dr. U.E. Zambarano Memorial Hospital in northern Rhode Island, the Dr. Joseph Ladd Center in southern Rhode Island, and the Rhode Island Medical Center in the middle of the state. Besides these institution-based operations, the Department sponsors a wide range of rehabilitative programming in the community other through direct operations of facilities such as group homes or through contracts with private non-profit providers of service

Tracking Active Learning in the Medical School Curriculum: A Learning-Centered Approach

Science.gov (United States)

McCoy, Lise; Pettit, Robin K; Kellar, Charlyn; Morgan, Christine

2018-01-01

Background: Medical education is moving toward active learning during large group lecture sessions. This study investigated the saturation and breadth of active learning techniques implemented in first year medical school large group sessions. Methods: Data collection involved retrospective curriculum review and semistructured interviews with 20 faculty. The authors piloted a taxonomy of active learning techniques and mapped learning techniques to attributes of learning-centered instruction. Results: Faculty implemented 25 different active learning techniques over the course of 9 first year courses. Of 646 hours of large group instruction, 476 (74%) involved at least 1 active learning component. Conclusions: The frequency and variety of active learning components integrated throughout the year 1 curriculum reflect faculty familiarity with active learning methods and their support of an active learning culture. This project has sparked reflection on teaching practices and facilitated an evolution from teacher-centered to learning-centered instruction. PMID:29707649

Offers

CERN Multimedia

Staff Association

2013-01-01

FUTUREKIDS proposes 15% discount for the Staff Association members who enroll their children in FUTUREKIDS activities. New workshop for 12-15 year olds, on how to develop applications for Android phones. Easter activities calendar Extracurricular Activities For Your Children The FUTUREKIDS Geneva Learning Center is open 6 days a week and offers a selection of after-school extracurricular activities for children and teenagers (ages 5 to 16). In addition to teaching in its Learning Centers, Futurekids collaborates with many private schools in Suisse Romande (Florimont, Moser, Champittet, Ecole Nouvelle, etc.) and with the Département de l'Instruction Publique (DIP) Genève. Courses and camps are usually in French but English groups can be set up on demand. FUTUREKIDS Computer Camps (during school holidays) FUTUREKIDS Computer Camps are a way of having a great time during vacations while learning something useful, possibly discovering a new hobby or even, why not, a fut...

A User-Centered Cooperative Information System for Medical Imaging Diagnosis.

Science.gov (United States)

Gomez, Enrique J.; Quiles, Jose A.; Sanz, Marcos F.; del Pozo, Francisco

1998-01-01

Presents a cooperative information system for remote medical imaging diagnosis. General computer-supported cooperative work (CSCW) problems addressed are definition of a procedure for the design of user-centered cooperative systems (conceptual level); and improvement of user feedback and optimization of the communication bandwidth in highly…

The financial management of research centers and institutes at U.S. medical schools: findings from six institutions.

Science.gov (United States)

Mallon, William T

2006-06-01

To explore three questions surrounding the financial management of research centers and institutes at U.S. medical schools: How do medical schools allocate institutional funds to centers and institutes? How and by whom are those decisions made? What are the implications of these decision-making models on the future of the academic biomedical research enterprise? Using a qualitative research design, the author and associates interviewed over 150 faculty members and administrators at six medical schools and their parent universities in 2004. Interview data were transcribed, coded, and analyzed using a grounded theory approach. This methodology generated rich descriptions and explanations of the six medical schools, which can produce extrapolations to, but not necessarily generalizable findings to, other institutions and settings. An examination of four dimensions of financial decision-making-funding timing, process, structure, and culture-produces two essential models of how medical schools approach the financial management of research centers. In the first, a "charity" model, center directors make hat-in-hand appeals directly to the dean, the result of which may depend on individual negotiation skills and personal relationships. In the second, a "planned-giving" model, the process for obtaining and renewing funds is institutionalized, agreed upon, and monitored. The ways in which deans, administrators, department chairs, and center directors attend to, decide upon, and carry out financial decisions can influence how people throughout the medical school think about interdisciplinary and collaborative activities marshalled though centers and institutes.

Satellite medical centers project

Science.gov (United States)

Aggarwal, Arvind

2002-08-01

World class health care for common man at low affordable cost: anywhere, anytime The project envisages to set up a national network of satellite Medical centers. Each SMC would be manned by doctors, nurses and technicians, six doctors, six nurses, six technicians would be required to provide 24 hour cover, each SMC would operate 24 hours x 7 days. It would be equipped with the Digital telemedicine devices for capturing clinical patient information and investigations in the form of voice, images and data and create an audiovisual text file - a virtual Digital patient. Through the broad band connectivity the virtual patient can be sent to the central hub, manned by specialists, specialists from several specialists sitting together can view the virtual patient and provide a specialized opinion, they can see the virtual patient, see the examination on line through video conference or even PCs, talk to the patient and the doctor at the SMC and controlle capturing of information during examination and investigations of the patient at the SMC - thus creating a virtual Digital consultant at the SMC. Central hub shall be connected to the doctors and consultants in remote locations or tertiary care hospitals any where in the world, thus creating a virtual hub the hierarchical system shall provide upgradation of knowledge to thedoctors in central hub and smc and thus continued medical education and benefit the patient thru the world class treatment in the smc located at his door step. SMC shall be set up by franchisee who shall get safe business opportunity with high returns, patients shall get Low cost user friendly worldclass health care anywhere anytime, Doctors can get better meaningful selfemplyment with better earnings, flexibility of working time and place. SMC shall provide a wide variety of services from primary care to world class Global consultation for difficult patients.

Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations.

Science.gov (United States)

Kraus, Sarah K; Sen, Sanchita; Murphy, Michelle; Pontiggia, Laura

2017-01-01

To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR) program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations. A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05. Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%), non-formulary omission (16.2%), dose discrepancy (10.1%), and frequency discrepancy (4.1%). Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours. A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations.

Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations

Directory of Open Access Journals (Sweden)

Kraus SK

2017-06-01

Full Text Available Objectives: To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations. Methods: A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05. Results: Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%, non-formulary omission (16.2%, dose discrepancy (10.1%, and frequency discrepancy (4.1%. Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours. Conclusion: A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations.

An Architecture for Continuous Data Quality Monitoring in Medical Centers.

Science.gov (United States)

Endler, Gregor; Schwab, Peter K; Wahl, Andreas M; Tenschert, Johannes; Lenz, Richard

2015-01-01

In the medical domain, data quality is very important. Since requirements and data change frequently, continuous and sustainable monitoring and improvement of data quality is necessary. Working together with managers of medical centers, we developed an architecture for a data quality monitoring system. The architecture enables domain experts to adapt the system during runtime to match their specifications using a built-in rule system. It also allows arbitrarily complex analyses to be integrated into the monitoring cycle. We evaluate our architecture by matching its components to the well-known data quality methodology TDQM.

Patient-Centered Medical Home Exposure and Its Impact on PA Career Intentions.

Science.gov (United States)

Kayingo, Gerald; Gilani, Owais; Kidd, Vasco Deon; Warner, Mary L

2016-10-01

The transformation of primary care (PC) training sites into patient-centered medical homes (PCMH) has implications for the education of health professionals. This study investigates the extent to which physician assistant (PA) students report learning about the PCMH model and how clinical exposure to PCMH might impact their interest in a primary care career. An electronic survey was distributed to second-year PA students who had recently completed their PC rotation from 12 PA programs. Descriptive statistics and ordered logistic regression analyses were used to characterize the results. A total of 202 second-year PA students completed the survey. When asked about their knowledge of the new health care delivery models, 30% of the students responded they had received instruction about the PCMH. Twenty- five percent of respondents stated they were oriented to new payment structures proposed in the Affordable Care Act and quality improvement principles. Based on their experiences in the primary care clerkship, 64% stated they were likely to pursue a career in primary care, 13% were not likely, and 23% were unsure. Predictors of interest in a primary care career included: (1) age greater than 35 years, (2) being a recipient of a NHSC scholarship, (3) clerkship site setting in an urban cluster of 2,500 to 50,000 people, (4) number of PCMH elements offered at site, and (4) positive impression of team-based care. PA students lack adequate instruction related to the new health care delivery models. Students whose clerkship sites offered greater number of PCMH elements were more interested in pursuing a career in primary care.

The economic impact and multiplier effect of a family practice clinic on an academic medical center.

Science.gov (United States)

Schneeweiss, R; Ellsbury, K; Hart, L G; Geyman, J P

1989-07-21

Academic medical centers are facing the need to expand their primary care referral base in an increasingly competitive medical environment. This study describes the medical care provided during a 1-year period to 6304 patients registered with a family practice clinic located in an academic medical center. The relative distribution of primary care, secondary referrals, inpatient admissions, and their associated costs are presented. The multiplier effect of the primary care clinic on the academic medical center was substantial. For every $1 billed for ambulatory primary care, there was $6.40 billed elsewhere in the system. Each full-time equivalent family physician generated a calculated sum of $784,752 in direct, billed charges for the hospital and $241,276 in professional fees for the other specialty consultants. The cost of supporting a primary care clinic is likely to be more than offset by the revenues generated from the use of hospital and referral services by patients who received care in the primary care setting.

Promoting cancer screening within the patient centered medical home.

Science.gov (United States)

Sarfaty, Mona; Wender, Richard; Smith, Robert

2011-01-01

While consensus has grown that primary care is the essential access point in a high-performing health care system, the current model of primary care underperforms in both chronic disease management and prevention. The Patient Centered Medical Home model (PCMH) is at the center of efforts to reinvent primary care practice, and is regarded as the most promising approach to addressing the burden of chronic disease, improving health outcomes, and reducing health spending. However, the potential for the medical home to improve the delivery of cancer screening (and preventive services in general) has received limited attention in both conceptualization and practice. Medical home demonstrations to date have included few evidence-based preventive services in their outcome measures, and few have evaluated the effect of different payment models. Decreasing use of hospitals and emergency rooms and an emphasis on improving chronic care represent improvements in effective delivery of healthcare, but leave opportunities for reducing the burden of cancer untouched. Data confirm that what does or does not happen in the primary care setting has a substantial impact on cancer outcomes. Insofar as cancer is the leading cause of death before age 80, the PCMH model must prioritize adherence to cancer screening according to recommended guidelines, and systems, financial incentives, and reimbursements must be aligned to achieve that goal. This article explores capacities that are needed in the medical home model to facilitate the integration of cancer screening and other preventive services. These capacities include improved patient access and communication, health risk assessments, periodic preventive health exams, use of registries that store cancer risk information and screening history, ability to track and follow up on tests and referrals, feedback on performance, and payment models that reward cancer screening. Copyright © 2011 American Cancer Society, Inc.

Towards a person-centered medical education: challenges and imperatives (I

Directory of Open Access Journals (Sweden)

Andrew Miles

2015-01-01

Full Text Available It is increasingly claimed that modern medicine has entered into crisis —a crisis of knowledge (uncertainty over what counts as “evidence” for decision-making and what does not, care (a deficit in sympathy, empathy, compassion, dignity, autonomy, patient safety (neglect, iatrogenic injury, malpractice, excess deaths, economic costs (which threaten to bankrupt health systems worldwide and clinical and institutional governance (a failure of basic and advanced management, inspirational and transformational leadership. We believe such a contention to be essentially correct. In the current article, we ask how the delineated components of the crisis can be individually understood in order to allow them to be collectively addressed. We ask how a transition can be effected away from impersonal, decontextualized and fragmented services in the direction of newer models of service provision that are personalized, contextualized and integrated. How, we ask, can we improve healthcare outcomes while simultaneously containing or lowering their costs? In initial answer to such questions —which are of considerable political as well as clinical significance— we assert that a new approach has become necessary, particularly in the context of the current epidemic of multi-morbid and socially complex long term illness. This new approach, we argue, is represented by the development and application of the concepts and methods of person-centered healthcare (PCH, a philosophy and technique in the care of the sick that enables clinicians and health systems to re-introduce humanistic ideals into clinical practice alongside continuing scientific advance, thereby restoring to medicine the humanism it has lost in over a century of empiricism. But the delivery of a person-centered healthcare within health systems requires a person-centered education and training. In this article we consider, then, why person-centered teaching innovations in the undergraduate medical

Campus Health Centers' Lack of Information Regarding Providers: A Content Analysis of Division-I Campus Health Centers' Provider Websites.

Science.gov (United States)

Perrault, Evan K

2018-07-01

Campus health centers are a convenient, and usually affordable, location for college students to obtain health care. Staffed by licensed and trained professionals, these providers can generally offer similar levels of care that providers at off-campus clinics can deliver. Yet, previous research finds students may forgo this convenient, on-campus option partially because of a lack of knowledge regarding the quality of providers at these campus clinics. This study sought to examine where this information deficit may come from by analyzing campus health centers' online provider information. All Division-I colleges or universities with an on-campus health center, which had information on their websites about their providers (n = 294), had their providers' online information analyzed (n = 2,127 providers). Results revealed that schools commonly offer professional information (e.g., provider specialties, education), but very little about their providers outside of the medical context (e.g., hobbies) that would allow a prospective student patient to more easily relate. While 181 different kinds of credentials were provided next to providers' names (e.g., MD, PA-C, FNP-BC), only nine schools offered information to help students understand what these different credentials meant. Most schools had information about their providers within one-click of the homepage. Recommendations for improving online information about campus health center providers are offered.

Joint principles: Integrating behavioral health care into the patient-centered medical home.

Science.gov (United States)

2014-06-01

The Patient-centered Medical Home (PCMH) is an innovative, improved, and evolving approach to providing primary care that has gained broad acceptance in the United States. The Joint Principles of the PCMH, formulated and endorsed in February 2007, are sound and describe the ideal toward which we aspire. However, there is an element running implicitly through these joint principles that is difficult to achieve yet indispensable to the success of the entire PCMH concept. The incorporation of behavioral health care has not always been included as practices transform to accommodate to the PCMH ideals. This is an alarming development because the PCMH will be incomplete and ineffective without the full incorporation of this element, and retrofitting will be much more difficult than prospectively integrating into the original design of the PCMH. Therefore we offer a complementary set of joint principles that recognizes the centrality of behavioral health care as part of the PCMH. This document follows the order and language of the original joint principles while emphasizing what needs to be addressed to insure incorporation of the essential behavioral elements. It is intended to supplement and not replace the original Joint Principles document, which still stands.

Michigan's Physician Group Incentive Program offers a regional model for incremental 'fee for value' payment reform.

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Share, David A; Mason, Margaret H

2012-09-01

Blue Cross Blue Shield of Michigan partnered with providers across the state to create an innovative, "fee for value" physician incentive program that would deliver high-quality, efficient care. The Physician Group Incentive Program rewards physician organizations-formal groups of physicians and practices that can accept incentive payments on behalf of their members-based on the number of quality and utilization measures they adopt, such as generic drug dispensing rates, and on their performance on these measures across their patient populations. Physicians also receive payments for implementing a range of patient-centered medical home capabilities, such as patient registries, and they receive higher fees for office visits for incorporating these capabilities into routine practice while also improving performance. Taken together, the incentive dollars, fee increases, and care management payments amount to a potential increase in reimbursement of 40 percent or more from Blue Cross Blue Shield of Michigan for practices designated as high-performing patient-centered medical homes. At the same time, we estimate that implementing the patient-centered medical home capabilities was associated with $155 million in lower medical costs in program year 2011 for Blue Cross Blue Shield of Michigan members. We intend to devote a higher percentage of reimbursement over time to communities of caregivers that offer high-value, system-based care, and a lower percentage of reimbursement to individual physicians on a service-specific basis.

Selection and construction of nuclear and radiation emergency medical center in a region

International Nuclear Information System (INIS)

Wang Guojun; He Xu; Liao Li; Gao Dong

2014-01-01

Three level of first-class comprehensive hospital is an important force of nuclear and radiation accident rescue, has a very rich experience in response to nuclear and radiation accidents and deal with large quantities of the sick and wounded. With the foundation and the ability of the construction and operation of medical emergency rescue center. This paper according to the median model location theory of emergency center, combined with the specific situation of the nuclear and radiation accident in Hunan Province, reference location, rescue experience, emergency allocation of resources, teaching and research capacity, establish regional medical emergency center of nuclear and radiation accidents based on three level of first-class comprehensive hospital, break the traditional concept that the center must be provincial capital,form a multi-level, three-dimensional, network of emergency hospital rescue system. The main duties of the center are accident emergency response, on-site treatment and technical guidance of accident, psychological grooming. The author propose building measures according to the duties of the center: increase national and provincial financial investment, carry out training, drills and first aid knowledge missionaries regularly, innovative materials management, speed up the construction of information platform, establish and improve the hospital rescue system, improve organization institution and system of plans, reengineering rescue process. (authors)

Cost-Benefit Analysis of Radiation Therapy Services at Tripler Army Medical Center

National Research Council Canada - National Science Library

Diehl, Diane S

2004-01-01

The purpose of this analysis was to examine the costs and benefits associated with continuance of "in-house" radiation therapy services to eligible beneficiaries at Tripler Army Medical Center (TAMC...

Key Elements of Clinical Physician Leadership at an Academic Medical Center

Science.gov (United States)

Dine, C. Jessica; Kahn, Jeremy M; Abella, Benjamin S; Asch, David A; Shea, Judy A

2011-01-01

Background A considerable body of literature in the management sciences has defined leadership and how leadership skills can be attained. There is considerably less literature about leadership within medical settings. Physicians-in-training are frequently placed in leadership positions ranging from running a clinical team or overseeing a resuscitation effort. However, physicians-in-training rarely receive such training. The objective of this study was to discover characteristics associated with effective physician leadership at an academic medical center for future development of such training. Methods We conducted focus groups with medical professionals (attending physicians, residents, and nurses) at an academic medical center. The focus group discussion script was designed to elicit participants' perceptions of qualities necessary for physician leadership. The lead question asked participants to imagine a scenario in which they either acted as or observed a physician leader. Two independent reviewers reviewed transcripts to identify key domains of physician leadership. Results Although the context was not specified, the focus group participants discussed leadership in the context of a clinical team. They identified 4 important themes: management of the team, establishing a vision, communication, and personal attributes. Conclusions Physician leadership exists in clinical settings. This study highlights the elements essential to that leadership. Understanding the physician attributes and behaviors that result in effective leadership and teamwork can lay the groundwork for more formal leadership education for physicians-in-training. PMID:22379520

Target marketing for the hospital-based wellness center.

Science.gov (United States)

Cangelosi, J D

1997-01-01

The American population is aging, medical technology is advancing, and life expectancies are on the rise. At the same time hospitals are looking for additional sources of income due to the pressures of government regulations and managed care. One of the options for hospitals looking for additional sources of income is the hospital-based but free-standing comprehensive wellness and fitness center. Such centers go beyond the facilities, programs and services offered by traditional health and fitness centers. In addition to physical fitness programs, hospital-based wellness centers offer programs in CPR, nutrition, weight control and many other programs of interest to an aging but active American populace. This research documents the hospital industry, wellness industry and the prospects of success or failure for he hospital attempting such a venture. The focus of the research is the experience of a particular hospital with regard to the programs, facilities and services deemed most important by its target market.

New trends in medical and service robots human centered analysis, control and design

CERN Document Server

Chevallereau, Christine; Pisla, Doina; Bleuler, Hannes; Rodić, Aleksandar

2016-01-01

Medical and service robotics integrates several disciplines and technologies such as mechanisms, mechatronics, biomechanics, humanoid robotics, exoskeletons, and anthropomorphic hands. This book presents the most recent advances in medical and service robotics, with a stress on human aspects. It collects the selected peer-reviewed papers of the Fourth International Workshop on Medical and Service Robots, held in Nantes, France in 2015, covering topics on: exoskeletons, anthropomorphic hands, therapeutic robots and rehabilitation, cognitive robots, humanoid and service robots, assistive robots and elderly assistance, surgical robots, human-robot interfaces, BMI and BCI, haptic devices and design for medical and assistive robotics. This book offers a valuable addition to existing literature.

Gender Disparities in Faculty Rank: Factors that Affect Advancement of Women Scientists at Academic Medical Centers

Directory of Open Access Journals (Sweden)

Cristina M. López

2018-04-01

Full Text Available While a significant portion of women within academic science are employed within medical schools, women faculty in these academic medical centers are disproportionately represented in lower faculty ranks. The medical school setting is a critical case for both understanding and advancing women in basic sciences. This study highlights the findings from focus groups conducted with women faculty across Assistant, Associate, and Full Professor ranks (n = 35 in which they discussed barriers and facilitators for advancement of women basic scientists at an academic medical center. Qualitative analysis demonstrated several emergent themes that affect women’s advancement, including gendered expectation norms (e.g., good citizenship, volunteerism, work-life balance, mentorship/sponsorship, adoption of a team science approach, tenure process milestones, soft money research infrastructure, institution specific policies (or lack thereof, and operating within an MD-biased culture. These findings are compared with the extant literature of women scientists in STEM institutions. Factors that emerged from these focus groups highlight the need for evidence-based interventions in the often overlooked STEM arena of academic medical centers.

38 CFR 17.351 - Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center.

Science.gov (United States)

2010-07-01

... replacement and upgrading of equipment at Veterans Memorial Medical Center. 17.351 Section 17.351 Pensions... Philippines § 17.351 Grants for the replacement and upgrading of equipment at Veterans Memorial Medical Center. Grants to assist the Republic of the Philippines in the replacement and upgrading of equipment and in...

Community-based participatory research and user-centered design in a diabetes medication information and decision tool.

Science.gov (United States)

Henderson, Vida A; Barr, Kathryn L; An, Lawrence C; Guajardo, Claudia; Newhouse, William; Mase, Rebecca; Heisler, Michele

2013-01-01

Together, community-based participatory research (CBPR), user-centered design (UCD), and health information technology (HIT) offer promising approaches to improve health disparities in low-resource settings. This article describes the application of CBPR and UCD principles to the development of iDecide/Decido, an interactive, tailored, web-based diabetes medication education and decision support tool delivered by community health workers (CHWs) to African American and Latino participants with diabetes in Southwest and Eastside Detroit. The decision aid is offered in English or Spanish and is delivered on an iPad in participants' homes. The overlapping principles of CBPR and UCD used to develop iDecide/Decido include a user-focused or community approach, equitable academic and community partnership in all study phases, an iterative development process that relies on input from all stakeholders, and a program experience that is specified, adapted, and implemented with the target community. Collaboration between community members, researchers, and developers is especially evident in the program's design concept, animations, pictographs, issue cards, goal setting, tailoring, and additional CHW tools. The principles of CBPR and UCD can be successfully applied in developing health information tools that are easy to use and understand, interactive, and target health disparities.

Turnkey offering a claimed sector 'first'.

Science.gov (United States)

Law, Oliver

2011-01-01

Manufacturer and supplier of LED theatre lights, HD camera systems, video integration technologies, and ceiling support units, Trumpf Medical Systems UK, and "logistical services" company Canute International Medical Services (CIMS), one of whose specialities is providing mobile medical units for diagnostic imaging, have entered into a partnership that will see the two companies offer fully fitted out modular operating theatres and other medical/clinical buildings incorporating the latest technology and equipment, on a fully project-managed, "turnkey" basis. Oliver Law, Trumpf Medical Systems UK managing director, explains the background, and the new service's anticipated customer benefits.

Quantitative Analysis of Contributing Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center

Science.gov (United States)

2008-06-06

Predictors of patient satisfaction for Brooke Army Medical Center Family Medicine Service primary care clinics was performed. Data was obtained from...Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center Presented to MAJ Eric Schmacker, Ph.D. In...study. All patients ’ medical information was protected at all times and under no circumstances will be discussed or released to any outside agency

[HIGH VELOCITY PENETRATING HEAD AND NECK INJURIES OF SYRIAN CIVIL WAR CASUALTIES TREATED IN THE GALILEE MEDICAL CENTER].

Science.gov (United States)

Ronen, Ohad; Assadi, Nidal; Sela, Eyal

2017-05-01

For two years the State of Israel has been treating casualties from the Syrian civil war. The Galilee Medical Center in Nahariya is the main hospital for this humanitarian mission. Objectives: To evaluate the demographic and clinical characteristics of the casualties that were treated in our department. Information from medical records of all Syrian casualties evacuated to the Galilee Medical Center were evaluated. Between March 2013 and December 2014, 450 casualties were evacuated to the Galilee Medical Center. Of those, 45 were treated in the Department of Otolaryngology - Head and Neck Surgery. Of the 45 cases, 43 were male (95.5%) and the mean age was 30.4 years (range 1-79 years). There was a significant difference in terms of gender (p Syria, and 12 died. Of all Syrian injured treated in the ENT department, the vast majority were young men. The main cause of injury was gunshot wounds. It is likely that the lack of protective gear that exist in western armies is a factor in the complex injuries treated at the Galilee Medical Center.

A 5-year scientometric analysis of research centers affiliated to Tehran University of Medical Sciences

Science.gov (United States)

Yazdani, Kamran; Rahimi-Movaghar, Afarin; Nedjat, Saharnaz; Ghalichi, Leila; Khalili, Malahat

2015-01-01

Background: Since Tehran University of Medical Sciences (TUMS) has the oldest and highest number of research centers among all Iranian medical universities, this study was conducted to evaluate scientific output of research centers affiliated to Tehran University of Medical Sciences (TUMS) using scientometric indices and the affecting factors. Moreover, a number of scientometric indicators were introduced. Methods: This cross-sectional study was performed to evaluate a 5-year scientific performance of research centers of TUMS. Data were collected through questionnaires, annual evaluation reports of the Ministry of Health, and also from Scopus database. We used appropriate measures of central tendency and variation for descriptive analyses. Moreover, uni-and multi-variable linear regression were used to evaluate the effect of independent factors on the scientific output of the centers. Results: The medians of the numbers of papers and books during a 5-year period were 150.5 and 2.5 respectively. The median of the "articles per researcher" was 19.1. Based on multiple linear regression, younger age centers (p=0.001), having a separate budget line (p=0.016), and number of research personnel (p<0.001) had a direct significant correlation with the number of articles while real properties had a reverse significant correlation with it (p=0.004). Conclusion: The results can help policy makers and research managers to allocate sufficient resources to improve current situation of the centers. Newly adopted and effective scientometric indices are is suggested to be used to evaluate scientific outputs and functions of these centers. PMID:26157724

The Institute for Safe Medication Practices and Poison Control Centers: Collaborating to Prevent Medication Errors and Unintentional Poisonings.

Science.gov (United States)

Vaida, Allen J

2015-06-01

This article provides an overview on the Institute for Safe Medication Practices (ISMP), the only independent nonprofit organization in the USA devoted to the prevention of medication errors. ISMP developed the national Medication Errors Reporting Program (MERP) and investigates and analyzes errors in order to formulate recommendations to prevent further occurrences. ISMP works closely with the US Food and Drug Administration (FDA), drug manufacturers, professional organizations, and others to promote changes in package design, practice standards, and healthcare practitioner and consumer education. By collaborating with ISMP to share and disseminate information, Poison Control centers, emergency departments, and toxicologists can help decrease unintentional and accidental poisonings.

Patient-centered medical homes in Louisiana had minimal impact on Medicaid population's use of acute care and costs.

Science.gov (United States)

Cole, Evan S; Campbell, Claudia; Diana, Mark L; Webber, Larry; Culbertson, Richard

2015-01-01

The patient-centered medical home model of primary care has received considerable attention for its potential to improve outcomes and reduce health care costs. Yet little information exists about the model's ability to achieve these goals for Medicaid patients. We sought to evaluate the effect of patient-centered medical home certification of Louisiana primary care clinics on the quality and cost of care over time for a Medicaid population. We used a quasi-experimental pre-post design with a matched control group to assess the effect of medical home certification on outcomes. We found no impact on acute care use and modest support for reduced costs and primary care use among medical homes serving higher proportions of chronically ill patients. These findings provide preliminary results related to the ability of the patient-centered medical home model to improve outcomes for Medicaid beneficiaries. The findings support a case-mix-adjusted payment policy for medical homes going forward. Project HOPE—The People-to-People Health Foundation, Inc.

76 FR 59407 - Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and...

Science.gov (United States)

2011-09-26

...] Center for Biologics Evaluation and Research Report of Scientific and Medical Literature and Information... Administration (FDA) is announcing the availability of its report of scientific and medical literature and... Research Report of Scientific and Medical Literature and Information on Non-Standardized Allergenic...

Activities of an ethics consultation service in a Tertiary Military Medical Center.

Science.gov (United States)

Waisel, D B; Vanscoy, S E; Tice, L H; Bulger, K L; Schmelz, J O; Perucca, P J

2000-07-01

The Joint Commission on Accreditation of Healthcare Organizations requires hospitals to have a mechanism to address issues of medical ethics. Most hospitals, especially those in the military, have an ethics committee composed solely of members who serve as an additional duty. To enhance the ethics consultation service, the 59th Medical Wing created a position under the chief of the medical staff for a full-time, fellowship-trained, medical ethicist. After establishment of this position, the number of consultations increased, a systematic program for caregiver education was developed and delivered, and an organizational presence was achieved by instituting positions on the institutional review board, the executive committee of the medical staff, and the credentials committee. Issues in medical care are becoming increasingly complicated, due in large part to financial stresses and technological advancements. Ethics consultation can help prevent and resolve many of these problems. This report discusses the activities of the first year of a full-time ethicist in a tertiary military medical center.

Academic medical centers as innovation ecosystems to address population -omics challenges in precision medicine.

Science.gov (United States)

Silva, Patrick J; Schaibley, Valerie M; Ramos, Kenneth S

2018-02-15

While the promise of the Human Genome Project provided significant insights into the structure of the human genome, the complexities of disease at the individual level have made it difficult to utilize -omic information in clinical decision making. Some of the existing constraints have been minimized by technological advancements that have reduced the cost of sequencing to a rate far in excess of Moore's Law (a halving in cost per unit output every 18 months). The reduction in sequencing costs has made it economically feasible to create large data commons capturing the diversity of disease across populations. Until recently, these data have primarily been consumed in clinical research, but now increasingly being considered in clinical decision- making. Such advances are disrupting common diagnostic business models around which academic medical centers (AMCs) and molecular diagnostic companies have collaborated over the last decade. Proprietary biomarkers and patents on proprietary diagnostic content are no longer driving biomarker collaborations between industry and AMCs. Increasingly the scope of the data commons and biorepositories that AMCs can assemble through a nexus of academic and pharma collaborations is driving a virtuous cycle of precision medicine capabilities that make an AMC relevant and highly competitive. A rebalancing of proprietary strategies and open innovation strategies is warranted to enable institutional precision medicine asset portfolios. The scope of the AMC's clinical trial and research collaboration portfolios with industry are increasingly dependent on the currency of data, and less on patents. Intrapeneurial support of internal service offerings, clinical trials and clinical laboratory services for example, will be important new points of emphasis at the academic-industry interface. Streamlining these new models of industry collaboration for AMCs are a new area for technology transfer offices to offer partnerships and to add value

Burnout among nurses working in medical and educational centers in Shahrekord, Iran

Science.gov (United States)

Moghaddasi, Jaefar; Mehralian, Hossein; Aslani, Yousef; Masoodi, Reza; Amiri, Masoud

2013-01-01

Background: Nursing burnout is the main characteristic of job stress that is a delayed reaction to chronic stressful situations in the workplace which could affect nurses who do not have sufficient emotional energy to cope and communicate with different types of patients. There is also sometimes this belief that they do not have the required capabilities for their jobs. The aim of this study was the evaluation of burnout among nurses working in medical and educational centers in Shahrekord. Materials and Methods: This descriptive study was performed on 340 nurses working in medical and educational centers in Shahrekord in 2009. Samples were selected using proportionate random sampling. Demographic information and the Maslach Burnout Inventory (MBI) were filled in for all nurses. Results: Burnout was considerable among nurses. The results showed that 34.6, 28.8, and 95.7% of the nurses had emotional exhaustion (EE), high depersonalization (DP), and high reduced personal accomplishment (PA), respectively. The mean scores (± standard deviation) for EE, DP, and PA were 22.77 (12.44), 6.99 (6.23), and 32.20 (9.26), respectively. Conclusions: Our results showed that burnout was noticeable among nurses working in medical and educational centers in Shahrekord. Disproportionate relationship between the number of nurses, workload, and income was the most important factor affecting nursing burnout. Due to the importance of nursing in the health-care system, policy makers should adopt suitable strategies for increasing the satisfaction of nurses. PMID:24403925

User-centered design of a mobile medication management.

Science.gov (United States)

Sedlmayr, Brita; Schöffler, Jennifer; Prokosch, Hans-Ulrich; Sedlmayr, Martin

2018-03-05

The use of a nationwide medication plan has been promoted as an effective strategy to improve patient safety in Germany. However, the medication plan only exists as a paper-based version, which is related to several problems, that could be circumvented by an electronic alternative. The main objective of this study was to report on the development of a mobile interface concept to support the management of medication information. The human-centered design (UCD) process was chosen. First the context of use was analyzed, and personas and an interaction concept were designed. Next, a paper prototype was developed and evaluated by experts. Based on those results, a medium-fidelity prototype was created and assessed by seven end-users who performed a thinking-aloud test in combination with a questionnaire based on the System Usability Scale (SUS). Initially for one persona/user type, an interface design concept was developed, which received an average SUS-Score of 92.1 in the user test. Usability problems have been solved so that the design concept could be fixed for a future implementation. Contribution: The approach of the UCD process and the methods involved can be applied by other researchers as a framework for the development of similar applications.

Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care.

Science.gov (United States)

Miller, Benjamin F; Ross, Kaile M; Davis, Melinda M; Melek, Stephen P; Kathol, Roger; Gordon, Patrick

2017-01-01

The patient-centered medical home (PCMH) is a promising framework for the redesign of primary care and more recently specialty care. As defined by the Agency for Healthcare Research and Quality, the PCMH framework has 5 attributes: comprehensive care, patient-centered care, coordinated care, accessible services, and quality and safety. Evidence increasingly demonstrates that for the PCMH to best achieve the Triple Aim (improved outcomes, decreased cost, and enhanced patient experience), treatment for behavioral health (including mental health, substance use, and life stressors) must be integrated as a central tenet. However, challenges to implementing the PCMH framework are compounded for real-world practitioners because payment reform rarely happens concurrently. Nowhere is this more evident than in attempts to integrate behavioral health clinicians into primary care. As behavioral health clinicians find opportunities to work in integrated settings, a comprehensive understanding of payment models is integral to the dialogue. This article describes alternatives to the traditional fee for service (FFS) model, including modified FFS, pay for performance, bundled payments, and global payments (i.e., capitation). We suggest that global payment structures provide the best fit to enable and sustain integrated behavioral health clinicians in ways that align with the Triple Aim. Finally, we present recommendations that offer specific, actionable steps to achieve payment reform, complement PCMH, and support integration efforts through policy. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

Science.gov (United States)

Akinci, Fevzi; Patel, Poonam M

2014-01-01

Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

Cross-cultural medical education: can patient-centered cultural competency training be effective in non-Western countries?

Science.gov (United States)

Ho, Ming-Jung; Yao, Grace; Lee, Keng-Lin; Beach, Mary Catherine; Green, Alexander R

2008-01-01

No evidence addresses the effectiveness of patient-centered cultural competence training in non-Western settings. To examine whether a patient-centered cultural competency curriculum improves medical students' skills in eliciting the patients' perspective and exploring illness-related social factors. Fifty-seven medical students in Taiwan were randomly assigned to either the control (n = 27) or one of two intervention groups: basic (n = 15) and extensive (n = 15). Both intervention groups received two 2-hour patient-centered cultural competency workshops. In addition, the extensive intervention group received a 2-hour practice session. The control group received no training. At the end of the clerkship, all students were evaluated with an objective structured clinical examination (OSCE). Students in the extensive intervention group scored significantly higher than the basic intervention and control groups in eliciting the patient's perspective (F = 18.38, p social factors (F = 6.66, p = 0.003, eta(2) = 0.20). Patient-centered cultural competency training can produce improvement in medical students' cross-cultural communication skills in non-Western settings, especially when adequate practice is provided.

Spectrum of tablet computer use by medical students and residents at an academic medical center

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Robert Robinson

2015-07-01

Full Text Available Introduction. The value of tablet computer use in medical education is an area of considerable interest, with preliminary investigations showing that the majority of medical trainees feel that tablet computers added value to the curriculum. This study investigated potential differences in tablet computer use between medical students and resident physicians.Materials & Methods. Data collection for this survey was accomplished with an anonymous online questionnaire shared with the medical students and residents at Southern Illinois University School of Medicine (SIU-SOM in July and August of 2012.Results. There were 76 medical student responses (26% response rate and 66 resident/fellow responses to this survey (21% response rate. Residents/fellows were more likely to use tablet computers several times daily than medical students (32% vs. 20%, p = 0.035. The most common reported uses were for accessing medical reference applications (46%, e-Books (45%, and board study (32%. Residents were more likely than students to use a tablet computer to access an electronic medical record (41% vs. 21%, p = 0.010, review radiology images (27% vs. 12%, p = 0.019, and enter patient care orders (26% vs. 3%, p < 0.001.Discussion. This study shows a high prevalence and frequency of tablet computer use among physicians in training at this academic medical center. Most residents and students use tablet computers to access medical references, e-Books, and to study for board exams. Residents were more likely to use tablet computers to complete clinical tasks.Conclusions. Tablet computer use among medical students and resident physicians was common in this survey. All learners used tablet computers for point of care references and board study. Resident physicians were more likely to use tablet computers to access the EMR, enter patient care orders, and review radiology studies. This difference is likely due to the differing educational and professional demands placed on

Assessment of medical waste management at a primary health-care center in Sao Paulo, Brazil

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Moreira, A.M.M., E-mail: anamariainforme@hotmail.com [Department of Environmental Health, School of Public Health, University of Sao Paulo, Avenida Doutor Arnaldo 715, Sao Paulo 01246-904 (Brazil); Guenther, W.M.R. [Department of Environmental Health, School of Public Health, University of Sao Paulo, Avenida Doutor Arnaldo 715, Sao Paulo 01246-904 (Brazil)

2013-01-15

Highlights: Black-Right-Pointing-Pointer Assessment of medical waste management at health-care center before/after intervention. Black-Right-Pointing-Pointer Qualitative and quantitative results of medical waste management plan are presented. Black-Right-Pointing-Pointer Adjustments to comply with regulation were adopted and reduction of waste was observed. Black-Right-Pointing-Pointer The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of Sao Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized

The patient-centered medical home: an ethical analysis of principles and practice.

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Braddock, Clarence H; Snyder, Lois; Neubauer, Richard L; Fischer, Gary S

2013-01-01

The patient-centered medical home (PCMH), with its focus on patient-centered care, holds promise as a way to reinvigorate the primary care of patients and as a necessary component of health care reform. While its tenets have been the subject of review, the ethical dimensions of the PCMH have not been fully explored. Consideration of the ethical foundations for the core principles of the PCMH can and should be part of the debate concerning its merits. The PCMH can align with the principles of medical ethics and potentially strengthen the patient-physician relationship and aspects of health care that patients value. Patient choice and these ethical considerations are central and at least as important as the economic and practical arguments in support of the PCMH, if not more so. Further, the ethical principles that support key concepts of the PCMH have implications for the design and implementation of the PCMH. This paper explores the PCMH in light of core principles of ethics and professionalism, with an emphasis both on how the concept of the PCMH may reinforce core ethical principles of medical practice and on further implications of these principles.

Evaluation of the ASCO Value Framework for Anticancer Drugs at an Academic Medical Center.

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Wilson, Leslie; Lin, Tracy; Wang, Ling; Patel, Tanuja; Tran, Denise; Kim, Sarah; Dacey, Katie; Yuen, Courtney; Kroon, Lisa; Brodowy, Bret; Rodondi, Kevin

2017-02-01

Anticancer drug prices have increased by an average of 12% each year from 1996 to 2014. A major concern is that the increasing cost and responsibility of evaluating treatment options are being shifted to patients. This research compared 2 value-based pricing models that were being considered for use at the University of California, San Francisco (UCSF) Medical Center to address the growing burden of high-cost cancer drugs while improving patient-centered care. The Medication Outcomes Center (MOC) in the Department of Clinical Pharmacy, University of California, San Francisco (UCSF), School of Pharmacy focuses on assessing the value of medication-related health care interventions and disseminating findings to the UCSF Medical Center. The High Cost Oncology Drug Initiative at the MOC aims to assess and adopt tools for the critical assessment and amelioration of high-cost cancer drugs. The American Society of Clinical Oncology (ASCO) Value Framework (2016 update) and a cost-effectiveness analysis (CEA) framework were identified as potential tools for adoption. To assess 1 prominent value framework, the study investigators (a) asked 8 clinicians to complete the ASCO Value Framework for 11 anticancer medications selected by the MOC; (b) reviewed CEAs assessing the drugs; (c) generated descriptive statistics; and (d) analyzed inter-rater reliability, convergence validity, and ranking consistency. On the scale of -20 to 180, the mean ASCO net health benefit (NHB) total score across 11 drugs ranged from 7.6 (SD = 7.8) to 53 (SD = 9.8). The Kappa coefficient (κ) for NHB scores across raters was 0.11, which is categorized as "slightly reliable." The combined κ score was 0.22, which is interpreted as low to fair inter-rater reliability. Convergent validity indicates that the correlation between NHB scores and CEA-based incremental cost-effectiveness ratios (ICERs) was low (-0.215). Ranking of ICERs, ASCO scores, and wholesale acquisition costs indicated different results

Does an offer for a free on-line continuing medical education (CME) activity increase physician survey response rate? A randomized trial.

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Viera, Anthony J; Edwards, Teresa

2012-03-07

Achieving a high response rate in a physician survey is challenging. Monetary incentives increase response rates but obviously add cost to a survey project. We wondered whether an offer of a free continuing medical education (CME) activity would be effective in improving survey response rate. As part of a survey of a national sample of physicians, we randomized half to an offer for a free on-line CME activity upon completion of a web-based survey and the other half to no such offer. We compared response rates between the groups. A total of 1214 out of 8477 potentially eligible physicians responded to our survey, for an overall response rate of 14.3%. The response rate among the control group (no offer of CME credit) was 16.6%, while among those offered the CME opportunity, the response rate was 12.0% (p offer for a free on-line CME activity did not improve physician survey response rate. On the contrary, the offer for a free CME activity actually appeared to worsen the response rate. © 2011 Viera et al; licensee BioMed Central Ltd.

Development of a Risk-Based Decision-Support-Model for Protecting an Urban Medical Center from a Nuclear Explosion

International Nuclear Information System (INIS)

Ben-Dor, G.; Shohet, I.M.; Ornai, D.; Brosh, B.

2014-01-01

Nuclear explosion is the worst man-made physical threat on the human society. The nuclear explosion includes several consequences, some of them are immediate and others are long term. The major influences are: long duration blast, extreme thermal release, nuclear radiations, and electro-magnetic pulse (EMP). Their damage range is very wide. When nuclear explosion occurs above or in an urban area it is possible that one or more medical centers will be affected. Medical centers include several layers of structures defined by their resistance capacity to the nuclear explosion influences, beginning with the structure's frame and ending with different systems and with vulnerable medical critical infrastructures such as communications, medical gas supply, etc. A comprehensive literature survey revealed that in spite of the necessity and the importance of medical centers in the daily life and especially in emergency and post nuclear explosion, there is a lack of research on this topic

Creating and sustainable development of specialized centers as a way to improve quality of medical care

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V. I. Guzeva

2016-01-01

Full Text Available Quality of care is evaluated on the completeness of the survey, the correct diagnosis, treatment efficacy, and its duration. Improving the quality and efficiency of medical care for children with paroxysmal disorders of consciousness is one of topical problems of neurology.Aim. The aim of the work is to justify the relationship between improving the quality of health care and sustainable development in the modern conditions of specialized medical centers on the example of the work on the identification and treatment of children with paroxysmal disorders of consciousness of the Center for diagnosis and treatment of epilepsy, and sleep disorders in children and adolescents at the department neurology, neurosurgery and medical genetics SPbGPMU.Materials and methods. For more accurate diagnosis and treatment at the Center conducted a comprehensive examination, including video-EEG оf 527 children aged 1 month to 18 years. A clinical trial study included medical cases, assessment of neurological and somatic status, the study of seizure types and forms of the disease. Instrumental methods of examination were determined by EEG and MRI studies of the brain.Main results. Comprehensive survey of sick children with monitoring video-EEG revealed that 317 children (60,1% had epileptic paroxysms and 210 children (39,8% – non-epileptic paroxysms. Correction treatment was performed in 284 (89,5% children with epileptic paroxysms and altered the treatment in 190 (90,4% children with epileptic paroxysms.Conclusion. The presented clinical data show the high effectiveness of the Centre in the diagnosis and treatment of children with paroxysmal disorders of consciousness. The accumulated experience in the Center confirms the relevance of the creation of the structure of scientific and educational institutions specialized centers in which patients will be given to high-quality medical care.

Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China.

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Qing, Yunbo; Hu, Guijie; Chen, Qingyun; Peng, Hailun; Li, Kailan; Wei, Jinling; Yi, Yanhua

2015-01-01

To produce competent undergraduate-level medical doctors for rural township health centers (THCs), the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs) starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. Among 4,669 medical students, 1,523 (33%) had a positive attitude and 2,574 (55%) had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary. Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.

Factors that influence the choice to work in rural township health centers among 4,669 clinical medical students from five medical universities in Guangxi, China

Directory of Open Access Journals (Sweden)

Yunbo Qing

2015-07-01

Full Text Available Purpose: To produce competent undergraduate-level medical doctors for rural township health centers (THCs, the Chinese government mandated that medical colleges in Central and Western China recruit rural-oriented, tuition-waived medical students (RTMSs starting in 2010. This study aimed to identify and assess factors that influence the choice to work in rural township health centers among both RTMSs and other students from five medical universities in Guangxi, China. Methods: An internet-based self-administered questionnaire survey was conducted with medical students in Guangxi province. Multinomial logistic regression was used to identify factors related to the attitudes toward work in a rural township health center. Results: Among 4,669 medical students, 1,523 (33% had a positive attitude and 2,574 (55% had a neutral attitude toward working in THCs. Demographic characteristics, personal job concerns, and knowledge of THCs were associated with the choice of a career in THCs. The factors related to a positive attitude included the following: three-year program, a rural-oriented medical program, being male, an expectation of working in a county or township, a focus on medical career development, some perceived difficulty of getting a job, having family support, sufficient knowledge of THCs, optimism toward THC development, seeking lower working pressure, and a lower expected monthly salary. Conclusion: Male students in a three-year program or a rural-oriented tuition-waived medical education program were more likely to work in THCs. Selecting medical students through interviews to identify their family support and intentions to work in THCs would increase recruitment and retention. Establishing favorable policies and financial incentives to improve living conditions and the social status of rural physicians is necessary.

Education and Outreach Programs Offered by the Center for High Pressure Research and the Consortium for Materials Properties Research in Earth Sciences

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Richard, G. A.

2003-12-01

Major research facilities and organizations provide an effective venue for developing partnerships with educational organizations in order to offer a wide variety of educational programs, because they constitute a base where the culture of scientific investigation can flourish. The Consortium for Materials Properties Research in Earth Sciences (COMPRES) conducts education and outreach programs through the Earth Science Educational Resource Center (ESERC), in partnership with other groups that offer research and education programs. ESERC initiated its development of education programs in 1994 under the administration of the Center for High Pressure Research (CHiPR), which was funded as a National Science Foundation Science and Technology Center from 1991 to 2002. Programs developed during ESERC's association with CHiPR and COMPRES have targeted a wide range of audiences, including pre-K, K-12 students and teachers, undergraduates, and graduate students. Since 1995, ESERC has offered inquiry-based programs to Project WISE (Women in Science and Engineering) students at a high school and undergraduate level. Activities have included projects that investigated earthquakes, high pressure mineral physics, and local geology. Through a practicum known as Project Java, undergraduate computer science students have developed interactive instructional tools for several of these activities. For K-12 teachers, a course on Long Island geology is offered each fall, which includes an examination of the role that processes in the Earth's interior have played in the geologic history of the region. ESERC has worked with Stony Brook's Department of Geosciences faculty to offer courses on natural hazards, computer modeling, and field geology to undergraduate students, and on computer programming for graduate students. Each summer, a four-week residential college-level environmental geology course is offered to rising tenth graders from the Brentwood, New York schools in partnership with

Prospects for rebuilding primary care using the patient-centered medical home.

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Landon, Bruce E; Gill, James M; Antonelli, Richard C; Rich, Eugene C

2010-05-01

Existing research suggests that models of enhanced primary care lead to health care systems with better performance. What the research does not show is whether such an approach is feasible or likely to be effective within the U.S. health care system. Many commentators have adopted the model of the patient-centered medical home as policy shorthand to address the reinvention of primary care in the United States. We analyze potential barriers to implementing the medical home model for policy makers and practitioners. Among others, these include developing new payment models, as well as the need for up-front funding to assemble the personnel and infrastructure required by an enhanced non-visit-based primary care practice and methods to facilitate transformation of existing practices to functioning medical homes.

Collaborating to improve the global competitiveness of US academic medical centers.

Science.gov (United States)

Allen, Molly; Garman, Andrew; Johnson, Tricia; Hohmann, Samuel; Meurer, Steve

2012-01-01

President Obama announced the National Export Initiative in his 2010 State of the Union address and set the ambitious goal of doubling US exports by the end of 2014 to support millions of domestic jobs. Understanding the competitive position of US health care in the global market for international patients, University Health System Consortium (UHC), an alliance of 116 academic medical centers and 272 of their affiliated hospitals, representing 90 percent of the nation's non-profit academic medical centers partnered with Rush University, a private University in Chicago, IL and the International Trade Administration of the US Department of Commerce International Trade Administration (ITA) to participate in the Market Development Cooperator Program. The goal of this private-public partnership is to increase the global competitiveness of the US health care industry, which represents over 16 percent of the GDP, amongst foreign health care providers. This article provides an overview of the US health care market and outlines the aims of the US Cooperative for International Patient Programs, the end result of the partnership between UHC, ITA and Rush University.

Syndrome surveillance of fentanyl-laced heroin outbreaks: Utilization of EMS, Medical Examiner and Poison Center databases.

Science.gov (United States)

Moore, P Quincy; Weber, Joseph; Cina, Steven; Aks, Steven

2017-11-01

Describe surveillance data from three existing surveillance systems during an unexpected fentanyl outbreak in a large metropolitan area. We performed a retrospective analysis of three data sets: Chicago Fire Department EMS, Cook County Medical Examiner, and Illinois Poison Center. Each included data from January 1, 2015 through December 31, 2015. EMS data included all EMS responses in Chicago, Illinois, for suspected opioid overdose in which naloxone was administered and EMS personnel documented other criteria indicative of opioid overdose. Medical Examiner data included all deaths in Cook County, Illinois, related to heroin, fentanyl or both. Illinois Poison Center data included all calls in Chicago, Illinois, related to fentanyl, heroin, and other prescription opioids. Descriptive statistics using Microsoft Excel® were used to analyze the data and create figures. We identified a spike in opioid-related EMS responses during an 11-day period from September 30-October 10, 2015. Medical Examiner data showed an increase in both fentanyl and mixed fentanyl/heroin related deaths during the months of September and October, 2015 (375% and 550% above the median, respectively.) Illinois Poison Center data showed no significant increase in heroin, fentanyl, or other opioid-related calls during September and October 2015. Our data suggests that EMS data is an effective real-time surveillance mechanism for changes in the rate of opioid overdoses. Medical Examiner's data was found to be valuable for confirmation of EMS surveillance data and identification of specific intoxicants. Poison Center data did not correlate with EMS or Medical Examiner data. Copyright © 2017 Elsevier Inc. All rights reserved.

Program review of the USDA Center for Medical, Agricultural and Veterinary Entomology

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The USDA-ARS Center for Medical, Agricultural and Veterinary Entomology (CMAVE) has a history that starts in 1932 in Orlando to develop methods to control mosquitoes, including malaria vectors under conditions simulating those of the south Pacific jungles, and other insects affecting man and animals...

Challenges and Opportunities to Improve Cervical Cancer Screening Rates in US Health Centers through Patient-Centered Medical Home Transformation

Directory of Open Access Journals (Sweden)

Olga Moshkovich

2015-01-01

Full Text Available Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen’s Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited.

Medication therapy management clinic: perception of healthcare professionals in a University medical center setting

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Shah M

2013-09-01

Full Text Available Objective: To determine the overall perception and utilization of the pharmacist managed medication therapy management (MTM clinic services, by healthcare professionals in a large, urban, university medical care setting.Methods: This was a cross-sectional, anonymous survey sent to 195 healthcare professionals, including physicians, nurses, and pharmacists at The University of Illinois Outpatient Care Center to determine their perception and utilization of the MTM clinic. The survey consisted of 12 questions and was delivered through a secure online application. Results: Sixty-two healthcare professionals (32% completed the survey. 82% were familiar with the MTM clinic, and 63% had referred patients to the clinic. Medication adherence and disease state management was the most common reason for referral. Lack of knowledge on the appropriate referral procedure was the prominent reason for not referring patients to the MTM clinic. Of the providers that were aware of MTM services, 44% rated care as ‘excellent’, 44% as ‘good’, 5% as ‘fair’, and 0% stated ‘poor’. Strengths of MTM clinic identified by healthcare providers included in-depth education to patients, close follow-up, and detailed medication reconciliation provided by MTM clinic pharmacists. Of those familiar with MTM clinic, recommendations included; increase marketing efforts to raise awareness of the MTM clinic service, create collaborative practice agreements between MTM pharmacists and physicians, and ensure that progress notes are more concise.Conclusion: In a large, urban, academic institution MTM clinic is perceived as a valuable resource to optimize patient care by providing patients with in-depth education as it relates to their prescribed medications and disease states. These identified benefits of MTM clinic lead to frequent patient referrals specifically for aid with medication adherence and disease state management.

Information technology leadership in academic medical centers: a tale of four cultures.

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Friedman, C P

1999-07-01

Persons and groups within academic medical centers bring consistent and predictable viewpoints to planning and decision making. The varied professional and academic cultures of these individuals appear to account primarily for the diversity of their viewpoints. Understanding these professional cultures can help leaders achieve some predictability in the complex environments for which they are responsible. Leaders in information technology in particular, in order to be successful, must become part-time anthropologists, immersing themselves in the varied workplaces of their constituents to understand the work they do and the cultures that have grown up around this work. Only in this way will they be able to manage the challenges that arise continuously as the technology and the needs it can address change over time. In this article, the author briefly describes the concept of culture, portrays four specific professional cultures that typically coexist in academic medical centers, and argues that understanding these cultures is absolutely critical to effective management and use of information resources.

Assessment of medical waste management at a primary health-care center in São Paulo, Brazil

International Nuclear Information System (INIS)

Moreira, A.M.M.; Günther, W.M.R.

2013-01-01

Highlights: ► Assessment of medical waste management at health-care center before/after intervention. ► Qualitative and quantitative results of medical waste management plan are presented. ► Adjustments to comply with regulation were adopted and reduction of waste was observed. ► The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of São Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized. Total waste generation increased 9.8%, but it was possible to reduce the volume of non

Outsourcing your medical practice call center: how to choose a vendor to ensure regulatory compliance.

Science.gov (United States)

Johnson, Bill

2014-01-01

Medical practices receive hundreds if not thousands of calls every week from patients, payers, pharmacies, and others. Outsourcing call centers can be a smart move to improve efficiency, lower costs, improve customer care, ensure proper payer management, and ensure regulatory compliance. This article discusses how to know when it's time to move to an outsourced call center, the benefits of making the move, how to choose the right call center, and how to make the transition. It also provides tips on how to manage the call center to ensure the objectives are being met.

An approach to human-centered design of nuclear medical equipment: the system of caption of the thyroid

International Nuclear Information System (INIS)

Santos, Isaac J.A. Luquetti; Silva, Carlos Borges da; Santana, Marcos; Carvalho, Paulo Victor R.; Oliveira, Mauro Vitor de; Mol, Antonio Carlos Mol; Grecco, Claudio Henrique; Augusto, Silas Cordeiro

2005-01-01

Technology plays an important role in modern medical centers, making health care increasingly complex, relying on complex technical equipment. This technical complexity is particularly noticeable in the nuclear medicine and can increase the risks for human error. Human error has many causes such as performance shaping factors, organizational factors and user interface design. Poorly design human system interfaces of nuclear medical equipment can increase the risks for human error. If all nuclear medical equipment had been designed with good user interfaces, incidents and accidents could be reduced as well as he time required to learn how to use the equipment. Although some manufacturers of nuclear medical equipment have already integrate human factors principles in their products, there is still a need to steer the development of nuclear medical technology toward more human-centered approach. The aim of this paper is to propose a methodology that contributes to the design, development and evaluation of nuclear medical equipment and human system interface, towards a human-centered approach. This methodology includes the ergonomic approach, based on the operator activity analysis, together with human factors standards and guidelines, questionnaires and user based testing. We describe a case study in which this methodology is being applied in evaluation of the thyroid uptake system, getting essential information and data, that ill be used in development of a new system. (author)

Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.

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Poncelet, Ann Noelle; Mazotti, Lindsay A; Blumberg, Bruce; Wamsley, Maria A; Grennan, Tim; Shore, William B

2014-01-01

The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers.

Implementing the patient-centered medical home in residency education.

Science.gov (United States)

Doolittle, Benjamin R; Tobin, Daniel; Genao, Inginia; Ellman, Matthew; Ruser, Christopher; Brienza, Rebecca

2015-01-01

In recent years, physician groups, government agencies and third party payers in the United States of America have promoted a Patient-centered Medical Home (PCMH) model that fosters a team-based approach to primary care. Advocates highlight the model's collaborative approach where physicians, mid-level providers, nurses and other health care personnel coordinate their efforts with an aim for high-quality, efficient care. Early studies show improvement in quality measures, reduction in emergency room visits and cost savings. However, implementing the PCMH presents particular challenges to physician training programs, including institutional commitment, infrastructure expenditures and faculty training. Teaching programs must consider how the objectives of the PCMH model align with recent innovations in resident evaluation now required by the Accreditation Council of Graduate Medical Education (ACGME) in the US. This article addresses these challenges, assesses the preliminary success of a pilot project, and proposes a viable, realistic model for implementation at other institutions.

Diversity leadership: the Rush University Medical Center experience.

Science.gov (United States)

Clapp, J R

2010-01-01

Meeting the challenges of diversity is crucial, and within healthcare organizations a particularly strong case exists for a diversity strategy. Rush University Medical Center in 2006 was at an important juncture. Since its founding, the organization had made notable progress toward advancing diversity and inclusiveness. On the other hand, many diversity-related problems continued. Rush convened a committee to review the work of the institution in this area. The committee's report called for changes, and a Diversity Leadership Group (DLG) model was established. This article documents the progress made since 2006 through implementation of the DLG model. The changes prescribed for Rush are presented as recommendations and challenges that other healthcare organizations may find applicable to their own institutions.

Fostering interprofessional teamwork in an academic medical center: Near-peer education for students during gross medical anatomy.

Science.gov (United States)

Shields, Richard K; Pizzimenti, Marc A; Dudley-Javoroski, Shauna; Schwinn, Debra A

2015-01-01

The purpose of this report is to describe student satisfaction with a near-peer interprofessional education (IPE) session for physical therapy and medical students. Ten senior physical therapy students worked in peer-groups to develop a musculoskeletal anatomy demonstration for first-semester medical students. Together with their classmates, they demonstrated observation, palpation, and musculoskeletal assessment of the shoulder and scapular-thoracic articulation to medical student dissection groups in the Gross Anatomy laboratory. The medical students were encouraged to consider the synergistic function of shoulder structures and the potential impact of a selected pathology: rotator cuff injury. The session provided the medical students with an opportunity to integrate their new anatomical knowledge into a framework for clinical musculoskeletal evaluation. The experience offered senior physical therapy students an opportunity to work in teams with their peers, internalize and adapt to constructive feedback, and seek common ground with members of another profession. Both student groups reported a high degree of satisfaction with the sessions and expressed a desire for further interaction. These positive perceptions by student stakeholders have prompted us to consider additional IPE exchanges for the anatomy course in the upcoming school year. Given the positive outcome of this descriptive study, we now plan to systematically test whether near-peer IPE interactions can enhance the degree that students learn key anatomical concepts. © 2014 American Association of Anatomists.

SU-E-P-01: An Informative Review On the Role of Diagnostic Medical Physicist in the Academic and Private Medical Centers

International Nuclear Information System (INIS)

Weir, V; Zhang, J

2014-01-01

Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medical physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department

SU-E-P-01: An Informative Review On the Role of Diagnostic Medical Physicist in the Academic and Private Medical Centers

Energy Technology Data Exchange (ETDEWEB)

Weir, V [Baylor Health Care System, Dallas, TX (United States); Zhang, J [University of Kentucky, Lexington, KY (United States)

2014-06-01

Purpose: The role of physicist in the academic and private hospital environment continues to evolve and expand. This becomes more obvious with the newly revised requirements of the Joint Commission (JC) on imaging modalities and the continued updated requirements of ACR accreditation for medical physics (i.e., starting in June 2014, a physicists test will be needed before US accreditation). We provide an informative review on the role of diagnostic medical physicist and hope that our experience will expedite junior physicists in understanding their role in medical centers, and be ready to more opportunities. Methods: Based on our experience, diagnostic medical physicists in both academic and private medical centers perform several clinical functions. These include providing clinical service and physics support, ensuring that all ionizing radiation devices are tested and operated in compliance with the State and Federal laws, regulations and guidelines. We also discuss the training and education required to ensure that the radiation exposure to patients and staff is as low as reasonably achievable. We review the overlapping roles of medical and health physicist in some institutions. Results: A detailed scheme on the new requirements (effective 7/1/2014) of the JC is provided. In 2015, new standards for fluoroscopy, cone beam CT and the qualifications of staff will be phased in. A summary of new ACR requirements for different modalities is presented. Medical physicist have other duties such as sitting on CT and fluoroscopy committees for protocols design, training of non-radiologists to meet the new fluoroscopy rules, as well as helping with special therapies such as Yittrium 90 cases. Conclusion: Medical physicists in both academic and private hospitals are positioned to be more involved and prominent. Diagnostic physicists need to be more proactive to involve themselves in the day to day activities of the radiology department.

Implementation of Patient-Centered Medical Homes in Adult Primary Care Practices.

Science.gov (United States)

Alexander, Jeffrey A; Markovitz, Amanda R; Paustian, Michael L; Wise, Christopher G; El Reda, Darline K; Green, Lee A; Fetters, Michael D

2015-08-01

There has been relatively little empirical evidence about the effects of patient-centered medical home (PCMH) implementation on patient-related outcomes and costs. Using a longitudinal design and a large study group of 2,218 Michigan adult primary care practices, our study examined the following research questions: Is the level of, and change in, implementation of PCMH associated with medical surgical cost, preventive services utilization, and quality of care in the following year? Results indicated that both level and amount of change in practice implementation of PCMH are independently and positively associated with measures of quality of care and use of preventive services, after controlling for a variety of practice, patient cohort, and practice environmental characteristics. Results also indicate that lower overall medical and surgical costs are associated with higher levels of PCMH implementation, although change in PCMH implementation did not achieve statistical significance. © The Author(s) 2015.

Integration of pharmacists into patient-centered medical homes in federally qualified health centers in Texas.

Science.gov (United States)

Wong, Shui Ling; Barner, Jamie C; Sucic, Kristina; Nguyen, Michelle; Rascati, Karen L

To describe the integration and implementation of pharmacy services in patient-centered medical homes (PCMHs) as adopted by federally qualified health centers (FQHCs) and compare them with usual care (UC). Four FQHCs (3 PCMHs, 1 UC) in Austin, TX, that provide care to the underserved populations. Pharmacists have worked under a collaborative practice agreement with internal medicine physicians since 2005. All 4 FQHCs have pharmacists as an integral part of the health care team. Pharmacists have prescriptive authority to initiate and adjust diabetes medications. The PCMH FQHCs instituted co-visits, where patients see both the physician and the pharmacist on the same day. PCMH pharmacists are routinely proactive in collaborating with physicians regarding medication management, compared with UC in which pharmacists see patients only when referred by a physician. Four face-to-face, one-on-one semistructured interviews were conducted with pharmacists working in 3 PCMH FQHCs and 1 UC FQHC to compare the implementation of PCMH with emphasis on 1) structure and workflow, 2) pharmacists' roles, and 3) benefits and challenges. On co-visit days, the pharmacist may see the patient before or after physician consultation. Pharmacists in 2 of the PCMH facilities proactively screen to identify diabetes patients who may benefit from pharmacist services, although the UC clinic pharmacists see only referred patients. Strengths of the co-visit model include more collaboration with physicians and more patient convenience. Payment that recognizes the value of PCMH is one PCMH principle that is not fully implemented. PCMH pharmacists in FQHCs were integrated into the workflow to address specific patient needs. Specifically, full-time in-house pharmacists, flexible referral criteria, proactive screening, well defined collaborative practice agreement, and open scheduling were successful strategies for the underserved populations in this study. However, reimbursement plans and provider

Energy Survey of Eisenhower Army Medical Center, Fort Gordon, Augusta, Georgia. Volume 2. Appendices

National Research Council Canada - National Science Library

1996-01-01

...) including low cost/no cost ECO's and perform complete evaluations of each. Energy equipment replacement projects already underway, approved, or planned by the Medical Center staff will be factored into the evaluations...

Communications and Collaboration Keep San Francisco VA Medical Center Project on Track

International Nuclear Information System (INIS)

Federal Energy Management Program

2001-01-01

This case study about energy saving performance contacts (ESPCs) presents an overview of how the Veterans Affairs Medical Center in San Francisco established an ESPC contract and the benefits derived from it. The Federal Energy Management Program instituted these special contracts to help federal agencies finance energy-saving projects at their facilities

Self-Referent Constructs and Medical Sociology: In Search of an Integrative Framework*

Science.gov (United States)

Kaplan, Howard B.

2010-01-01

A theoretical framework centering on four classes of self-referent constructs is offered as a device for integrating the diverse areas constituting medical sociology. Guidance by this framework sensitizes the researcher to the occurrence of parallel processes in adjacent disciplines, facilitates recognition of the etiological significance of findings from other disciplines for explaining medical sociological phenomena, and encourages transactions between sociology and medical sociology whereby each informs and is informed by the other. PMID:17583268

Comparison and alignment of an academic medical center's strategic goals with ASHP initiatives.

Science.gov (United States)

Engels, Melanie J; Chaffee, Bruce W; Clark, John S

2015-12-01

An academic medical center's strategic goals were compared and aligned with the 2015 ASHP Health-System Pharmacy Initiative and the Pharmacy Practice Model Initiative (PPMI). The department's pharmacy practice model steering committee identified potential solutions to narrow prioritized gaps using a modified nominal group technique and a multivoting dot technique. Five priority solutions were identified and assigned to work groups to develop business plans, which included admission medication history and reconciliation for high-risk patients and those with complex medication regimens, pharmacist provision of discharge counseling to high-risk patients and those with complex medication regimens, improved measurement and reporting of the impact of PPMI programs on patient outcomes, implementation of a departmentwide formalized peer review and evaluation process, and the greeting of every patient at some time during his or her visit by a pharmacy team member. Stakeholders evaluated the business plans based on feasibility, financial return on investment, and anticipated safety enhancements. The solution that received the highest priority ranking and was subsequently implemented was "improved measurement and reporting of the impact of PPMI programs on patient outcomes." A defined process was followed for identifying gaps among current practices at an academic medical center and the 2015 ASHP Health-System Pharmacy Initiative and the PPMI. A key priority to better document the impact of pharmacists on patient care was identified for our department by using a nominal group technique brainstorming process and a multivoting dot technique and creating standardized business plans for five potential priority projects. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Development of a pharmacy student research program at a large academic medical center.

Science.gov (United States)

McLaughlin, Milena M; Skoglund, Erik; Bergman, Scott; Scheetz, Marc H

2015-11-01

A program to promote research by pharmacy students created through the collaboration of an academic medical center and a college of pharmacy is described. In 2009, Midwestern University Chicago College of Pharmacy and Northwestern Memorial Hospital (NMH) expanded their existing partnership by establishing a program to increase opportunities for pharmacy students to conduct clinical-translational research. All professional year 1, 2, or 3 students at the college, as well as professional year 4 students on rotation at NMH, can participate in the program. Central to the program's infrastructure is the mentorship of student leads by faculty- and hospital-based pharmacists. The mentors oversee the student research projects and guide development of poster presentations; student leads mentor junior students and assist with orientation and training activities. Publication of research findings in the peer-reviewed literature is a key program goal. In the first four years after program implementation, participation in a summer research program grew nearly 10-fold (mainly among incoming professional year 2 or 3 students, and student poster presentations at national pharmacy meetings increased nearly 20-fold; the number of published research articles involving student authors increased from zero in 2009 to three in 2012 and two in 2013. A collaborative program between an academic medical center and a college of pharmacy has enabled pharmacy students to conduct research at the medical center and has been associated with increases in the numbers of poster presentations and publications involving students. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Phased implementation of AT and T PACS at Duke University Medical Center

International Nuclear Information System (INIS)

Stockbridge, C.; Ravin, C.E.

1986-01-01

''Help me communicate more quickly and more effectively with referring clinicians''. This request was the driving behind the installation of the AT and T CommView System at Duke. The CommView System is a type of Digital Image Management System and Picture Archival Communication System whose chief purpose is to deliver interpolated diagnostic images to referring clinicians and attending physicians. The system acquires electronic images from modalities in a diagnostic imaging facility, stores these images in computer managed patient files and distributes these on demand over fiber optic cable to Display Consoles. The CommView System was designed at AT and T Bell Labs; it uses fiber optic ribbon cable between buildings fused to multistrand lightguide building cables to distribute images, typically around a medical center or campus at data transfer rates of 40 Mbps. This paper gives the rationale used in designing a start-up network and placing the initial equipment for a field of the AT and T CommView System in the Radiology Department of Duke University Medical Center

Strategies for the Integration of Medical and Health Representation within Law Enforcement Intelligence Fusion Centers

National Research Council Canada - National Science Library

Morrissey, James F

2007-01-01

Terrorism-related intelligence gathering, analysis and information dissemination would be improved and enhanced by including a medical and health element in law enforcement intelligence fusion centers...

Parental Perceptions of Family Centered Care in Medical Homes of Children with Neurodevelopmental Disabilities.

Science.gov (United States)

Zajicek-Farber, Michaela L; Lotrecchiano, Gaetano R; Long, Toby M; Farber, Jon Matthew

2015-08-01

Life course theory sets the framework for strong inclusion of family centered care (FCC) in quality medical homes of children with neurodevelopmental disabilities (CNDD). The purpose of this study was to explore the perceptions of families with their experiences of FCC in medical homes for CNDD. Using a structured questionnaire, the Family-Centered Care Self-Assessment Tool developed by Family Voices, this study surveyed 122 parents of CNDD in a large urban area during 2010-2012. Data collected information on FCC in the provision of primary health care services for CNDD and focused on family-provider partnerships, care setting practices and policies, and community services. Frequency analysis classified participants' responses as strengths in the "most of the time" range, and weaknesses in the "never" range. Only 31 % of parents were satisfied with the primary health care their CNDD received. Based on an accepted definition of medical home services, 16 % of parents reported their CNDD had most aspects of a medical home, 64 % had some, and 20 % had none. Strengths in FCC were primarily evident in the family-provider partnership and care settings when focused on meeting the medical care needs of the child. Weaknesses in FCC were noted in meeting the needs of families, coordination, follow-up, and support with community resources. Improvements in key pediatric health care strategies for CNDD are recommended. CNDD and their families have multifaceted needs that require strong partnerships among parents, providers, and communities. Quality medical homes must include FCC and valued partnerships with diverse families and community-based providers.

On the scene: American University of Beirut Medical Center, Beirut, Lebanon.

Science.gov (United States)

Mouro, Gladys; Tashjian, Hera; Daaboul, Tania; Kozman, Katia; Alwan, Farah; Shamoun, Anthony

2011-01-01

American University of Beirut Medical Center is the first Magnet hospital in the Middle East. In this article, authors reflect back on the journey to excellence, specifically in establishing shared governance in a challenging cultural and organizational milieu. Perspectives from nurses at different levels are included to highlight their experiences throughout the journey. Evolution of the organization's shared governance model is described and initiatives of the councils are illustrated.

A new concept for medical imaging centered on cellular phone technology.

Directory of Open Access Journals (Sweden)

Yair Granot

2008-04-01

Full Text Available According to World Health Organization reports, some three quarters of the world population does not have access to medical imaging. In addition, in developing countries over 50% of medical equipment that is available is not being used because it is too sophisticated or in disrepair or because the health personnel are not trained to use it. The goal of this study is to introduce and demonstrate the feasibility of a new concept in medical imaging that is centered on cellular phone technology and which may provide a solution to medical imaging in underserved areas. The new system replaces the conventional stand-alone medical imaging device with a new medical imaging system made of two independent components connected through cellular phone technology. The independent units are: a a data acquisition device (DAD at a remote patient site that is simple, with limited controls and no image display capability and b an advanced image reconstruction and hardware control multiserver unit at a central site. The cellular phone technology transmits unprocessed raw data from the patient site DAD and receives and displays the processed image from the central site. (This is different from conventional telemedicine where the image reconstruction and control is at the patient site and telecommunication is used to transmit processed images from the patient site. The primary goal of this study is to demonstrate that the cellular phone technology can function in the proposed mode. The feasibility of the concept is demonstrated using a new frequency division multiplexing electrical impedance tomography system, which we have developed for dynamic medical imaging, as the medical imaging modality. The system is used to image through a cellular phone a simulation of breast cancer tumors in a medical imaging diagnostic mode and to image minimally invasive tissue ablation with irreversible electroporation in a medical imaging interventional mode.

Examining Health Information Technology Implementations: Case of the Patient-Centered Medical Home

Science.gov (United States)

Behkami, Nima A.

2012-01-01

It has been shown that the use of Health Information Technology (HIT) is associated with reduced cost and increased quality of care. This dissertation examined the use of registries in Patient Centered Medical Home (PCMH) practices. A survey questionnaire was sent to a nationwide group of clinics certified for being a PCMH. They were asked to…

Transformation of an academic medical center: lessons learned from restructuring and downsizing.

Science.gov (United States)

Woodard, B; Fottler, M D; Kilpatrick, A O

1999-01-01

This article reviews management literature on health care transformation and describes the processes, including restructuring, job redesign, and downsizing, involved in one academic medical center's experience. The article concludes with lessons learned at each of the stages of the transformation process: planning, implementation, and process continuation. Managerial implications for similar transformation efforts in other health care organizations are suggested.

Offer patterns of nationally placed livers by donation service area.

Science.gov (United States)

Lai, Jennifer C; Feng, Sandy; Vittinghoff, Eric; Roberts, John P

2013-04-01

We previously reported that national liver distribution is highly concentrated in 6 US centers, and this raises the possibility of expedited placement. Therefore, we evaluated all national offers of nationally placed livers (n=1625) to adult wait-list candidates from February 2005 to January 2010. We developed a model to predict national utilization pathways; pathways exceeding the best-fit linear unbiased predictions by ≥3 standard errors were defined as preferred. All 51 donation service areas (DSAs) placed 1 or more livers nationally, but the percentage per DSA ranged from 1% to 36%. Of 2830 possible national DSA-center pathways, 87% were used. Five hundred eighty livers (36%) were accepted on the first national offer. Four DSAs accounted for 47% of first-national-offer livers, and 44% of these were accepted by a single center. In comparison with first-offer livers using nonpreferred pathways, first offers along a preferred pathway were offered to fewer status 1 candidates (19% versus 61%) and had lower median model for end-stage liver disease (MELD) scores (22 versus 36, Poffer to non-status 1 candidates with MELD scores less than their local transplant MELD scores. Although this practice may facilitate liver placement, it raises the possibility of expedience trumping patient need. Here we propose changes to the national liver distribution system that will help to balance equity, efficiency, and transparency. Copyright © 2013 American Association for the Study of Liver Diseases.

Analysis of the Service Quality of Medical Centers Using Servqual Model (Case:Shaheed Rahnemoon Hospital

Directory of Open Access Journals (Sweden)

H Zare Ahmadabadi

2007-07-01

Full Text Available Introduction: Many organizations, especially service oriented ones, relative to their goals and mission, have a special view towards quality phenomena and its management. Methods: This paper analyzes medical service quality in one case; The internal section of Shaheed Rahnemoon Hospital Based on the basis of gap analysis model and Servqual technique. A questionnaire was designed and applied to measure expectations and perceptions of patients and personnel of the hospital. Results: On application of non-parametric statistical tests, we propose certain recommendations. These tests drive on five conceptual dimensions of service quality including intangibility, responsiveness, reliability, assurance and empathy. Results show that patients in this section were satisfied from the service provider’s responsiveness, but there are significant differences between expectations and perceptions in other dimensions. Conclusion: The service quality analysis models are useful for managers of medical centers to distinguish gaps between the two sides of service representation; patients and medical centers personnel. Ultimately, they can reinforce strengths and control weaknesses.

Patient-centered communication in digital medical encounters.

Science.gov (United States)

Alpert, Jordan M; Dyer, Karen E; Lafata, Jennifer Elston

2017-10-01

Patients are increasingly using the secure messaging function available through online patient portals to communicate with their health care providers, yet little is known about the characteristics of conversations that occur. The goal of this study is to describe the types of messages initiated by patients communicating via patient portals and to assess whether providers employ patient-centered strategies in their electronic responses. A total of 193 messages from 58 message threads between patients and providers were collected during a one-week period in a large health care system. Content analysis of patient messages was conducted and deductive analysis of provider responses was employed for two types of patient-centered communication, provider use of supportive talk and partnership building. Patients sent nearly double the number of messages compared to providers (65% versus 35%). Patient messages expressed concern, sought medical solutions and requested assistance with administrative tasks. Over half (53.4%) of provider replies did not contain language reflective of either partnership building or supportive talk. Partnership building language and supportive talk occurred at lower rates than documented in the literature on in-person encounters. This may represent a lost opportunity to strengthen the patient-provider relationship. As secure messaging is increasingly utilized as a form of patient-provider communication, it is important to understand how aspects of this communication channel, including the patient-centeredness of the language used by providers, impact patient-provider relationships and patient outcomes. Copyright © 2017 Elsevier B.V. All rights reserved.

Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.

Science.gov (United States)

Sasnett, Bonita; Harris, Susie T; White, Shelly

Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

CredibleMeds.org: What does it offer?

Science.gov (United States)

Woosley, Raymond L; Black, Kristin; Heise, C William; Romero, Klaus

2018-02-01

Since the 1990s, when numerous non-cardiac drugs were first recognized to have the potential to prolong the QT interval and cause torsades de pointes (TdP), clinicians, drug regulators, drug developers, and clinical investigators have become aware of the complexities of assessing evidence and determining TdP causality for the many drugs being marketed or under development. To facilitate better understanding, the Arizona Center for Education and Research on Therapeutics, known as AZCERT, has developed the CredibleMeds.org website which includes QTdrugs, a listing of over 220 drugs placed in four risk categories based on their association with QT prolongation and TdP. Since the site was launched in 1999, it has become the single and most reliable source of information of its kind for patients, healthcare providers, and research scientists. Over 96,000 registered users rely on the QTdrugs database as their primary resource to inform their medication use, their prescribing or their clinical research into the impact of QT-prolonging drugs and drug-induced arrhythmias. The QTdrugs lists are increasingly used as the basis for clinical decision support systems in healthcare and for metrics of prescribing quality by healthcare insurers. A free smartphone app and an application program interface enable rapid and mobile access to the lists. Also, the CredibleMeds website offers numerous educational resources for patients, educators and healthcare providers that foster the safe use of medications. Copyright © 2018 Elsevier Inc. All rights reserved.

77 FR 21547 - Proposed Priorities; Disability and Rehabilitation Research Projects and Centers Program

Science.gov (United States)

2012-04-10

... recreational technologies that need to be tested for use by individuals with disabilities. For example, virtual reality (VR) and body movement tracking video-game technologies offer an emerging and highly promising...). Currently, therapy robots are found only in large medical and rehabilitation centers. There is a need to...

Lessons Learned from Implementing the Patient-Centered Medical Home

Directory of Open Access Journals (Sweden)

Ellen P. Green

2012-01-01

Full Text Available The Patient-Centered Medical Home (PCMH is a primary care model that provides coordinated and comprehensive care to patients to improve health outcomes. This paper addresses practical issues that arise when transitioning a traditional primary care practice into a PCMH recognized by the National Committee for Quality Assurance (NCQA. Individual organizations' experiences with this transition were gathered at a PCMH workshop in Alexandria, Virginia in June 2010. An analysis of their experiences has been used along with a literature review to reveal common challenges that must be addressed in ways that are responsive to the practice and patients’ needs. These are: NCQA guidance, promoting provider buy-in, leveraging electronic medical records, changing office culture, and realigning workspace in the practice to accommodate services needed to carry out the intent of PCMH. The NCQA provides a set of standards for implementing the PCMH model, but these standards lack many specifics that will be relied on in location situations. While many researchers and providers have made critiques, we see this vagueness as allowing for greater flexibility in how a practice implements PCMH.

Medical-Legal Partnerships At Veterans Affairs Medical Centers Improved Housing And Psychosocial Outcomes For Vets.

Science.gov (United States)

Tsai, Jack; Middleton, Margaret; Villegas, Jennifer; Johnson, Cindy; Retkin, Randye; Seidman, Alison; Sherman, Scott; Rosenheck, Robert A

2017-12-01

Medical-legal partnerships-collaborations between legal professionals and health care providers that help patients address civil legal problems that can affect health and well-being-have been implemented at several Veterans Affairs (VA) medical centers to serve homeless and low-income veterans with mental illness. We describe the outcomes of veterans who accessed legal services at four partnership sites in Connecticut and New York in the period 2014-16. The partnerships served 950 veterans, who collectively had 1,384 legal issues; on average, the issues took 5.4 hours' worth of legal services to resolve. The most common problems were related to VA benefits, housing, family issues, and consumer issues. Among a subsample of 148 veterans who were followed for one year, we observed significant improvements in housing, income, and mental health. Veterans who received more partnership services showed greater improvements in housing and mental health than those who received fewer services, and those who achieved their predefined legal goals showed greater improvements in housing status and community integration than those who did not. Medical-legal partnerships represent an opportunity to expand cross-sector, community-based partnerships in the VA health care system to address social determinants of mental health.

An analytics approach to designing patient centered medical homes.

Science.gov (United States)

Ajorlou, Saeede; Shams, Issac; Yang, Kai

2015-03-01

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

Research Strategies for Academic Medical Centers: A Framework for Advancements toward Translational Excellence

Science.gov (United States)

Haley, Rand; Champagne, Thomas J., Jr.

2017-01-01

This review article presents a simplified framework for thinking about research strategy priorities for academic medical centers (AMCs). The framework can serve as a precursor to future advancements in translational medicine and as a set of planning guideposts toward ultimate translational excellence. While market pressures, reform uncertainties,…

Aphasia centers in North America: a survey.

Science.gov (United States)

Simmons-Mackie, Nina; Holland, Audrey L

2011-08-01

There is a growing trend toward dedicated programs designed to improve the lives of people with aphasia and their families. We are referring to these programs collectively as "aphasia centers." These programs purportedly differ from more traditional medically based aphasia rehabilitation. However, there is no directory of aphasia centers and no definition of what constitutes such a program. Therefore, an online survey was designed to identify and describe aphasia centers in the United States and Canada. A 37-question survey was posted online via SurveyMonkey. An introductory letter was distributed by electronic mail to a listserv and mailing lists of programs associated with aphasia. Potential respondents who considered themselves an aphasia center were asked to complete the survey. A total of 33 survey responses were analyzed, and descriptive data were compiled resulting in a description of the following aspects of aphasia centers: demographic information, mission, admission and discharge policies, assessment practices, program logistics, staffing patterns, marketing, funding, and services offered. In addition, a qualitative analysis of written text responses revealed the following key themes that appear to characterize the responding programs: services that differ from traditional aphasia rehabilitation; a sense of community; a holistic focus on quality of life, psychosocial well-being, participation, and social support; the centrality of group interaction; and variety/intensity of services. © Thieme Medical Publishers.

Primary care program improves reimbursement. The Federally Qualified Health Center program helps hospitals improve services to the medically indigent.

Science.gov (United States)

Fahey, T M; Gallitano, D G

1993-03-01

Under a program created by Congress in 1989, certain primary care treatment centers serving the medically and economically indigent can become Federally Qualified Health Centers (FQHCs). Recently enacted rules and regulations allow participants in the FQHC program to receive 100 percent reasonable cost reimbursement for Medicaid services and 80 percent for Medicare services. An all-inclusive annual cost report is the basis for determining reimbursement rates. The report factors in such expenses as physician and other healthcare and professional salaries and benefits, medical supplies, certain equipment depreciation, and overhead for facility and administrative costs. Both Medicaid and Medicare reimbursement is based on an encounter rate, and states employ various methodologies to determine the reimbursement level. In Illinois, for example, typical reimbursement for a qualified encounter ranges from $70 to $88. To obtain FQHC status, an organization must demonstrate community need, deliver the appropriate range of healthcare services, satisfy management and finance requirements, and function under a community-based governing board. In addition, an FQHC must provide primary healthcare by physicians and (where appropriate) midlevel practitioners; it must also offer its community diagnostic laboratory and x-ray services, preventive healthcare and dental care, case management, pharmacy services, and arrangements for emergency services. Because FQHCs must be freestanding facilities, establishing them can trigger a number of ancillary legal issues, such as those involved in forming a new corporation, complying with not-for-profit corporation regulations, applying for tax-exempt status, and applying for various property and sales tax exemptions. Hospitals that establish FQHCs must also be prepared to relinquish direct control over the delivery of primary care services.

Enabling Access to Medical and Health Education in Rwanda Using Mobile Technology: Needs Assessment for the Development of Mobile Medical Educator Apps.

Science.gov (United States)

Rusatira, Jean Christophe; Tomaszewski, Brian; Dusabejambo, Vincent; Ndayiragije, Vincent; Gonsalves, Snedden; Sawant, Aishwarya; Mumararungu, Angeline; Gasana, George; Amendezo, Etienne; Haake, Anne; Mutesa, Leon

2016-06-01

Lack of access to health and medical education resources for doctors in the developing world is a serious global health problem. In Rwanda, with a population of 11 million, there is only one medical school, hence a shortage in well-trained medical staff. The growth of interactive health technologies has played a role in the improvement of health care in developed countries and has offered alternative ways to offer continuous medical education while improving patient's care. However, low and middle-income countries (LMIC) like Rwanda have struggled to implement medical education technologies adapted to local settings in medical practice and continuing education. Developing a user-centered mobile computing approach for medical and health education programs has potential to bring continuous medical education to doctors in rural and urban areas of Rwanda and influence patient care outcomes. The aim of this study is to determine user requirements, currently available resources, and perspectives for potential medical education technologies in Rwanda. Information baseline and needs assessments data collection were conducted in all 44 district hospitals (DHs) throughout Rwanda. The research team collected qualitative data through interviews with 16 general practitioners working across Rwanda and 97 self-administered online questionnaires for rural areas. Data were collected and analyzed to address two key questions: (1) what are the currently available tools for the use of mobile-based technology for medical education in Rwanda, and (2) what are user's requirements for the creation of a mobile medical education technology in Rwanda? General practitioners from different hospitals highlighted that none of the available technologies avail local resources such as the Ministry of Health (MOH) clinical treatment guidelines. Considering the number of patients that doctors see in Rwanda, an average of 32 patients per day, there is need for a locally adapted mobile education app

Joint marketing cites excellence: Fairview-University Medical Center advertises cooperatively with University of Minnesota Physicians.

Science.gov (United States)

Botvin, Judith D

2004-01-01

Fairview-University Medical Center and University of Minnesota Physicians, both in Minneapolis, are enjoying the benefits of a co-branded advertising campaign. It includes print ads, brochures, and other marketing devices.

Mental Health Providers: Credentials, Services Offered and What to Expect

Science.gov (United States)

... and specific services they offer Treatment approaches and philosophy Which insurance providers they work with Office hours, ... trademarks of Mayo Foundation for Medical Education and Research. © 1998-2018 Mayo Foundation for Medical Education and ...

Personalizing Type 2 Diabetes Management: Use of a Patient-Centered Approach to Individualizing A1C Goals and Pharmacological Regimens.

Science.gov (United States)

Lahiri, Sharon W

2017-12-01

IN BRIEF Caring for people with type 2 diabetes requires a patient-centered approach to treatment targets and medication regimens. Focusing on patients' individual characteristics, needs, and treatment responses can improve compliance and clinical outcomes. Medication selection can be guided by the mechanisms of action, advantages, disadvantages, and costs of available options; patients' behavioral and psychological variables, personal preferences, and socioeconomic status also should be taken into account. This article provides an overview of patient-centered and individualized diabetes management, offers pharmacological recommendations for specific clinical scenarios, and describes a complicated case illustrating the patient-centered approach in clinical practice.

Master's Level Graduate Training in Medical Physics at the University of Colorado Health Sciences Center.

Science.gov (United States)

Ibbott, Geoffrey S.; Hendee, William R.

1980-01-01

Describes the master's degree program in medical physics developed at the University of Colorado Health Sciences Center. Required courses for the program, and requirements for admission are included in the appendices. (HM)

Stakeholder Perspectives on Changes in Hypertension Care Under the Patient-Centered Medical Home.

Science.gov (United States)

O'Donnell, Alison J; Bogner, Hillary R; Cronholm, Peter F; Kellom, Katherine; Miller-Day, Michelle; McClintock, Heather F de Vries; Kaye, Elise M; Gabbay, Robert

2016-02-25

Hypertension is a major modifiable risk factor for cardiovascular and kidney disease, yet the proportion of adults whose hypertension is controlled is low. The patient-centered medical home (PCMH) is a model for care delivery that emphasizes patient-centered and team-based care and focuses on quality and safety. Our goal was to investigate changes in hypertension care under PCMH implementation in a large multipayer PCMH demonstration project that may have led to improvements in hypertension control. The PCMH transformation initiative conducted 118 semistructured interviews at 17 primary care practices in southeastern Pennsylvania between January 2011 and January 2012. Clinicians (n = 47), medical assistants (n = 26), office administrators (n = 12), care managers (n = 11), front office staff (n = 7), patient educators (n = 4), nurses (n = 4), social workers (n = 4), and other administrators (n = 3) participated in interviews. Study personnel used thematic analysis to identify themes related to hypertension care. Clinicians described difficulties in expanding services under PCMH to meet the needs of the growing number of patients with hypertension as well as how perceptions of hypertension control differed from actual performance. Staff and office administrators discussed achieving patient-centered hypertension care through patient education and self-management support with personalized care plans. They indicated that patient report cards were helpful tools. Participants across all groups discussed a team- and systems-based approach to hypertension care. Practices undergoing PCMH transformation may consider stakeholder perspectives about patient-centered, team-based, and systems-based approaches as they work to optimize hypertension care.

Benefits of the effective dose equivalent concept at a medical center

International Nuclear Information System (INIS)

Vetter, R.J.; Classic, K.L.

1991-01-01

A primary objective of the recommendations of the International Committee on Radiological Protection Publication 26 is to insure that no source of radiation exposure is unjustified in relation to its benefits. This objective is consistent with goals of the Radiation Safety Committee and Institutional Review Board at medical centers where research may involve radiation exposure of human subjects. The effective dose equivalent concept facilitates evaluation of risk by those who have little or no knowledge of quantities or biological effects of radiation. This paper presents effective dose equivalent data used by radiation workers and those who evaluate human research protocols as these data relate to personal dosimeter reading, entrance skin exposure, and target organ dose. The benefits of using effective dose equivalent to evaluate risk of medical radiation environments and research protocols are also described

Health Care Provider Burnout in a United States Military Medical Center During a Period of War.

Science.gov (United States)

Sargent, Paul; Millegan, Jeffrey; Delaney, Eileen; Roesch, Scott; Sanders, Martha; Mak, Heather; Mallahan, Leonard; Raducha, Stephanie; Webb-Murphy, Jennifer

2016-02-01

Provider burnout can impact efficiency, empathy, and medical errors. Our study examines burnout in a military medical center during a period of war. A survey including the Maslach Burnout Inventory (MBI), deployment history, and work variables was distributed to health care providers. MBI subscale means were calculated and associations between variables were analyzed. Approximately 60% of 523 respondents were active duty and 34% had deployed. MBI subscale means were 19.99 emotional exhaustion, 4.84 depersonalization, and 40.56 personal accomplishment. Frustration over administrative support was associated with high emotional exhaustion and depersonalization; frustration over life/work balance was associated with high emotional exhaustion. Levels of burnout in our sample were similar to civilian medical centers. Sources of frustration were related to administrative support and life/work balance. Deployment had no effect on burnout levels. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Patient-centered medical home initiatives expanded in 2009-13: providers, patients, and payment incentives increased.

Science.gov (United States)

Edwards, Samuel T; Bitton, Asaf; Hong, Johan; Landon, Bruce E

2014-10-01

Patient-centered medical home initiatives are central to many efforts to reform the US health care delivery system. To better understand the extent and nature of these initiatives, in 2013 we performed a nationwide cross-sectional survey of initiatives that included payment reform incentives in their models, and we compared the results to those of a similar survey we conducted in 2009. We found that the number of initiatives featuring payment reform incentives had increased from 26 in 2009 to 114 in 2013. The number of patients covered by these initiatives had increased from nearly five million to almost twenty-one million. We also found that the proportion of time-limited initiatives--those with a planned end date--was 20 percent in 2013, a decrease from 77 percent in 2009. Finally, we found that the dominant payment model for patient-centered medical homes remained fee-for-service payments augmented by per member per month payments and pay-for-performance bonuses. However, those payments and bonuses were higher in 2013 than they were in 2009, and the use of shared-savings models was greater. The patient-centered medical home model is likely to continue both to become more common and to play an important role in delivery system reform. Project HOPE—The People-to-People Health Foundation, Inc.

Relationship between Participation in Patient- and Family-Centered Care Training and Communication Adaptability among Medical Students: Changing Hearts, Changing Minds

Science.gov (United States)

Rossignol, Lisa

2015-01-01

Background: Patient- and family-centered care (PFCC) training is an important component of many medical school curricula in the US. Purpose: To determine if an existing quantitative measure of communication adaptability can be used to determine skills acquired by medical students after PFCC training. Methods: A census was conducted of 43 third-year medical students at the University of New Mexico School of Medicine, Albuquerque, NM. Students participated in the Families as Faculty program of Parents Reaching Out during their pediatric rotation. A pretest and posttest of Duran’s 1983 Communicative Adaptability Scale was performed. Results: A one-way analysis of variance was conducted and revealed that there was statistical significance for the factor called appropriate disclosure (p = 0.04). When mean plot was conducted, there was a positive correlation between pretest and posttests in social experience, wit, and social confirmation. There was a negative correlation for articulation and social composure, which was not significant. Conclusion: The Communicative Adaptability Scale was an effective way to evaluate communication skills that students acquire from PFCC training. An increase in appropriate disclosure is an important gain because it means students have become more sensitive to the level of intimacy that the other person is seeking and the student is willing to offer more information. Information sharing is one of the core concepts of PFCC. Finally, the negative correlation for articulation and social composure indicate that Families as Faculty may increase anxiety for medical students, so this is an area of the education that may need to be revisited. PMID:26176569

Academic season does not influence cardiac surgical outcomes at US Academic Medical Centers.

Science.gov (United States)

Lapar, Damien J; Bhamidipati, Castigliano M; Mery, Carlos M; Stukenborg, George J; Lau, Christine L; Kron, Irving L; Ailawadi, Gorav

2011-06-01

Previous studies have demonstrated the influence of academic season on outcomes in select surgical populations. However, the influence of academic season has not been evaluated nationwide in cardiac surgery. We hypothesized that cardiac surgical outcomes were not significantly influenced by time of year at both cardiothoracic teaching hospitals and non-cardiothoracic teaching hospitals nationwide. From 2003 to 2007, a weighted 1,614,394 cardiac operations were evaluated using the Nationwide Inpatient Sample database. Patients undergoing cardiac operations at cardiothoracic teaching and non-cardiothoracic teaching hospitals were identified using the Association of American Medical College's Graduate Medical Education Tracking System. Hierarchic multivariable logistic regression analyses were used to estimate the effect of academic quarter on risk-adjusted outcomes. Mean patient age was 65.9 ± 10.9 years. Women accounted for 32.8% of patients. Isolated coronary artery bypass grafting was the most common operation performed (64.7%), followed by isolated valve replacement (19.3%). The overall incidence of operative mortality and composite postoperative complication rate were 2.9% and 27.9%, respectively. After accounting for potentially confounding risk factors, timing of operation by academic quarter did not independently increase risk-adjusted mortality (p = 0.12) or morbidity (p = 0.24) at academic medical centers. Risk-adjusted mortality and morbidity for cardiac operations were not associated with time of year in the US at teaching and nonteaching hospitals. Patients should be reassured of the safety of performance of cardiac operations at academic medical centers throughout a given academic year. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Creating a vision for your medical call center.

Science.gov (United States)

Barr, J L; Laufenberg, S; Sieckman, B L

1998-01-01

MCC technologies and applications that can have a positive impact on managed care delivery are almost limitless. As you determine your vision, be sure to have in mind the following questions: (1) Do you simply want an efficient front end for receiving calls? (2) Do you want to offer triage services? (3) Is your organization ready for a fully functional "electronic physician's office?" Understand your organization's strategy. Where are you going, not only today but five years from now? That information is essential to determine your vision. Once established, your vision will help determine what you need and whether you should build or outsource. Vendors will assist in cost/benefit analysis of their equipment, but do not lose sight of internal factors such as "prior inclination" costs in the case of a nurse triage program. The technology is available to take your vision to its outer reaches. With the projected increase in utilization of call center services, don't let your organization be left behind!

Current neurotrauma treatment practice in secondary medical service centers

International Nuclear Information System (INIS)

Suehiro, Eiichi; Yoshino, Hiroko; Koizumi, Hiroyasu; Yoneda, Hiroshi; Suzuki, Michiyasu

2011-01-01

Despite neurotrauma treatment practices comprising a significant amount of neurosurgical work for secondary medical service centers, little attention has been placed on neurotrauma cases and evaluation of current neurotrauma treatment practices is limited. Therefore we investigated current neurotrauma practices in our hospital located in a Japanese suburban city. We analyzed 439 patients with traumatic brain injury (TBI) admitted to our hospital between April 2004 and October 2010. Patients were divided into three groups based on the Glasgow Coma Scale (GCS) score on admission: mild TBI (GCS 14-15) in 252 patients (57.4%), moderate TBI (GCS 9-13) in 116 patients (26.4%), and severe TBI (GCS 3-8) in 71 patients (16.2%). Age, gender, alcohol consumption, cause of injury, cranial CT findings, neurosurgical procedure, length of hospital stay, and clinical outcome were analyzed. The average age of the patients was 59.2 years old. Male patients comprised 65%. Alcohol consumption was reported in 81 cases (18.5%), most of them with moderate TBI. Fall (208 cases, 47.4%) was the most frequent cause of injury, followed by traffic accident (115 cases, 26.2%) and high fall (73 cases, 16.6%). Acute subdural hematoma (174 cases, 39.6%) was most frequently seen in cranial CT findings on admission, which significantly increased with severity. A neurosurgical procedure was performed for 70 cases (15.9%), of which 15 (6.0%) were mild TBI and 18 (15.5%) were moderate TBI. The average hospital stay was 20.8 days, which significantly increased with severity. The overall rate of favorable outcome was 82.7%, and mortality was 8.2%; outcome deteriorated with severity. Some mild and moderate TBI cases had deteriorated and required surgery or resulted in death. These findings suggest that cautious treatment is necessary even in mild to moderate TBI cases which are often encountered in secondary medical service centers. (author)

Impact of Mobile Dose-Tracking Technology on Medication Distribution at an Academic Medical Center.

Science.gov (United States)

Kelm, Matthew; Campbell, Udobi

2016-05-01

Medication dose-tracking technologies have the potential to improve efficiency and reduce costs associated with re-dispensing doses reported as missing. Data describing this technology and its impact on the medication use process are limited. The purpose of this study is to assess the impact of dose-tracking technology on pharmacy workload and drug expense at an academic, acute care medical center. Dose-tracking technology was implemented in June 2014. Pre-implementation data were collected from February to April 2014. Post-implementation data were collected from July to September 2014. The primary endpoint was the percent of re-dispensed oral syringe and compounded sterile product (CSP) doses within the pre- and post-implementation periods per 1,000 discharges. Secondary endpoints included pharmaceutical expense generated from re-dispensing doses, labor costs, and staff satisfaction with the medication distribution process. We observed an average 6% decrease in re-dispensing of oral syringe and CSP doses from pre- to post-implementation (15,440 vs 14,547 doses; p = .047). However, when values were adjusted per 1,000 discharges, this trend did not reach statistical significance (p = .074). Pharmaceutical expense generated from re-dispensing doses was significantly reduced from pre- to post-implementation ($834,830 vs $746,466 [savings of $88,364]; p = .047). We estimated that $2,563 worth of technician labor was avoided in re-dispensing missing doses. We also saw significant improvement in staff perception of technology assisting in reducing missing doses (p = .0003), as well as improvement in effectiveness of resolving or minimizing missing doses (p = .01). The use of mobile dose-tracking technology demonstrated meaningful reductions in both the number of doses re-dispensed and cost of pharmaceuticals dispensed.

[Management of medical care for the victims of road accidents in traumatology centers of Saint-Petersburg].

Science.gov (United States)

Tulupov, A N; Afonchikov, V Iu; Chikin, A E; Taniia, S Sh; Ganin, A S

2014-01-01

The number of road accidents, fatal outcomes and victims exceeded in 1.5 times in Saint-Petersburg in comparison with Moscow. At the average, 600 victims were treated in each of 6 first-level traumatology centers every year. The quantity of patients, who were admitted to 3 second-level traumatology centers, numbered 10 times less. About 300 people entered to others hospitals. The lethality consisted of 15%, 20% and 37%, respectively. There are a lot of matters, that should be discussed, such as an importance of better treatment financing of multitrauma by using compulsory medical insurance system, an optimization of pre-admission treatment and a necessity of patient delivery by mobile medical team using the anaesthesiology and resuscitation.

Faculty development programs for medical teachers in India

Directory of Open Access Journals (Sweden)

SANJAY ZODPEY

2016-04-01

Full Text Available Introduction: India has the highest number of medical colleges in the world and subsequently the higher number of medical teachers. There is a dire need of adopting a systematic approach to faculty development to enhance quality education to meet health challenges for 21st Century. This manuscript provides a landscape of faculty development programs in India, identifying gaps and opportunities for reforms in faculty development. Methods: Conventionally, FDPs are organized by medical colleges and universities through Basic Courses and Advanced Courses focusing on pedagogy. Medical Council of India is facilitating FDPs through 18 selected regional centers to enable medical teachers to avail modern education technology for teaching from July 2009. Foundation for Advancement of International Medical Education and Research has three Regional Institutes in India. Results: Recommendations include the need for formulating a national strategy for faculty development to not only enhance the quantity of medical teachers but also the quality of medical education; providing support for Departments of Medical Education/Regional Centers in terms of finance and staffing and incorporation of teaching skills in postgraduate training. Conclusion: Distance learning courses focusing on educational leadership and pedagogy for medical teachers can be an option to reach a wider audience. FDPs can be an asset in recruiting and retaining teachers as they offer valued professional development opportunities.

Publications in academic medical centers: technology-facilitated culture clash.

Science.gov (United States)

Berner, Eta S

2014-05-01

Academic culture has a set of norms, expectations, and values that are sometimes tacit and sometimes very explicit. In medical school and other health professions educational settings, probably the most common norm includes placing a high value on peer-reviewed research publications, which are seen as the major evidence of scholarly productivity. Other features of academic culture include encouraging junior faculty and graduate students to share their research results at professional conferences and lecturing with slides as a major way to convey information. Major values that faculty share with journal editors include responsible conduct of research and proper attribution of others' words and ideas. Medical school faculty also value technology and are often quick to embrace technological advances that can assist them in their teaching and research. This article addresses the effects of technology on three aspects of academic culture: education, presentations at professional meetings, and research publications.The technologies discussed include online instruction, dissemination of conference proceedings on the Internet, plagiarism-detection software, and new technologies deployed by the National Center for Biotechnology Information, the home of PubMed. The author describes how the ease of deploying new technologies without faculty changing their norms and behavior in the areas of teaching and research can lead to conflicts of values among key stakeholders in the academic medical community, including faculty, journal editors, and professional associations. The implications of these conflicts and strategies for managing them are discussed.

Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center

Science.gov (United States)

Detweiler, Mark B.; Pagadala, Bhuvaneshwar; Candelario, Joseph; Boyle, Jennifer S.; Detweiler, Jonna G.; Lutgens, Brian W.

2016-01-01

The effectiveness of medications for PTSD in general has been well studied, but the effectiveness of medicatio.ns prescribed specifically for post-traumatic stress disorder (PTSD) nightmares is less well known. This retrospective chart review examined the efficacy of various medications used in actual treatment of PTSD nightmares at one Veteran Affairs Hospital. Records at the Salem, VA Veterans Affairs Medical Center (VAMC) were examined from 2009 to 2013 to check for the efficacy of actual treatments used in comparis.on with treatments suggested in three main review articles. The final sample consisted of 327 patients and 478 separate medication trials involving 21 individual medications plus 13 different medication combinations. The three most frequently utilized medications were prazosin (107 trials), risperidone (81 trials), and quetiapine (72 trials). Five medications had 20 or more trials with successful results (partial to full nightmare cessation) in >50% of trials: risperidone (77%, 1.0–6.0 mg), clonidine (63%, 0.1–2.0 mg), quetiapine (50%, 12.5–800.0 mg), mirtazapine (50%; 7.5–30.0 mg), and terazosin (64%, 50.0–300.0 mg). Notably, olanzapine (2.5–10.0) was successful (full remission) in all five prescription trials in five separate patients. Based on the clinical results, the use of risperidone, clonidine, terazosin, and olanzapine warrants additional investigation in clinically controlled trials as medications prescribed specifically for PTSD nightmares. PMID:27999253

Patient-Centered Medical Home and Family Burden in Attention-Deficit Hyperactivity Disorder.

Science.gov (United States)

Ronis, Sarah D; Baldwin, Constance D; Blumkin, Aaron; Kuhlthau, Karen; Szilagyi, Peter G

2015-01-01

Attention-deficit hyperactivity disorder (ADHD) can impair child health and functioning, but its effects on the family's economic burden are not well understood. The authors assessed this burden in US families of children with ADHD, and the degree to which access to a patient-centered medical home (PCMH) might reduce this burden. We conducted cross-sectional analyses of 2005-2006 and 2009-2010 National Surveys of Children with Special Health Care Needs, focusing on families of children with ADHD. They defined family economic burden as (1) family financial problems (annual expenses for the child's health care or illness-related financial problems for the family) and/or (2) family employment problems (job loss, work time loss, or failure to change jobs to avoid insurance loss). Relative risk models assessed associations between PCMH and family economic burden, adjusted for child age, sex, ethnicity, ADHD severity, poverty status, caregiver education, and insurance. In 2009, 26% of families reported financial problems because of the child's ADHD, 2.1% reported out-of-pocket expenses >5% of income, and 36% reported employment problems. Only 38% reported care that met all 5 criteria for a PCMH (similar to rates in 2005-2006). In multivariable analysis, care in a PCMH was associated with 48% lower relative risk (RR) of financial problems (RR = 0.52, p family-centered care and care coordination were more strongly associated with lower burden. The economic burdens of families with ADHD are significant but may be alleviated by family-centered care and care coordination in a medical home.

[Medical fault or professional negligence? Case studies in two recovery nutrition centers in Niger].

Science.gov (United States)

Halidou Doudou, M; Manzo, M L; Guero, D

2014-12-01

In developing countries such as Niger, the risk of medical malpractice is ubiquitous in health, jeopardizing patient safety. The aim of this work was to contribute to patients' safety and respect of code of ethics and conduct in the exercise of the medical profession. The reported cases involved two children under 5 years who were admitted to nutrition rehabilitation centers, died as a result of medical malpractice. In Niger, there are no statistics on this phenomenon and a few cases found have always been considered "accident" or "fate." The establishment of an observatory collections of such information should improve their frequency, consequences and propose a prevention plan. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

A Primer on Endoscopic Electronic Medical Records

OpenAIRE

Atreja, Ashish; Rizk, Maged; Gurland, Brooke

2010-01-01

Endoscopic electronic medical record systems (EEMRs) are now increasingly utilized in many endoscopy centers. Modern EEMRs not only support endoscopy report generation, but often include features such as practice management tools, image and video clip management, inventory management, e-faxes to referring physicians, and database support to measure quality and patient outcomes. There are many existing software vendors offering EEMRs, and choosing a software vendor can be time consuming and co...

Medical Tourism: Globalization of the Healthcare Marketplace

Science.gov (United States)

Horowitz, Michael D.; Rosensweig, Jeffrey A.; Jones, Christopher A.

2007-01-01

The citizens of many countries have long traveled to the United States and to the developed countries of Europe to seek the expertise and advanced technology available in leading medical centers. In the recent past, a trend known as medical tourism has emerged wherein citizens of highly developed countries choose to bypass care offered in their own communities and travel to less developed areas of the world to receive a wide variety of medical services. Medical tourism is becoming increasingly popular, and it is projected that as many as 750,000 Americans will seek offshore medical care in 2007. This phenomenon is driven by marketplace forces and occurs outside of the view and control of the organized healthcare system. Medical tourism presents important concerns and challenges as well as potential opportunities. This trend will have increasing impact on the healthcare landscape in industrialized and developing countries around the world. PMID:18311383

Medical tourism: globalization of the healthcare marketplace.

Science.gov (United States)

Horowitz, Michael D; Rosensweig, Jeffrey A; Jones, Christopher A

2007-11-13

The citizens of many countries have long traveled to the United States and to the developed countries of Europe to seek the expertise and advanced technology available in leading medical centers. In the recent past, a trend known as medical tourism has emerged wherein citizens of highly developed countries choose to bypass care offered in their own communities and travel to less developed areas of the world to receive a wide variety of medical services. Medical tourism is becoming increasingly popular, and it is projected that as many as 750,000 Americans will seek offshore medical care in 2007. This phenomenon is driven by marketplace forces and occurs outside of the view and control of the organized healthcare system. Medical tourism presents important concerns and challenges as well as potential opportunities. This trend will have increasing impact on the healthcare landscape in industrialized and developing countries around the world.

Impact of a Patient-Centered Medical Home on Access, Quality, and Cost

Science.gov (United States)

2013-02-01

Effec- tiveness Data and Information Set metrics, and composite measures for access, patient satisfaction, provider communica- tion, and customer service...reduced health care costs. The patient -centered medical home (PCMH) concept is “an approach to providing comprehensive primary care [in] a health care... patient at the right place and right time” is vital to the appro- priate utilization of health care services across a broad spec- trum of patient needs

The field of medical anthropology in Social Science & Medicine.

Science.gov (United States)

Panter-Brick, Catherine; Eggerman, Mark

2018-01-01

Conceptually and methodologically, medical anthropology is well-positioned to support a "big-tent" research agenda on health and society. It fosters approaches to social and structural models of health and wellbeing in ways that are critically reflective, cross-cultural, people-centered, and transdisciplinary. In this review article, we showcase these four main characteristics of the field, as featured in Social Science & Medicine over the last fifty years, highlighting their relevance for an international and interdisciplinary readership. First, the practice of critical inquiry in ethnographies of health offers a deep appreciation of sociocultural viewpoints when recording and interpreting lived experiences and contested social worlds. Second, medical anthropology champions cross-cultural breadth: it makes explicit local understandings of health experiences across different settings, using a fine-grained, comparative approach to develop a stronger global platform for the analysis of health-related concerns. Third, in offering people-centered views of the world, anthropology extends the reach of critical enquiry to the lived experiences of hard-to-reach population groups, their structural vulnerabilities, and social agency. Finally, in developing research at the nexus of cultures, societies, biologies, and health, medical anthropologists generate new, transdisciplinary conversations on the body, mind, person, community, environment, prevention, and therapy. As featured in this journal, scholarly contributions in medical anthropology seek to debate human health and wellbeing from many angles, pushing forward methodology, social theory, and health-related practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

Measuring the Cost of the Patient-Centered Medical Home: A Cost-Accounting Approach.

Science.gov (United States)

Lieberthal, Robert D; Payton, Colleen; Sarfaty, Mona; Valko, George

To explore the cost for individual practices to become more patient-centered, we inventoried and calculated the cost of costly activities involved in implementing the Patient-Centered Medical Home (PCMH) as defined by the National Committee for Quality Assurance. There were 3 key findings. The cost of each PCMH-related clinical activity can be classified in 1 of 3 major categories. Cost offsets can be used to defray part of the cost recognition. The cost of PCMH transformation varied by practice with no clear level or pattern of costs. Our study suggests that small- and medium-sized practices may experience difficulty with the financial burden of PCMH recognition.

[Medical centers--methods, purpose and benefits].

Science.gov (United States)

Schrappe, Matthias

2007-01-01

The German hospital sector is characterized by a profound deficit in organizational integration. The implementation of centers as one way to improve the situation is complicated by the heterogeneity of the concept and understanding of the term "center". The author proposes to distinguish between functional, divisional and process-oriented centers. In German hospitals where the transition from functional to divisional organization is under way matrix elements can be expected to be introduced into organizational practice. Process-oriented centers like breast centers represent matrix components by simultaneously applying functional and process-oriented perspectives. Matrix components map the complexity of clinical structures, but increase coordination and management load and should be applied only to a limited number of care processes.

Detecting Postpartum Depression in Referents to Medical and Health Centers in Hamadan City

Directory of Open Access Journals (Sweden)

F. Shobeiri

2007-10-01

Full Text Available Introduction & Objective: Pregnancy and childbirth are significant developmental excitable for most women. Physical, intrapersonal and relational adaptations are needed to adjust successfully to pregnancy and delivery. Postpartum depression is a serious psychiatric disorder and the adverse impact on infants has been noted. The purpose of this study was to detect postpartum depression in referents to medical and health centers in Hamadan city.Materials & Methods: A descriptive and cross-sectional study involving 400 women completed the Beck Depression Inventory (BDI within 2-8 weeks of delivery was conducted in urban health centers in Hamadan city, Iran. Data were collected through interviews with women in the clinics in the health centers. Data processing and statistical analysis were performed using SPSS 10.0.Results: The results revealed that majority of women (68.0% were considered normal. Depression was detected in 32.0% of women. Out of these 19.0, 4.0 and 9.0% were mild, moderate and severe depression, respectively. There were statistically significant differences between postpartum depression and age, number of delivery, education, job and husband's job (P=0.000.Conclusion: Nearly 32.0% of selected women had depression. Therefore, it is important for medical personnel to be well versed in the course and treatment of postpartum depression. Post partum depression should be screened and treated as early as possible for several reasons. It can cause significant suffering for the woman who experiences it, and it can have deleterious consequences for the newborn.

Strategi Public Relations Dalam Membangun Branding Rumah Sakit Telogorejo Menjadi Semarang Medical Center

OpenAIRE

Pertiwi, Rifka Ayu; Naryoso, Agus; Luqman, Yanuar

2013-01-01

ViiiSTRATEGI PUBLIC RELATIONS DALAM MEMBANGUN BRANDINGRUMAH SAKIT TELOGOREJO MENJADI SEMARANG MEDICALCENTERAbstrakPerubahan brand merupakan hal yang sering terjadi pada sebuah institusi atauperusahaan. Hal ini menjadi salah satu pekerjaan humas yang bersangkutan dalammendapatkan kesadaran target audiens terhadap Perubahan brand tersebut.RS Telogorejo melakukan Perubahan brand menjadi Semarang MedicalCenter. Sedangkan brand RS Telogorejo sudah melekat di benak target audienssebagai rumah sakit...

STRESSFUL SITUATIONS IN THE WORK OF A MULTIPROFILE PEDIATRIC MEDICAL FACILITY'S CALL CENTER

Directory of Open Access Journals (Sweden)

I. M. Spivak

2015-01-01

Full Text Available Stressful situations in the work of a pediatric medical facility's call center are associated with patients' violation of social communication norms and aggressive behavior, as well as the operator's professional/maternal conflict. The following psychological resources facilitate better stress resistance of operators: self-confidence, mature and rational attitude, personal activity, inner satisfaction, optimism, emotional breadth and emotional colleague support. 

Financial impact of hand surgery programs on academic medical centers.

Science.gov (United States)

Hasan, Jafar S; Chung, Kevin C; Storey, Amy F; Bolg, Mary L; Taheri, Paul A

2007-02-01

This study analyzes the financial performance of hand surgery in the Department of Surgery at the University of Michigan. This analysis can serve as a reference for other medical centers in the financial evaluation of a hand surgery program. Fiscal year 2004 billing records for all patients (n = 671) who underwent hand surgery procedures were examined. The financial data were separated into professional revenues and costs (relating to the hand surgery program in the Section of Plastic Surgery) and into facility revenues and costs (relating to the overall University of Michigan Health System). Professional net revenue was calculated by applying historical collection rates to procedural and clinic charges. Facility revenue was calculated by applying historical collection rates to the following charge categories: inpatient/operating room, clinic facility, neurology/electromyography, radiology facilities, and occupational therapy. Total professional costs were calculated by adding direct costs and allocated overhead costs. Facility costs were obtained from the hospital's cost accounting system. Professional and facility incomes were calculated by subtracting costs from revenues. The net professional revenue and total costs were 1,069,836 and 1,027,421 dollars, respectively. Professional operating income was 42,415 dollars, or 3.96 percent of net professional revenue. Net facility revenue and total costs were 5,500,606 and 4,592,534 dollars, respectively. Facility operating income was 908,071 dollars, or 16.51 percent of net facility revenues. While contributing to the academic mission of the institution, hand surgery is financially rewarding for the Department of Surgery. In addition, hand surgery activity contributes substantially to the financial well-being of the academic medical center.

Medical student service learning program teaches secondary students about career opportunities in health and medical fields.

Science.gov (United States)

Karpa, Kelly; Vakharia, Kavita; Caruso, Catherine A; Vechery, Colin; Sipple, Lanette; Wang, Adrian

2015-12-01

Engagement of academic medical centers in community outreach provides the public with a better understanding of basic terms and concepts used in biomedical sciences and increases awareness of important health information. Medical students at one academic medical center initiated an educational outreach program, called PULSE, that targets secondary students to foster their interest in healthcare and medicine. High school student participants are engaged in a semester-long course that relies on interactive lectures, problem-based learning sessions, mentoring relationships with medical students, and opportunities for shadowing healthcare providers. To date, the curriculum has been offered for 7 consecutive years. To determine the impact that participation in the curriculum has had on college/career choices and to identify areas for improvement, an electronic questionnaire was sent to former participants. Based on a 32% response rate, 81% of former participants indicated that participation in the course influenced their decision to pursue a medical/science-related career. More than half (67%) of respondents indicated intent to pursue a MD/PhD or other postgraduate degree. Based on responses obtained, additional opportunities to incorporate laboratory-based research and simulation sessions should be explored. In addition, a more formalized mentoring component has been added to the course to enhance communication between medical students and mentees. Health/medicine-related educational outreach programs targeting high school students may serve as a pipeline to introduce or reinforce career opportunities in healthcare and related sciences. Copyright © 2015 The American Physiological Society.

Opportunities for social workers in the patient centered medical home.

Science.gov (United States)

Hawk, Mary; Ricci, Edmund; Huber, George; Myers, Marcella

2015-01-01

The Patient Centered Medical Home (PCMH) has been hailed as one method of improving chronic care outcomes in the United States. A number of studies have underscored the importance of the social work role within the PCMH, yet little existing research explores the social worker as a driver of improved patient care. The Pennsylvania Chronic Care Initiative was created with a primary goal of increasing the number of practices that were recognized as PCMH by the National Committee for Quality Assurance. This article describes findings from in-depth qualitative interviews with representatives from seven primary care practices, in which the authors examined barriers and facilitators to implementation of the initiative. Barriers to implementation included small practice size, payer-driven care, not having a strong physician champion, variability within patient populations, and high implementation costs. Facilitators included having a social worker coordinate behavioral health services, clinical nurse case managers, preexisting models of outcomes-driven care, and being part of an integrated health delivery and financing system. Recommendations strengthening the role of medical social workers in primary care practices are discussed.

Collaboration between a college of pharmacy and a for-profit health system at an academic medical center.

Science.gov (United States)

Bird, Matthew L; Dunn, Rebecca L; Hagemann, Tracy M; Burton, Michael E; Britton, Mark L; St Cyr, Mark B

2012-07-01

The genesis and growth of a successful 14-year partnership between the University of Oklahoma (OU) college of pharmacy and the OU Medical Center (OUMC) department of pharmacy are described. Pursuant to a 1998 joint operating agreement, the medical center and pharmacy school have achieved a high degree of collaboration on a wide range of educational and clinical initiatives. The close relationship has conferred a number of benefits on both institutions, including (1) expanded experiential education opportunities for pharmacy students, (2) joint faculty and staff funding arrangements that have facilitated the development and accreditation of OU pharmacy residency programs, and (3) patient care initiatives that have increased awareness of pharmacists' important contributions in areas such as venous thromboembolism prophylaxis, antibiotic stewardship, and core measures compliance. In addition to the formal integration of the college of pharmacy into the OUMC organizational structure, ongoing teamwork by clinicians and administrators at the two institutions has strengthened the 14-year partnership while helping to identify creative solutions to evolving communications, technology, and reimbursement challenges. Potential growth opportunities include the expansion of pharmacy services into additional service areas and greater involvement by OU pharmacy school faculty in the training of medical, nursing, and allied health professionals. A large for-profit academic medical center and a college of pharmacy developed a successful collaboration that is mutually beneficial and provides increased clinical, educational, and scholarly opportunities, advancing the mission of both institutions.

Role for automated communication strategies in medication adherence management.

Science.gov (United States)

Ross, S Michael

2008-11-01

Lack of medication adherence is a prevalent problem that causes a broad range of health-and health-economics-related issues. Adherence management is therefore an important strategy, but it also presents its own set of challenges. Interventional communication from care support teams at managed care organizations and disease management and wellness programs has proved effective at modifying patients' medication adherence and reporting behaviors. However, these communications do not work well from an economic standpoint. It is not economically feasible to scale call centers and the numbers of clinical and professional staff to communicate with the increasing number of patients with chronic diseases who require ongoing medication use. Using communication automation to augment traditional call center outreach can help to mediate patient medication-taking behaviors. Specific design criteria for the automation of this interaction are discussed in this article, offering supporting data from a recent trial of 304 elderly patients with hypertension, and showing the benefits of using such a system for effective blood pressure monitoring, at reduced costs.

Preventing and responding to complaints of sexual harassment in an academic health center: a 10-year review from the Medical University of South Carolina.

Science.gov (United States)

Best, Connie L; Smith, Daniel W; Raymond, John R; Greenberg, Raymond S; Crouch, Rosalie K

2010-04-01

There is a high incidence of sexual harassment and gender discrimination in academic health center (AHC) settings according to multiple surveys of medical students. Therefore, it is incumbent on AHCs to develop programs both to educate faculty, residents, and students and to handle complaints of possible episodes of sexual harassment or gender discrimination. Despite the apparent high prevalence of gender discrimination and sexual harassment, and the importance of handling complaints of gender discrimination and sexual harassment in a prompt, consistent, and rational manner, there are few descriptions of programs that address those concerns in AHCs.Herein, the authors describe their experiences in dealing with complaints of sexual harassment and gender discrimination for a 10-year period of time (late 1997 to early 2007) at the Medical University of South Carolina, through an Office of Gender Equity. They describe their complaint process, components of their prevention training, and the outcomes of 115 complaints. Key elements of their policies are highlighted. The authors offer an approach that could serve as a model for other AHCs.

Observing principles of medical ethics during family planning services at Tehran urban healthcare centers in 2007

Directory of Open Access Journals (Sweden)

Saeed Motevallizadeh

2011-01-01

Full Text Available Background: Family planning has been defined in the framework of mothers and children plan as one of Primary Healthcare (PHC details. Besides quantity, the quality of services, particularly in terms of ethics, such as observing individuals’ privacy, is of great importance in offering family planning services.Objective: A preliminary study to gather information about the degree of medical ethics offered during family planning services at Tehran urban healthcare centers.Materials and Methods: A questionnaire was designed for study. In the first question regarding informed consent, 47 clients who were advised about various contraception methods were asked whether advantages and disadvantages of the contraceptive methods have been discussed by the service provider. Then a certain rank was measured for either client or method in 2007. Finally, average value of advantage and disadvantage for each method was measured. In questions about autonomy, justice and beneficence, yes/no answers have been expected and measured accordingly.Results: Health care providers have stressed more on the advantages of pills and disadvantages of tubectomy and have paid less attention to advantages of injection ampoules and disadvantages of pills in first time clients. While they have stressed more on the advantages and disadvantages of tubectomy and less attention to advantages of condom and disadvantages of vasectomy in second time clients. Clients divulged their 100% satisfaction in terms of observing turns and free charges services.Observance degree of autonomy was 64.7% and 77.3% for first time and second- time clients respectively.Conclusion: Applying the consultant’s personal viewpoint for selecting a method will breach an informed consent for first and second time clients. System has good consideration to justice and no malfeasance

Use of HIV pre-exposure prophylaxis during the preconception, antepartum and postpartum periods at two United States medical centers.

Science.gov (United States)

Seidman, Dominika L; Weber, Shannon; Timoney, Maria Teresa; Oza, Karishma K; Mullins, Elizabeth; Cohan, Deborah L; Wright, Rodney L

2016-11-01

Pregnancy may increase a woman's susceptibility to HIV. Maternal HIV acquisition during pregnancy and lactation is associated with increased perinatal and lactational HIV transmission. There are no published reports of preexposure prophylaxis use after the first trimester of pregnancy or during lactation. The purpose of this study was to report the use of preexposure prophylaxis and to identify gaps in HIV prevention services for women who were at substantial risk of HIV preconception and during pregnancy and lactation at 2 United States medical centers. Chart review was performed on women who were identified as "at significant risk" for HIV acquisition preconception (women desiring pregnancy) and during pregnancy and lactation at 2 medical centers in San Francisco and New York from 2010-2015. Women were referred to specialty clinics for women who were living with or were at substantial risk of HIV. Twenty-seven women who were identified had a median age of 27 years. One-half of the women had unstable housing, 22% of the women had ongoing intimate partner violence, and 22% of the women had active substance use. Twenty-six women had a male partner living with HIV, and 1 woman had a male partner who had sex with men. Of the partners who were living with HIV, 73% (19/26) were receiving antiretroviral therapy, and 42% (11/26) had documented viral suppression. Thirty-nine percent (10/26) of partners had known detectable virus, and 19% (5/26) had unknown viral loads. Women were identified by clinicians, health educators, and health departments. Approximately one-third of the women were identified preconception (8/27); the majority of the women were identified during pregnancy (18/27) with a median gestational age of 20 weeks (interquartile range, 11-23), and 1 woman was identified in the postpartum period. None of the pregnant referrals had received safer conception counseling to reduce HIV transmission. Twenty-six percent of all women (7/27) were eligible for

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

Science.gov (United States)

Dolovich, Lisa

2012-04-01

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

Preclinical students’ experiences in early clerkships after skills training partly offered in primary health care centers: a qualitative study from Indonesia

Science.gov (United States)

2012-01-01

Background Students may encounter difficulties when they have to apply clinical skills trained in their pre-clinical studies in clerkships. Early clinical exposure in the pre-clinical phase has been recommended to reduce these transition problems. The aim of this study is to explore differences in students' experiences during the first clerkships between students exclusively trained in a skills laboratory and peers for whom part of their skills training was substituted by early clinical experiences (ECE). Methods Thirty pre-clinical students trained clinical skills exclusively in a skills laboratory; 30 peers received part of their skills training in PHC centers. Within half a year after commencing their clerkships all 60 students shared their experiences in focus group discussions (FGDs). Verbatim transcripts of FGDs were analyzed using Atlas-Ti software. Results Clerkship students who had participated in ECE in PHC centers felt better prepared to perform their clinical skills during the first clerkships than peers who had only practiced in a skills laboratory. ECE in PHC centers impacted positively in particular on students’ confidence, clinical reasoning, and interpersonal communication. Conclusion In the Indonesian setting ECE in PHC centers reduce difficulties commonly encountered by medical students in the first clerkships. PMID:22640419

[Medical equipment companies and their ties with technology development centers in Mexico].

Science.gov (United States)

Hernández, B; Arredondo, A; Cruz, C; Sánchez, E; Damián, T

1993-10-01

The purpose of this study was to determine the characteristics of the companies that produce, distribute, and service medical equipment in Mexico and the factors related to whether or not they had established ties with research and technology development centers. The data analyzed came from a survey of such companies carried out in Mexico City and environs in 1989. The information was updated in 1991. Multivariate analyses were carried out in order to identify the characteristics of companies that had established ties or wished to do so and the areas of interest of those companies. Of 208 companies surveyed, only 23% had ties with research centers. The companies that had such ties or were interested in establishing them tended to invest in research and to have made plans for expansion. The establishment of ties appeared to be a two-way process, with positive consequences for the companies involved, the research centers, and the health sector. It was concluded that it would be advantageous to design programs to promote ties with companies having the characteristics mentioned.

Putting patients first: a novel patient-centered model for medical enterprise success.

Science.gov (United States)

Dhawan, Naveen

2014-01-01

This article introduces a new way of viewing patient-customers. It encourages a greater emphasis on patients' needs and the importance of considering dimensions of the patient experience to better serve them. It also draws from examples in the general business world as they can be applied to medical enterprises. The author introduces a model that directs all business activities toward the end consumer with an underlying guidance by patient needs. A business is advised to understand its customer, design a patient-directed vision, and focus on creating a unique customer experience. The article delineates key action items for physicians and administrators that will allow them to better meet their patient-customers' needs and develop loyalty. By practicing a patient-centered approach and following these guidelines, one may ensure greater success of the medical enterprise.

Three-dimensional imaging technology offers promise in medicine.

Science.gov (United States)

Karako, Kenji; Wu, Qiong; Gao, Jianjun

2014-04-01

Medical imaging plays an increasingly important role in the diagnosis and treatment of disease. Currently, medical equipment mainly has two-dimensional (2D) imaging systems. Although this conventional imaging largely satisfies clinical requirements, it cannot depict pathologic changes in 3 dimensions. The development of three-dimensional (3D) imaging technology has encouraged advances in medical imaging. Three-dimensional imaging technology offers doctors much more information on a pathology than 2D imaging, thus significantly improving diagnostic capability and the quality of treatment. Moreover, the combination of 3D imaging with augmented reality significantly improves surgical navigation process. The advantages of 3D imaging technology have made it an important component of technological progress in the field of medical imaging.

Cerebral angioplasty practice at major medical centers in the United States

International Nuclear Information System (INIS)

Chaturvedi, S.; St Pierre, M.E.; Bertasio, B.

2000-01-01

Concern has been expressed recently regarding the proliferation of angioplasty and/or stenting of cerebral vessels. However, little is known about the volume of angioplasties being performed or the number of experienced interventionalists. A questionnaire was mailed to directors of accredited radiology residency programs in the United States, to define the level of expertise available at teaching hospitals in terms of angioplasty and/or stenting. Of 200 programs surveyed, 111 responded (56 %). Of 111 program directors 47 (42 %) indicated that cerebral angioplasty was being performed at their center. The greatest experience is currently for angioplasty of post-subarachnoid hemorrhage vasospasm (mean 16 procedures performed) and the least experience for dilation of basilar artery atherosclerosis (mean five procedures performed). The reported stroke and/or death rate in centers performing angioplasty of the extracranial carotid system is 1.5 %. Comparisons with other medical specialties (e. g., cardiologists, neurologists, neurosurgeons) are necessary to determine the full scope of extracranial neurovascular procedures being performed and the corresponding complication rates. (orig.)

Impact on Seniors of the Patient-Centered Medical Home: Evidence from a Pilot Study

Science.gov (United States)

Fishman, Paul A.; Johnson, Eric A.; Coleman, Kathryn; Larson, Eric B.; Hsu, Clarissa; Ross, Tyler R.; Liss, David; Tufano, James; Reid, Robert J.

2012-01-01

Purpose: To assess the impact on health care cost and quality among seniors of a patient-centered medical home (PCMH) pilot at Group Health Cooperative, an integrated health care system in Washington State. Design and Methods: A prospective before-and-after evaluation of the experience of seniors receiving primary care services at 1 pilot clinic…

Radiation safety knowledge of medical center radiology technologists in southern Taiwan

Energy Technology Data Exchange (ETDEWEB)

Su Wen-Chuan; Huang Ying-Fong; Chen Cheng-Chung; Chang Pao-Shu [Kaohsiung Medical University, Taiwan (China)

2000-05-01

People who live in Taiwan are getting more and more afraid of radiation. Sometimes the phobia results from distorted knowledge. Radiology technologists, in one hand, are more well-educated in radiation and, in the other hand, have more chance to expose to radiation when they are operating radiation producing medical instruments in their daily life. So we are interested in whether they have enough knowledge to protect themselves. We pick up the radiology technology board examination to make the questionnaire for this study. The population is the radiology technologists who work at department of diagnostic radiology, of radiation therapy and nuclear medicine in medical centers. Statistics is then used to see the relationship between knowledge and the factors including gender, age and career period. Based on statistics, we find out that there is significant correlation between the knowledge with age or education level. Elder or lower education level ones has worse knowledge. Continued education may be highly recommended for radiology technologists to avoid occupational radiation injury. (author)

Radiation safety knowledge of medical center radiology technologists in southern Taiwan

International Nuclear Information System (INIS)

Su Wen-Chuan; Huang Ying-Fong; Chen Cheng-Chung; Chang Pao-Shu

2000-01-01

People who live in Taiwan are getting more and more afraid of radiation. Sometimes the phobia results from distorted knowledge. Radiology technologists, in one hand, are more well-educated in radiation and, in the other hand, have more chance to expose to radiation when they are operating radiation producing medical instruments in their daily life. So we are interested in whether they have enough knowledge to protect themselves. We pick up the radiology technology board examination to make the questionnaire for this study. The population is the radiology technologists who work at department of diagnostic radiology, of radiation therapy and nuclear medicine in medical centers. Statistics is then used to see the relationship between knowledge and the factors including gender, age and career period. Based on statistics, we find out that there is significant correlation between the knowledge with age or education level. Elder or lower education level ones has worse knowledge. Continued education may be highly recommended for radiology technologists to avoid occupational radiation injury. (author)

Surgeon leadership in the coding, billing, and contractual negotiations for fenestrated endovascular aortic aneurysm repair increases medical center contribution margin and physician reimbursement.

Science.gov (United States)

Aiello, Francesco; Durgin, Jonathan; Daniel, Vijaya; Messina, Louis; Doucet, Danielle; Simons, Jessica; Jenkins, James; Schanzer, Andres

2017-10-01

Fenestrated endovascular aneurysm repair (FEVAR) allows endovascular treatment of thoracoabdominal and juxtarenal aneurysms previously outside the indications of use for standard devices. However, because of considerable device costs and increased procedure time, FEVAR is thought to result in financial losses for medical centers and physicians. We hypothesized that surgeon leadership in the coding, billing, and contractual negotiations for FEVAR procedures will increase medical center contribution margin (CM) and physician reimbursement. At the UMass Memorial Center for Complex Aortic Disease, a vascular surgeon with experience in medical finances is supported to manage the billing and coding of FEVAR procedures for medical center and physician reimbursement. A comprehensive financial analysis was performed for all FEVAR procedures (2011-2015), independent of insurance status, patient presentation, or type of device used. Medical center CM (actual reimbursement minus direct costs) was determined for each index FEVAR procedure and for all related subsequent procedures, inpatient or outpatient, 3 months before and 1 year subsequent to the index FEVAR procedure. Medical center CM for outpatient clinic visits, radiology examinations, vascular laboratory studies, and cardiology and pulmonary evaluations related to FEVAR were also determined. Surgeon reimbursement for index FEVAR procedure, related adjunct procedures, and assistant surgeon reimbursement were also calculated. All financial analyses were performed and adjudicated by the UMass Department of Finance. The index hospitalization for 63 FEVAR procedures incurred $2,776,726 of direct costs and generated $3,027,887 in reimbursement, resulting in a positive CM of $251,160. Subsequent related hospital procedures (n = 26) generated a CM of $144,473. Outpatient clinic visits, radiologic examinations, and vascular laboratory studies generated an additional CM of $96,888. Direct cost analysis revealed that grafts

A Study to Evaluate the Organization and the Operating Procedures of the Patient Assistance Function at Brooke Army Medical Center, Fort Sam Houston, Texas

Science.gov (United States)

1979-08-01

15 March 1979. 59Interview with Wendy L. Farace , Head Nurse, Obstetrics/Gynecology Clinic, Brooke Army Medical Center, Fort Sam Houston, Texas, 8...6 February 1979. Farace , Wendy L. Head Nurse, Obstetrica/Gynecology Clinic, Brooke Army Medical Center, Fort Sam Houston, Texas. Interview, 8 January

An Analysis of Information Technology Adoption by IRBs of Large Academic Medical Centers in the United States.

Science.gov (United States)

He, Shan; Botkin, Jeffrey R; Hurdle, John F

2015-02-01

The clinical research landscape has changed dramatically in recent years in terms of both volume and complexity. This poses new challenges for Institutional Review Boards' (IRBs) review efficiency and quality, especially at large academic medical centers. This article discusses the technical facets of IRB modernization. We analyzed the information technology used by IRBs in large academic institutions across the United States. We found that large academic medical centers have a high electronic IRB adoption rate; however, the capabilities of electronic IRB systems vary greatly. We discuss potential use-cases of a fully exploited electronic IRB system that promise to streamline the clinical research work flow. The key to that approach utilizes a structured and standardized information model for the IRB application. © The Author(s) 2014.

Improvements in self-efficacy for engaging in patient-centered communication following a course in peer-supervision and communication for medical students

DEFF Research Database (Denmark)

Lassesen, Berit; O Connor, Maja; Kjær, Louise Binow

and Department of Psychology and Behavioral Science, Aarhus University, Aarhus, Denmark; 3Center for Medical Education, Aarhus University, Aarhus, Denmark.; belas@clu.au.dk Aim: The aim was to evaluate the outcome of a training course in peer-supervision and communication with the aim of improving medical...... student self-efficacy for engaging in patient-centered communication and examine the influence of course-related motivation to learn, course-related self-efficacy, and medical student well-being at baseline. Methods: A total of 127 graduate school medical students in clinical clerkship who participated...... in a course in peer-supervision and communication completed a pre-course questionnaire package including: 1) The Patient-Centeredness Self-Efficacy Questionnaire (PCSEQ), 2) Course-Related Motivation to Learn (CRML), 3) Course-Related Self-Efficacy (CRSE), and 4) the Medical Student Well-Being Index (MSWBI...

The ten successful elements of an ambulatory care center.

Science.gov (United States)

Watkins, G

1997-01-01

Experts in healthcare predict that in the future, over 80% of all care will be provided either in the home or ambulatory care centers. How radiology facilities position themselves for this shifting market is critical to their long-term success, even though it appears there are endless opportunities for providing care in this atmosphere. The ten most critical elements that healthcare providers must address to ensure their preparedness are discussed. Location is critical, particularly since patients no longer want to travel to regional medical centers. The most aggressive providers are building local care centers to serve specific populations. Ambulatory care centers should project a high tech, high touch atmosphere. Patient comfort and the appeal of the overall environment must be considered. Centers need to focus on their customers' needs in multiple areas of care. A quick and easy registration process, providing dressing gowns in patient areas, clear billing functions--these are all important areas that centers should develop. Physicians practicing in the ambulatory care center are key to its overall success and can set the tone for all staff members. Staff members must be friendly and professional in their work with patients. The hours offered by the center must meet the needs of its client base, perhaps by offering evening and weekend appointments. Keeping appointments on schedule is critical if a center wants satisfied customers. It's important to identify the target before developing your marketing plan. Where do your referrals come from? Look to such sources as referring physicians, managed care plans and patients themselves. Careful billing is critical for survival in the ambulatory care world. Costs are important and systems that can track cost per exam are useful. Know your bottom line. Service remains the central focus of all successful ambulatory care center functions.

Substantial Churn In Health Insurance Offerings By Small Employers, 2014-15.

Science.gov (United States)

Vistnes, Jessica P; Rohde, Frederick; Miller, G Edward; Cooper, Philip F

2017-09-01

New data for 2014-15 from the Medical Expenditure Panel Survey-Insurance Component longitudinal survey show substantial churn in insurance offers by small employers (those with fifty or fewer workers), with 14.6 percent of employers that offered insurance in 2014 having dropped it in 2015 and 5.5 percent of those that did not offer it adding coverage. Project HOPE—The People-to-People Health Foundation, Inc.

Development of a safe and pragmatic awake craniotomy program at Maine Medical Center.

Science.gov (United States)

Rughani, Anand I; Rintel, Theodor; Desai, Rajiv; Cushing, Deborah A; Florman, Jeffrey E

2011-01-01

Awake craniotomy offers an excellent means of performing intraoperative mapping and optimizing surgical resection of brain tumors. Awake craniotomy relies on a strong collaboration between anesthesiologists, neurosurgeons, and operating room staff. The authors recently introduced awake craniotomy for tumor resection at the Maine Medical Center and propose that it can be performed safely, effectively, and efficiently in a high-volume community hospital. We describe a practical approach to performing awake craniotomy involving streamlined anesthetic protocols and simplified intraoperative testing parameters in a carefully selected group of patients. Our first 25 patients are retrospectively reviewed with particular attention to the anesthetic protocol, the extent of resection, the operative time, post-operative complications, the length of hospitalization, and their functional status at follow-up. The authors established an anesthetic protocol based primarily on midazolam, fentanyl, propofol, and local anesthetic. The authors note that all but one patient was able to tolerate the awake procedure. Gross total resection was achieved in nearly 80% of patients with a glial tumor. Operative time was short, averaging 159 minutes of entire anesthesia care. Length of stay averaged 3.7 days. Persistent new post-operative deficits were noted in 2 of 25 patients. There was no substantial difference in total hospital charges for patients undergoing awake craniotomy when compared to a matched historical control. With attention focused on patient selection and a streamlined anesthetic protocol, the authors were able to successfully implement an awake craniotomy protocol in a community setting with satisfying results, including low operative morbidity, short operative times, low anesthetic complications, and excellent patient tolerance.

Health information security: a case study of three selected medical centers in iran.

Science.gov (United States)

Hajrahimi, Nafiseh; Dehaghani, Sayed Mehdi Hejazi; Sheikhtaheri, Abbas

2013-03-01

Health Information System (HIS) is considered a unique factor in improving the quality of health care activities and cost reduction, but today with the development of information technology and use of internet and computer networks, patients' electronic records and health information systems have become a source for hackers. This study aims at checking health information security of three selected medical centers in Iran using AHP fuzzy and TOPSIS compound model. To achieve that security measures were identified, based on the research literature and decision making matrix using experts' points of view. Among the 27 indicators, seven indicators were selected as effective indicators and Fuzzy AHP technique was used to determine the importance of security indicators. Based on the comparisons made between the three selected medical centers to assess the security of health information, it is concluded that Chamran hospital has the most acceptable level of security and attention in three indicators of "verification and system design, user access management, access control system", Al Zahra Hospital in two indicators of "access management and network access control" and Amin Hospital in "equipment safety and system design". In terms of information security, Chamran Hospital ranked first, Al-Zahra Hospital ranked second and Al- Zahra hospital has the third place.

Survey on prevalence and causes of self-medication in women referring to health centers in Ahwaz, in 2013

Directory of Open Access Journals (Sweden)

Pourandoght Afshary

2015-11-01

Full Text Available Background: Today, considerable advances achieved in different scientific fields have led to an ever-increasing access of people to various medications and their unauthorized consumption, which negatively affects the healthcare and treatment system. Thus, this study was conducted to determine the Prevalence and causes of this phenomenon in the female population of Ahwaz. Material and Methods: In this Cross-sectional study364 Women referring to seven health centers in Ahwaz were selected randomly and based on the family medical file number and by proportional distribution to each center and semi-structured questionnaires were completed through interviews. The data were analyzed by Chi square test and logistic regression. P<0.05 was considered significant. Results: Self-medication was observed in 70.1% of women. The most frequent group  was those above the age of 30. The most common self-medication case was urogenitaldisorders (58.7%. there was a significant relation between education (p<0.003 and number of births (p=0.003 and unauthorized drug consumption. The most causes for synthetic drug use were previous illness background (48.6% and high medication costs (50.6%, and about herbal drugs were high medication costs (41.1%, and the effectiveness of these products about medicinal herbs (38.1 %. Conclusion: High rate of self-medication in the studied society necessitates training on proper use of drugs through the use of social media.

Learning from Primary Health Care Centers in Nepal: reflective writings on experiential learning of third year Nepalese medical students

OpenAIRE

Dhital, Rolina; Subedi, Madhusudan; Prasai, Neeti; Shrestha, Karun; Malla, Milan; Upadhyay, Shambhu

2015-01-01

Background Medical education can play important role in cultivating the willingness among the medical students to work in underprivileged areas after their graduation. Experiential learning through early exposure to primary health care centers could help students better understand the opportunities and challenges of such settings. However, the information on the real experiences and reflections of medical students on the rural primary health care settings from low-income countries like Nepal ...

Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas.

Science.gov (United States)

Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen

2016-05-01

Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities.

Systemic lupus erythematosus and thyroid disease - Experience in a single medical center in Taiwan.

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Liu, Yu-Chuan; Lin, Wen-Ya; Tsai, Ming-Chin; Fu, Lin-Shien

2017-06-28

To investigate the association of systemic lupus erythematosus (SLE) with thyroid diseases in a medical center in central Taiwan. This is a retrospective cohort of 2796 SLE patients in a tertiary referral medical center from 2000 to 2013. We screened SLE by catastrophic illness registration from national insurance bureau; and thyroid diseases by ICD 9 codes, then confirmed by thyroid function test, auto-antibody, medical and/or surgical intervention. We compared the rate of hyperthyroidism, hypothyroidism and autoimmune thyroid disease (AITD) in SLE patients and the 11,184 match controls. We calculated the rate of these thyroid diseases and positive antibodies to thyroglobulin (ATGAb), thyroid peroxidase (TPOAb) in SLE patients grouped by the presence of overlap syndrome and anti-dsDNA antibody. We also compared the association of thyroid diseases to severe SLE conditions, including renal, central nervous system (CNS) involvement, and thrombocytopenia. Compared to the matched controls, the cumulative incidence of thyroid disease, including hyperthyroidism, hypothyroidism and AITD, were all higher in SLE patients (p hyperthyroidism. SLE patients with thyroid diseases also carry higher risk for severe complications such as renal involvement (p = 0.024) central nervous system involvement (p hyperthyroidism, hypothyroidism, and AITD than the matched control. Among lupus patients, the risks of thyroid diseases are even higher in the presence of overlap syndrome. SLE patients with thyroid diseases had higher risk of renal and CNS involvement. Copyright © 2017. Published by Elsevier B.V.

Curriculum Trends in Medical Education in Mauritius

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Aprajita Panwar

2017-08-01

Full Text Available Medical education began in Mauritius with the establishment of Sir Seewoosagur Ramgoolam (SSR Medical college in 1999 followed by a breakthrough in field of medicine with opening of Anna Medical College and Research Center (AMCRC in 2010 and Padhamshree DY PatilMedical College in 2013.Though it was an appreciable beginning of medical education in Mauritius, medical schools are currently experiencing hardships in delivering right medical exposure to health care professionals.Mauritian medical schools now need to review their current teaching methodology and present curriculum to keep pace with global standards. Integrated curriculum which is now gaining popularity world-wide is to be introduced and strongly implemented in medical schools in Mauritius. This curriculum would breach barriers and improve integration between pre-clinical and clinical sciences thus facilitating long-term retention of knowledge in medical schools and develop a professionally soundapproach towards management of health care. Horizontal curriculum can be replaced by vertical and spiral integration. For this major change, faculty engaged in medical profession are to be acquainted about innovative strategies and emerging trends in medical education. Thus this article aims to highlight the current scenario of medical education in Mauritius and also offer suggestions about possible future strategies to be implemented in medical colleges.Keywords: MEDICAL EDUCATION, CURRICULUM, CHALLENGES

An intelligent algorithm for identification of optimum mix of demographic features for trust in medical centers in Iran.

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Yazdanparast, R; Zadeh, S Abdolhossein; Dadras, D; Azadeh, A

2018-06-01

Healthcare quality is affected by various factors including trust. Patients' trust to healthcare providers is one of the most important factors for treatment outcomes. The presented study identifies optimum mixture of patient demographic features with respect to trust in three large and busy medical centers in Tehran, Iran. The presented algorithm is composed of adaptive neuro-fuzzy inference system and statistical methods. It is used to deal with data and environmental uncertainty. The required data are collected from three large hospitals using standard questionnaires. The reliability and validity of the collected data is evaluated using Cronbach's Alpha, factor analysis and statistical tests. The results of this study indicate that middle age patients with low level of education and moderate illness severity and young patients with high level of education, moderate illness severity and moderate to weak financial status have the highest trust to the considered medical centers. To the best of our knowledge this the first study that investigates patient demographic features using adaptive neuro-fuzzy inference system in healthcare sector. Second, it is a practical approach for continuous improvement of trust features in medical centers. Third, it deals with the existing uncertainty through the unique neuro-fuzzy approach. Copyright © 2018 Elsevier B.V. All rights reserved.

Multipayer patient-centered medical home implementation guided by the chronic care model.

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Gabbay, Robert A; Bailit, Michael H; Mauger, David T; Wagner, Edward H; Siminerio, Linda

2011-06-01

A unique statewide multipayer ini Pennsylvania was undertaken to implement the Patient-Centered Medical Home (PCMH) guided by the Chronic Care Model (CCM) with diabetes as an initial target disease. This project represents the first broad-scale CCM implementation with payment reform across a diverse range of practice organizations and one of the largest PCMH multipayer initiatives. Practices implemented the CCM and PCMH through regional Breakthrough Series learning collaboratives, supported by Improving Performance in Practice (IPIP) practice coaches, with required monthly quality reporting enhanced by multipayer infrastructure payments. Some 105 practices, representing 382 primary care providers, were engaged in the four regional collaboratives. The practices from the Southeast region of Pennsylvania focused on diabetes patients (n = 10,016). During the first intervention year (May 2008-May 2009), all practices achieved at least Level 1 National Committee for Quality Assurance (NCQA) Physician Practice Connections Patient-Centered Medical Home (PPC-PCMH) recognition. There was significant improvement in the percentage of patients who had evidence-based complications screening and who were on therapies to reduce morbidity and mortality (statins, angiotensin-converting enzyme inhibitors). In addition, there were small but statistically significant improvements in key clinical parameters for blood pressure and cholesterol levels, with the greatest absolute improvement in the highest-risk patients. Transforming primary care delivery through implementation of the PCMH and CCM supported by multipayer infrastructure payments holds significant promise to improve diabetes care.

[Work satisfaction, quality of life and leisure time of residents at the Soroka University Medical Center, Beer Sheba, Israel].

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Acker, Asaf; Perry, Zvi; Reuveni, Haim; Toker, Asaf

2009-02-01

Work dissatisfaction among physicians worldwide continues to rise over the last few decades, mainly due to declining professional prestige, tack of self fulfillment, time pressure and tack of leisure time. Physicians' burnout is a major result of dissatisfaction, causing doctors to leave the medical profession, and to provide lower quality of care. To examine the work satisfaction, quality of life and leisure time of residents in the Soroka University Medical Center. A validated questionnaire was delivered during the second half of 2004 to 252 residents in the Soroka University Medical Center The data was analyzed using the SPSS 12 for windows program. Descriptive analysis, parametric Students' T Test [where pleisure time. Further attention must be given to these matters--a step which will eventually improve patient care, and delay, to some extent, the burnout of physicians.

Relationships among communication competence, self-efficacy, and job satisfaction in Korean nurses working in the emergency medical center setting.

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Park, Min Sook; Jeoung, Yeonok; Lee, Hye Kyung; Sok, Sohyune R

2015-06-01

The communication competence of nurses working in emergency medical center settings is essential to establish a therapeutic nurse-patient relationship. Education and strategic development are required to improve the communication competence of emergency room (ER) nurses. This study was conducted to determine the relationships among individual communication competence, self-efficacy, and job satisfaction in Korean nurses in the emergency medical center setting. A cross-sectional descriptive design was adopted. The study sample included 214 nurses at 11 emergency medical centers in Seoul and Kyunggi-Do, Korea. Measures used included the Global Interpersonal Communication Competence, self-efficacy scale, and job satisfaction scale. The collected data were analyzed using the SPSS version 18.0 statistical software program and included descriptive statistics (frequency, percentage, mean, standard deviation, independent t test, analysis of variance, and Pearson's correlation coefficient). The degrees of communication competence and self-efficacy of ER nurses were good, with higher scores than the median values. However, the degree of job satisfaction was poor, indicating a lower score than the median value. Religious affiliation and previous participation in communication education each had a significant impact on communication competence. Religious affiliation and time of worse duty each had a significant impact on self-efficacy. Length of career (year) in the emergency medical center and type of hospital each had a significant impact on job satisfaction. Positive correlations were identified among communication competence, self-efficacy, and job satisfaction. This study supported the presence of significant correlations among communication competence, self-efficacy, and job satisfaction. Thus, it is necessary to develop training programs that are customized to individual characteristics such as self-efficacy and job satisfaction to improve the communicative competence

Using Learner-Centered, Simulation-Based Training to Improve Medical Students’ Procedural Skills

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Serkan Toy

2017-03-01

Full Text Available Purpose: To evaluate the effectiveness of a learner-centered, simulation-based training developed to help medical students improve their procedural skills in intubation, arterial line placement, lumbar puncture, and central line insertion. Method: The study participants were second and third year medical students. Anesthesiology residents provided the training and evaluated students’ procedural skills. Two residents were present at each station to train the medical students who rotated through all 4 stations. Pre/posttraining assessment of confidence, knowledge, and procedural skills was done using a survey, a multiple-choice test, and procedural checklists, respectively. Results: In total, 24 students were trained in six 4-hour sessions. Students reported feeling significantly more confident, after training, in performing all 4 procedures on a real patient ( P < .001. Paired-samples t tests indicated statistically significant improvement in knowledge scores for intubation, t (23 = −2.92, P < .001, and arterial line placement, t (23 = −2.75, P < .001. Procedural performance scores for intubation ( t (23 = −17.29, P < .001, arterial line placement ( t (23 = −19.75, P < .001, lumbar puncture ( t (23 = −16.27, P < .001, and central line placement ( t (23 = −17.25, P < .001 showed significant improvement. Intraclass correlation coefficients indicated high reliability in checklist scores for all procedures. Conclusions: The simulation sessions allowed each medical student to receive individual attention from 2 residents for each procedure. Students’ written comments indicated that this training modality was well received. Results showed that medical students improved their self-confidence, knowledge, and skills in the aforementioned procedures.

Implementation of Epic Beaker Clinical Pathology at an academic medical center

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Matthew D Krasowski

2016-01-01

Full Text Available Background: Epic Beaker Clinical Pathology (CP is a relatively new laboratory information system (LIS operating within the Epic suite of software applications. To date, there have not been any publications describing implementation of Beaker CP. In this report, we describe our experience in implementing Beaker CP version 2012 at a state academic medical center with a go-live of August 2014 and a subsequent upgrade to Beaker version 2014 in May 2015. The implementation of Beaker CP was concurrent with implementations of Epic modules for revenue cycle, patient scheduling, and patient registration. Methods: Our analysis covers approximately 3 years of time (2 years preimplementation of Beaker CP and roughly 1 year after using data summarized from pre- and post-implementation meetings, debriefings, and the closure document for the project. Results: We summarize positive aspects of, and key factors leading to, a successful implementation of Beaker CP. The early inclusion of subject matter experts in the design and validation of Beaker workflows was very helpful. Since Beaker CP does not directly interface with laboratory instrumentation, the clinical laboratories spent extensive preimplementation effort establishing middleware interfaces. Immediate challenges postimplementation included bar code scanning and nursing adaptation to Beaker CP specimen collection. The most substantial changes in laboratory workflow occurred with microbiology orders. This posed a considerable challenge with microbiology orders from the operating rooms and required intensive interventions in the weeks following go-live. In postimplementation surveys, pathology staff, informatics staff, and end-users expressed satisfaction with the new LIS. Conclusions: Beaker CP can serve as an effective LIS for an academic medical center. Careful planning and preparation aid the transition to this LIS.

Strom Thurmond Biomedical Research Center at the Medical Univesity for South Carolina Charleston, South Carolina

Energy Technology Data Exchange (ETDEWEB)

1994-02-01

The Department of Energy (DOE) has prepared an Environmental Assessment (EA) evaluating the proposed construction and operation of the Strom Thurmond Biomedical Research Center (Center) at the Medical University of South Carolina (MUSC), Charleston, SC. The DOE is evaluating a grant proposal to authorize the MUSC to construct, equip and operate the lower two floors of the proposed nine-story Center as an expansion of on-going clinical research and out-patient diagnostic activities of the Cardiology Division of the existing Gazes Cardiac Research Institute. Based on the analysis in the EA, the DOE has determined that the proposed action does not constitute a major federal action significantly affecting the quality of the human environment within the meaning of the NEPA. Therefore, the preparation of an Environmental Impact Statement is not required.

Organization and performance evaluation of the regional air medical service

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A. A. Lobzhanidze

2016-01-01

Full Text Available We prove the need to create the regional system of air medical service in St. Petersburg and Leningrad Region.We describe the mechanism of managing the medical service transport system which includes patients’ evacuation both by automobile and aviation. We offer algorithms of assessing the cost effectiveness of air medical service both at the time of treatment and making the patient able to work and during the entire period of hisparticipation in social labor activities. This project is being implemented since 2014. Data in the article are provided on the basis of actually realized flights by helicopter center LLC«Helidrive» which took part in pilot project.

Patient-centered medical homes improve care for adults with chronic conditions.

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Pourat, Nadereh; Lavarreda, Shana Alex; Snyder, Sophie

2013-05-01

The success of health care reform implementation in 2014 partly depends on more efficient delivery of care to the millions of California residents eligible to gain insurance. Emerging evidence supports the effectiveness of the patient-centered medical home (PCMH) as a potential model of care delivery, which improves health outcomes and reduces costs. Among other principles, PCMH entails receipt of care from a personal doctor, who coordinates the patient's care and develops an individualized treatment plan for the patient. These principles are particularly essential in delivery of care to those with chronic conditions who require more intensive care management. Using the 2009 California Health Interview Survey (CHIS 2009), this policy brief indicates that patients who reported meeting these fundamental PCMH principles were more likely to have visited the doctor and to have received flu shots, and they also had better communication with providers than those who did not report meeting these PCMH principles. The data also showed that uninsured individuals, Medi-Cal beneficiaries, those at or below 133% of the federal poverty level, Latinos, and Asian-Americans were less likely to report meeting all three PCMH principles. These findings highlight the population groups that would most benefit from the PCMH care delivery model, particularly Medi-Cal beneficiaries and those eligible for Covered California, the California health benefits exchange.

Using an expanded outcomes framework and continuing education evidence to improve facilitation of patient-centered medical home recognition and transformation.

Science.gov (United States)

Van Hoof, Thomas J; Kelvey-Albert, Michele; Katz, Matthew; Lalime, Ken; Sacks, Ken; Meehan, Thomas P

2014-01-01

The patient-centered medical home is a model for delivering primary care in the United States. Primary care clinicians and their staffs require assistance in understanding the innovation and in applying it to practice. The purpose of this article is to describe and to critique a continuing education program that is relevant to, and will become more common in, primary care. A multifaceted educational strategy prepared 20 primary care private practices to achieve National Committee for Quality Assurance Level 3 recognition as Patient-Centered Medical Homes. Eighteen (90%) practices submitted an application to the National Committee for Quality Assurance. On the first submission attempt, 13 of 18 (72%) achieved Level 3 recognition and 5 (28%) achieved Level 1 recognition. An interactive multifaceted educational strategy can be successful in preparing primary care practices for Patient-Centered Medical Homes recognition, but the strategy may not ensure transformation. Future educational activities should consider an expanded outcomes framework and the evidence of effective continuing education to be more successful with recognition and transformation.

Plastic Surgery Complications from Medical Tourism Treated in a U.S. Academic Medical Center.

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Ross, Kimberly M; Moscoso, Andrea V; Bayer, Lauren R; Rosselli-Risal, Liliana; Orgill, Dennis P

2018-04-01

Medical tourism is a growing, multi-billion dollar industry fueled by improvements in the global transportation infrastructure. The authors studied patients living in the United States who travel to other countries for plastic surgical procedures and returned to have their complications treated in the authors' center. A retrospective patient evaluation was performed. Patients who had presented to an urban tertiary academic hospital plastic surgery service with complications or complaints associated with plastic surgery performed in a developing country were studied. The authors collected demographic information, types of surgery performed, destinations, insurance coverage, and complications. Seventy-eight patients were identified over 7 years. Most commonly, complications were seen following abdominoplasty (n = 35), breast augmentation (n = 25), and foreign body injections (n = 15). Eighteen patients underwent multiple procedures in one operative setting. The most common destination country was the Dominican Republic (n = 59). Complications included surgical-site infections (n = 14), pain (n = 14), and wound healing complications (n = 12). Eighty-six percent of patients (n = 67) relied on their medical insurance to pay for their follow-up care or manage their complications, with the most common type of health insurance coverage being Massachusetts Medicaid (n = 48). Cosmetic surgery performed in developing countries can carry substantial risks of complications that can be challenging to patients, primary care providers, insurers, and plastic surgical teams not associated with the original surgery. These complications pose significant burdens on our public health systems.

Additional mailing phase for FIT after a medical offer phase: The best way to improve compliance with colorectal cancer screening in France.

Science.gov (United States)

Piette, Christine; Durand, Gérard; Bretagne, Jean-François; Faivre, Jean

2017-03-01

Compliance with colorectal cancer screening is critical to its effectiveness. The organisation of the mass screening programme in France has recently been modified with no evaluation of the consequences. To evaluate the impact of the way the screening test is delivered on compliance. During the first six months of the screening campaign (Ille-Vilaine, Brittany), general practitioners were asked to propose a faecal immunochemical test (FIT), OC-Sensor, to individuals at average risk for colorectal cancer (n=152,097). A subset of non-participants in the medical phase (n=13,071) was randomly chosen to receive a reminder that included the screening test or a simple postal reminder without the screening test. Compliance was 31% if the screening test was proposed during a medical consultation. In non-participants during the medical phase, it was 45% in those receiving both a reminder and the screening test and 28% amongst those receiving a simple reminder. An estimated overall participation rate of 54% can be expected if non-participants in the medical phase are sent a reminder together with the screening test. In France, a compliance rate above the minimum uptake rate of 45% recommended by European Union experts can be achieved if the FIT is mailed to non-participants after the medical free-offer phase. Copyright © 2016. Published by Elsevier Ltd.

A Study of Civilian Registered Nurse Recruitment at Madigan Army Medical Center, Tacoma, Washington.

Science.gov (United States)

1982-06-01

34 May, 1981, "Nurse, Where Are You?" Judy Armstrong . 5 1nitial Report and Preliminary Recommendations, National Commission on Nursing (September 1981...Interview with Ms. R. Marsh, Staffing Specialist, Force Develop- ment Division, Madigan Army Medical Center, Tacoma, WA (Dec 81) 20Philip Kotler ...Marketing Management. Boston: Allyn and Bacon, Inc., 1980. Kotler , Philip. Marketing for Nonprofit Institutions. Englewood Cliffs, N.D.: Prentice-Hall

48 CFR 570.303-3 - Late offers, modifications of offers, and withdrawals of offers.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Late offers, modifications of offers, and withdrawals of offers. 570.303-3 Section 570.303-3 Federal Acquisition Regulations... PROPERTY Contracting Procedures for Leasehold Interests in Real Property 570.303-3 Late offers...

CAPITAL STRUCTURE ANALYSIS OF THE MEDICAL DIAGNOSTIC-CONSULTATIVE CENTERS IN VARNA (absolute indicators

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Lyubomira Koeva-Dimitrova

2016-08-01

Full Text Available The capital structure analysis of medical institutions is related to the assessment of their financial sustainability. The degree of their financial sustainability indicates the extent to which the medical institution is exposed to financial risk. This financial risk is related to the use of foreign capital (debts, loans, etc. and it is defined as the probability of insolvency and possible bankruptcy due to the existence of debts which could not be repaid at some point in the foreseeable future. Objective: To analyze the capital structure of the medical diagnostic-consultative centers in Varna city and on this basis to assess their long-term solvency and existence of financial risk. Materials and Methods: The materials for the study are the published annual financial statements (up to 05. 01. 2016 in the Commercial Register for the period from year 2008 to 2014 of all MDCCs (Medical Diagnostic Consultative centers, registered in Varna - 9 in total. In the study are applied logical-mathematical methods (comparison, grouping, detail, graphical method; financial and accounting analysis (balance sheet analysis; analysis of absolute ratios for financial sustainability. Results: Upon analysis of the capital structure of MDCC's are studied the main absolute indicators characterizing the conditions for financial sustainability and the existence of financial risk regarding the solvency. A table represents the overall assessment of the degree of financial sustainability of the companies according to the type and structure of the fulfilled criteria. It was ascertained that for year 2014, DCC 3, 4, 5 and 8 have met all the conditions and according to them these hospitals have very high financial sustainability. DCC 7 has an average financial sustainability, DCC 1 and 2 are in a financial crisis and DCC 6 and 9 are facing bankruptcy. It must be emphasized that nearly half of the studied health care organizations (DCC 1, 2, 6 and 9 need urgent intervention by

Increasing Therapist Productivity: Using Lean Principles in the Rehabilitation Department of an Academic Medical Center.

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Johnson, Diana; Snedeker, Kristie; Swoboda, Michael; Zalieckas, Cheryl; Dorsey, Rachel; Nohe, Cassandra; Smith, Paige; Roche, Renuka

The Department of Rehabilitation Services, within the University of Maryland Medical Center's 650-bed academic medical center, was experiencing difficulty in meeting productivity standards. Therapists in the outpatient division believed they were not spending enough time performing billable patient care activities. Therapists in the inpatient division had difficulty keeping pace with the volume of incoming referrals. Collectively, these issues caused dissatisfaction among referral sources and frustration among the staff within the rehabilitation department. The department undertook a phased approach to address these issues that included examining the evidence, using Lean process improvement principles, and employing transformational leadership strategies to drive improvements in productivity and efficiency. The lessons learned support the importance of having meaningful metrics appropriate for the patient population served, the use of Lean as an effective tool for improving productivity in rehabilitation departments, the impact of engaging staff at the grassroots level, and the importance of having commitment from leaders. The study findings have implications for not only rehabilitation and hospital leadership, but CEOs and managers of any business who need to eliminate waste or increase staff productivity.

DEVELOPMENT OF CLINICAL SCENARIO’S INFORMATION MODEL IN THE MEDICAL SIMULATION CENTER

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I. V. Tolmachyov

2014-01-01

Full Text Available There is the big issue in medical education which is students don’t have enough skills. Often even with theoretical knowledge graduate medical students need to improve their skills by working with patients. Obviously it can be a risk for patients and takes quite long time. This situation could be changed with applying simulation technologies in medical education. Medical education with virtual simulators allows reducing the time of skills development and improving the quality of training. The aims of this work are developing informational model and creating clinical scenarios of emergency states in the Medical Simulation Center.Objectives:– to analyze the process of scenario conducting;– to create clinical scenarios of emergency states (anaphylactic shock, hypovolemic shock, obstructive shock with specialist’s help.The scenarios consist of sections such as main aim, skills, required mannequins, preparation of the mannequins, preparation of medical equipment and instruments for the scenario, preparation of special materials, scenario description, guide for operator, information for trainees.By analyzing the process of scenario conducting the key participants were defined who are operator, assistant, trainer, trainees. Also the main scenario stages were defined. Based on the stages diagram of variants of scenario conducting was designed.As an example there are fragments of scenario “Obstructive shock – a pulmonary embolism” in this article. Learn skills are cognitive, technical, social ones.Results. This paper presents an analysis of the clinical scenario conducting. Information model was developed which based on object-oriented decomposition. The model is the diagram of variants of scenario conducting. Scenario’s structure for emergency states was formulated. The scenarios are anaphylactic shock, hypovolemic shock, obstructive shock (pulmonary embolism, tension pneumothorax, pulmonary edema, hypertensive crisis, respiratory

Expansion of the consultation-liaison psychiatry paradigm at a university medical center: integration of diversified clinical and funding models.

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Bourgeois, James A; Hilty, Donald M; Klein, Sally C; Koike, Alan K; Servis, Mark E; Hales, Robert E

2003-01-01

The perspective of the contemporary Consultation-Liason Service (CLS) psychiatrist is increasingly one of consultant to medical and surgical colleagues in models other than inpatient medical and surgical units. Simultaneously, the need for a clinically and educationally robust inpatient CLS persists despite funding pressures. The University of California, Davis Medical Center Department of Psychiatry has made use of creative organizational and financial models to accomplish the inpatient CLS clinical and educational missions in a fiscally responsible manner. In addition, the department has in recent years expanded the delivery of psychiatry consultation-liaison clinical and educational services to other models of care delivery, broadening the role and influence of the CLS. Several of the initiatives described in this paper parallel an overall evolution of the practice of consultation-liaison psychiatry in response to managed care influences and other systems pressures. This consultation-liaison paradigm expansion with diversified sources of funding support facilitates the development of consultation-liaison psychiatry along additional clinical, administrative, research, and educational dimensions. Other university medical centers may consider adaptation of some of the initiatives described here to their institutions.

[Auto-dialysis: an 11-year experience of a hemodialysis center in France].

Science.gov (United States)

Montagnac, R; Schillinger, F

1996-03-30

Report 11 years of experience with self-managed hemodialysis in patients medically apt for extra-hospital dialysis and living close enough to small outpatient hemodialysis units to become totally self-sufficient. Among the 276 patients with chronic renal failure managed at the hemodialysis center at the Troyes hospital during the 11-year study period from 1984 through 1994, self-managed hemodialysis at small outpatient units was initiated in 127 (46%). None of these 127 patients required medical assistance or specific care during dialysis sessions. At initial hospital admission, only 60/127 (47%) were totally self-sufficient: 52 (41%) were later graft recipients; and 21 (16.5%) had to return to the hospital for a medical or surgical condition incompatible with extra-hospital care but all of these 21 patients remained self-sufficient. Extra-hospital hemodialysis in units close to the patients residence offers patients a better quality of life, even when medical assistance is required. All patients who require hemodialysis can thus be treated at lower cost without compromising quality of treatment. Perfect self-sufficiency may not be a goal in itself, but self-managed hemodialysis can be a very useful technique for patients without major medical problems. Continuing contact with the organizing hemodialysis center guarantees the safety of the system.

Variations in survival after cardiac arrest among academic medical center-affiliated hospitals.

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Michael Christopher Kurz

Full Text Available Variation exists in cardiac arrest (CA survival among institutions. We sought to determine institutional-level characteristics of academic medical centers (AMCs associated with CA survival.We examined discharge data from AMCs participating with Vizient clinical database-resource manager. We identified cases using ICD-9 diagnosis code 427.5 (CA or procedure code 99.60 (CPR. We estimated hospital-specific risk-standardized survival rates (RSSRs using mixed effects logistic regression, adjusting for individual mortality risk. Institutional and community characteristics of AMCs with higher than average survival were compared with those with lower survival.We analyzed data on 3,686,296 discharges in 2012, of which 33,700 (0.91% included a CA diagnosis. Overall survival was 42.3% (95% CI 41.8-42.9 with median institutional RSSR of 42.6% (IQR 35.7-51.0; Min-Max 19.4-101.6. We identified 28 AMCs with above average survival (median RSSR 61.8% and 20 AMCs with below average survival (median RSSR 26.8%. Compared to AMCs with below average survival, those with high CA survival had higher CA volume (median 262 vs.119 discharges, p = 0.002, total beds (722 vs. 452, p = 0.02, and annual surgical volume (24,939 vs. 13,109, p<0.001, more likely to offer cardiac catheterization (100% vs. 72%, p = 0.007 or cardiac surgery (93% vs. 61%, p = 0.02 and cared for catchment areas with higher household income ($61,922 vs. $49,104, p = 0.004 and lower poverty rates (14.6% vs. 17.3%, p = 0.03.Using discharge data from Vizient, we showed AMCs with higher CA and surgical case volume, cardiac catheterization and cardiac surgery facilities, and catchment areas with higher socioeconomic status had higher risk-standardized CA survival.

A Total Information Management System For All Medical Images

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Ouimette, Donald; Nudelman, Sol; Ramsby, Gale; Spackman, Thomas

1985-09-01

A PACS has been designed for the University of Connecticut Health Center to serve all departments acquiring images for diagnosis, surgery and therapy. It incorporates a multiple community communications architecture to provide complete information management for medical images, medical data and departmental administrative matter. The system is modular and expandable. It permits an initial installation for radiology and subsequent expansion to include other departments at the Health Center, beginning with internal medicine, surgery, ophthalmology and dentistry. The design permits sufficient expansion to offer the potential for accepting the additional burden of a hospital information system. Primary parameters that led to this system design were based on the anticipation that departments in time could achieve generating 60 to 90% of their images suited to insertion in a PACS, that a high network throughput for large block image transfers would be essen-tial and that total system reliability was fundamental to success.

75 FR 6401 - Medical Devices Regulated by the Center for Biologics Evaluation and Research; Availability of...

Science.gov (United States)

2010-02-09

... Biologics Evaluation and Research (HFM-17), Food and Drug Administration, suite 200N, 1401 Rockville Pike... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration [Docket No. FDA-2009-M-0513] Medical Devices Regulated by the Center for Biologics Evaluation and Research; Availability of Summaries...

Teleradiology support for maternal and newborn health in II level perinatal centers

International Nuclear Information System (INIS)

Stratulat, P.; Gamurari, Inesa; Caraus, Tatiana; Curteanu, Ala

2013-01-01

Telemedicine can be defined as the use of electronic signals to transfer medical information from one system to another. The emergence and development of teleradiology occurred due to the needs of optimal allocation of resources. The effectiveness of medical care is being increasing simply by the fact that an expert radiologist or other specialist can view patient images from his working place without losing his precious time for traveling. Teleradiology solution offers a range of advantages: reducing the presence of specialists on call, rapid obtaining of second opinions, medical centers interconnection etc.In our study we will focus on the teleradiology activity. A prospective study of consulted cases was conducted via teleradiology; there were applied two basic methods of transmitting information. In 01.01.2012 to 31.12.2012 there were totally examined 393 children and consulted 430 radiological images, of them - through Skype - 102 children and 199 images via iPath platform. Successful implementation of teleradiology within telemedicine has improved the quality of diagnosis in cases treated in the pilot centers. (authors)

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use.

Science.gov (United States)

Jones, Audrey L; Cochran, Susan D; Leibowitz, Arleen; Wells, Kenneth B; Kominski, Gerald; Mays, Vickie M

2015-12-01

The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI�

Discharge against medical advice in a pediatric emergency center in the State of Qatar

Directory of Open Access Journals (Sweden)

Hala Abdulateef

2012-05-01

Full Text Available Objective: The objective of this study was to analyze cases that had left the Pediatric Emergency Center Al Sadd, Doha (PEC against medical advice, with the aim of developing policies to help reduce this occurrence. Methodology: All patients that were admitted to the main PEC observation room for treatment and/or investigation and subsequently left against medical advice from February 18, 2007 to June 18, 2007, were followed by a phone call, and a questionnaire, which was completed by the departmental patient representative. Results: 99,133 patients attended the facility during the study period. Of those, 106 left the facility against medical advice. Ninety-four guardians were successfully contacted. 90% of the cases were in children below 2 years of age. In 87% of the cases the mother was the main decision maker for leaving against medical advice. Domestic obligations were the leading cause of DAMA (discharge against medical advice, reported in 45% of the cases. Respondents reported that the consequences of DAMA were well explained by medical staff before they left the facility however, they had not met with the departmental patient representative during their stay. Conclusion:As the majority of DAMA cases occurred in infants, medical staff should address the concerns of this group early on in the course of treatment. Maintaining communication and providing support, in particular for mothers of higher risk groups may help to reduce the rate of DAMA cases.

Gatekeepers as Care Providers: The Care Work of Patient-centered Medical Home Clerical Staff.

Science.gov (United States)

Solimeo, Samantha L; Ono, Sarah S; Stewart, Kenda R; Lampman, Michelle A; Rosenthal, Gary E; Stewart, Greg L

2017-03-01

International implementation of the patient-centered medical home (PCMH) model for delivering primary care has dramatically increased in the last decade. A majority of research on PCMH's impact has emphasized the care provided by clinically trained staff. In this article, we report our ethnographic analysis of data collected from Department of Veterans Affairs staff implementing PACT, the VA version of PCMH. Teams were trained to use within-team delegation, largely accomplished through attention to clinical licensure, to differentiate staff in providing efficient, patient-centered care. In doing so, PACT may reinforce a clinically defined culture of care that countermands PCMH ideals. Such competing rubrics for care are brought into relief through a focus on the care work performed by clerks. Ethnographic analysis identifies clerks' care as a kind of emotional dirty work, signaling important areas for future anthropological study of the relationships among patient-centered care, stigma, and clinical authority. © 2016 by the American Anthropological Association.

Incorporating the principles of the patient- centered medical home into a student-run free clinic

Directory of Open Access Journals (Sweden)

Riddle MC

2014-09-01

Full Text Available Megan C Riddle,1,* Jiahui Lin,3,* Jonathan B Steinman,2 Joshua D Salvi,2 Margaret M Reynolds,3 Anne S Kastor,3,† Christina Harris,4 Carla Boutin-Foster3 1Department of Psychiatry and Behavioral Sciences, University of Washington, 2Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD–PhD Program, 3Department of Internal Medicine, Weill Cornell Medical College, New York, NY, 4Department of Medicine, Division of General Internal Medicine, VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, LA, USA *These authors contributed equally to this work †Anne S Kastor passed away on July 5, 2013. Abstract: As the health care delivery landscape changes, medical schools must develop creative strategies for preparing future physicians to provide quality care in this new environment. Despite the growing prominence of the patient-centered medical home (PCMH as an effective model for health care delivery, few medical schools have integrated formal education on the PCMH into their curricula. Incorporating the PCMH model into medical school curricula is important to ensure that students have a comprehensive understanding of the different models of health care delivery and can operate effectively as physicians. The authors provide a detailed description of the process by which the Weill Cornell Community Clinic (WCCC, a student-run free clinic, has integrated PCMH principles into a service-learning initiative. The authors assessed patient demographics, diagnoses, and satisfaction along with student satisfaction. During the year after a PCMH model was adopted, 112 students and 19 licensed physicians volunteered their time. A review of the 174 patients seen from July 2011 to June 2012 found that the most common medical reasons for visits included management of hypertension, hyperlipidemia, diabetes, gastrointestinal conditions, arthritis, anxiety, and depression. During the year after the adoption of the PCMH model, 87

Statement of the American Psychological Association in response to the "joint principles: integrating behavioral health care into the patient-centered medical home".

Science.gov (United States)

Anderson, Norman B; Belar, Cynthia D; Cubic, Barbara A; Garrison, Ellen G; Johnson, Suzanne Bennett; Kaslow, Nadine J

2014-06-01

Comments on the article "Joint principles: Integrating behavioral health care into the patient-centered medical home" (see record 2014-24217-011), presented by the Working Party Group on Integrated Behavioral Healthcare. The American Psychological Association (APA) shares concerns about the lack of reference to behavioral health care in the original 2007 Joint Principles of the Patient-Centered Medical Home for which this new document is intended to supplement but not replace. The decision to support the supplemental Joint Principles was not an easy one for APA, as there is one area of significant concern. That concern is related to the use of the term "physician-directed medical practice"

Using a Lego-based communications simulation to introduce medical students to patient-centered interviewing.

Science.gov (United States)

Harding, S R; D'Eon, M F

2001-01-01

Teaching patient-centered interviewing skills to medical students can be challenging. We have observed that 1st-year medical students, in particular, do not feel free to concentrate on the interviewing skills because they are preoccupied with complicated technical medical knowledge. The Lego simulation we use with our 1st-year students as part of a professional-skills course overcomes that difficulty. The Lego activity is a role play analogous to a doctor-patient interview that uses identical sets of Legos for the "doctor" and for the "patients" and a small construction that represents a patient history. With a simple questionnaire, data were collected from students at different points during instruction. Results indicate that the Lego activity was very effective in helping students learn the importance of open-ended questioning. It also was rated as highly as the very dynamic interactive part of the instructional session. The effectiveness of the Lego activity may be due to the properties of analogies.

Set up and operation for medical radiation exposure quality control system of health promotion center

Energy Technology Data Exchange (ETDEWEB)

Kim, Jung Su; Kim, Jung Min [Korea University,Seoul (Korea, Republic of); Jung, Hae Kyoung [Dept. of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Sungnam (Korea, Republic of)

2016-03-15

In this study, standard model of medical radiation dosage quality control system will be suggested and the useful of this system in clinical field will be reviewed. Radiation dosage information of modalities are gathered from digital imaging and communications in medicine(DICOM) standard data(such as DICOM dose SR and DICOM header) and stored in database. One CT scan, two digital radiography modalities and two mammography modalities in one health promotion center in Seoul are used to derive clinical data for one month. After 1 months research with 703 CT scans, the study shows CT 357.9 mGy·cm in abdomen and pelvic CT, 572.4 mGy·cm in brain without CT, 55.9 mGy·cm in calcium score/heart CT, screening CT at 54 mGy·cm in chest screening CT(low dose screening CT scan), 284.99 mGy·cm in C-spine CT and 341.85 mGy·cm in L-spine CT as health promotion center reference level of each exam. And with 1955 digital radiography cases, it shows 274.0 mGy·cm{sup 2} and for mammography 6.09 mGy is shown based on 536 cases. The use of medical radiation shall comply with the principles of justification and optimization. This quality management of medical radiation exposure must be performed in order to follow the principle. And the procedure to reduce the radiation exposure of patients and staff can be achieved through this. The results of this study can be applied as a useful tool to perform the quality control of medical radiation exposure.

Set up and operation for medical radiation exposure quality control system of health promotion center

International Nuclear Information System (INIS)

Kim, Jung Su; Kim, Jung Min; Jung, Hae Kyoung

2016-01-01

In this study, standard model of medical radiation dosage quality control system will be suggested and the useful of this system in clinical field will be reviewed. Radiation dosage information of modalities are gathered from digital imaging and communications in medicine(DICOM) standard data(such as DICOM dose SR and DICOM header) and stored in database. One CT scan, two digital radiography modalities and two mammography modalities in one health promotion center in Seoul are used to derive clinical data for one month. After 1 months research with 703 CT scans, the study shows CT 357.9 mGy·cm in abdomen and pelvic CT, 572.4 mGy·cm in brain without CT, 55.9 mGy·cm in calcium score/heart CT, screening CT at 54 mGy·cm in chest screening CT(low dose screening CT scan), 284.99 mGy·cm in C-spine CT and 341.85 mGy·cm in L-spine CT as health promotion center reference level of each exam. And with 1955 digital radiography cases, it shows 274.0 mGy·cm"2 and for mammography 6.09 mGy is shown based on 536 cases. The use of medical radiation shall comply with the principles of justification and optimization. This quality management of medical radiation exposure must be performed in order to follow the principle. And the procedure to reduce the radiation exposure of patients and staff can be achieved through this. The results of this study can be applied as a useful tool to perform the quality control of medical radiation exposure

Medical and Rehabilitation Centers in Children’s Houses — New Opportunities for Treatment and Rehabilitation of Children

Directory of Open Access Journals (Sweden)

I.V. Balychevtseva

2014-05-01

Full Text Available The article presents data on the opening of medical and rehabilitations centers at the children’s houses of Donetsk region. Approaches, terms, possibilities and methods of rehabilitations used during the treatment and restoration of disabled children are provided.

A revisionist view of the integrated academic health center.

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Rodin, Judith

2004-02-01

Like many academic health centers that had expanded aggressively during the 1990s, the nation's first vertically integrated academic health center, the University of Pennsylvania Health System, was profoundly challenged by the dramatic and unanticipated financial impacts of the Balanced Budget Act of 1997. The author explains why-although Penn's Health System had lost $300 million over two years and its debts threatened to cause serious financial and educational damage to the rest of the University-Penn chose to manage its way out of the financial crisis (instead of selling or spinning off its four hospitals, clinical practices, and possibly even its medical school). A strategy of comprehensive integration has not only stabilized Penn's Health System financially, but strengthened its position of leadership in medical education, research, and health care delivery. The author argues that a strategy of greater horizontal integration offers important strategic advantages to academic health centers. In an era when major social and scientific problems demand broadly multidisciplinary and highly-integrated approaches, such horizontally integrated institutions will be better able to educate citizens and train physicians, develop new approaches to health care policy, and answer pressing biomedical research questions. Institutional cultural integration is also crucial to create new, innovative organizational structures that bridge traditional disciplinary, school, and clinical boundaries.

Characteristics of Patient-Centered Medical Home Initiatives that Generated Savings for Medicare: a Qualitative Multi-Case Analysis.

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Burton, Rachel A; Lallemand, Nicole M; Peters, Rebecca A; Zuckerman, Stephen

2018-02-05

Through the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare, Medicaid, and private payers offered supplemental payments to 849 primary care practices that became patient-centered medical homes (PCMHs) in eight states; practices also received technical assistance and data reports. Average Medicare payments were capped at $10 per beneficiary per month in each state. Since there was variation in the eight participating states' demonstration designs, experiences, and outcomes, we conducted a qualitative multi-case analysis to identify the key factors that differentiated states that were estimated to have generated net savings for Medicare from states that did not. States' MAPCP Demonstration initiatives were comprehensively profiled in case studies based on secondary document review, three rounds of annual interviews with state staff, payers, practices, and other stakeholders, and other data sources. Case study findings were summarized in a case-ordered predictor-outcome matrix, which identified the presence or absence of key demonstration design features and experiences and arrayed states based on the amount of net savings or losses they generated for Medicare. We then used this matrix to identify initiative features that were present in at least three of the four states that generated net savings and absent from at least three of the four states that did not generate savings. A majority of the states that generated net savings: required practices to be recognized PCMHs to enter the demonstration, did not allow late entrants into the demonstration, used a consistent demonstration payment model across participating payers, and offered practices opportunities to earn performance bonuses. Practices in states that generated net savings also tended to report receiving the demonstration payments and bonuses they expected to receive, without any issues. Designers of future PCMH initiatives may increase their likelihood of generating net savings by

Examining the Customer Roles of Buyers and Users for Servitized Offerings

DEFF Research Database (Denmark)

Chakkol, Mehmet; Raja, Jawwad; Johnson, Mark

to identify and examine the emergent customer needs for different servitized offerings. Hence, building on a large-scale survey of 325 respondents, this research examines the needs of different customer centers (i.e. buyers and users) with respect to basic, intermediate and advanced servitized offerings.......Prior research on servitization generally adopts a provider perspective to examine the selling and provision of servitized offerings. However a lack of understanding, both in academia and practice, is evident about the buying decision from a customer perspective. In particular, it is necessary...

OPERATION OF THE CALL CENTER AT A HIGH-TECHNOLOGY PEDIATRIC MEDICAL INSTITUTION (WITH COMMENTARY BY A.A. MODESTOV

Directory of Open Access Journals (Sweden)

I. N. Chernomurov

2014-01-01

Full Text Available Introduction of modern information systems is one of the important objectives of medicine, as it contributes to higher availability of medical services for the population. Public relations of medical organizations involve websites of these organizations, outdoor advertising and other information sources. However, obtainment of competent inquiry answers by telephone remains a problem. People often choose between organizations depending on quality of the obtained information. Apparently, the issue can be resolved by establishing call centers that are not merely communications centers, but are staffed with competent trained personnel, who support the organization’s interaction with patients (or the legal representatives thereof. The article presents the authors’ experience of establishing a call center dedicated to the organization’s public image development, as well as higher demand of the available services and promotion thereof. The fulfilled modernization resulted in a sharp increase in the amount of calls received (1,500‑1,600 within the working hours; 900 – before modernization and reduction in the number of complaints of busy line. 

Humanities mini-course curricula for midcareer health professionals at the Penn State Milton S. Hershey Medical Center.

Science.gov (United States)

Myers, Kimberly R; George, Daniel R

2012-08-01

The field of medical humanities has traditionally focused on medical students and, more recently, on premedical undergraduates. Comparatively little formal humanities pedagogy has been dedicated to midcareer health professionals. To address this lack, the Department of Humanities at the Pennsylvania State University College of Medicine and the Milton S. Hershey Medical Center designed eight annual humanities mini-courses for faculty and staff throughout the college and medical center.These mini-courses fell into four categories: reading, reflection, and discussion; creative expression; technology; and ethics. They were geared toward midcareer health professionals who were seeking new intellectual and creative stimulation and variety in daily routine. They also provided humanities faculty the opportunity to devote attention to topics that capitalize on their professional training and that interest them personally.Participants indicated a high degree of satisfaction with the mini-courses for four principal reasons: (1) learning the tools and methodologies of a new discipline or domain other than biomedicine, (2) using their minds and training in uncustomary ways, (3) forming new alliances with colleagues (which served to lessen the sense of professional isolation), and (4) enjoying a respite from the stressful flow of the workday. Humanities faculty facilitators provided more mixed responses but agreed that conducting the mini-courses had been a positive overall experience.Although this article provides a foundational framework for the development of a humanities mini-course series, the authors encourage others to replicate these curricula in other medical settings as an important step toward a robust pedagogy designed for midcareer health care professionals.

The patient-centered medical home in oncology: from concept to reality.

Science.gov (United States)

Page, Ray D; Newcomer, Lee N; Sprandio, John D; McAneny, Barbara L

2015-01-01

In recent years, the cost of providing quality cancer care has been subject to an epic escalation causing concerns on the verge of a health care crisis. Innovative patient-management models in oncology based on patient-centered medical home (PCMH) principles, coupled with alternative payments to traditional fee for service (FFS), such as bundled and episodes payment are now showing evidence of effectiveness. These efforts have the potential to bend the cost curve while also improving quality of care and patient satisfaction. However, going forward with FFS alternatives, there are several performance-based payment options with an array of financial risks and rewards. Most novel payment options convey a greater financial risk and accountability on the provider. Therefore, the oncology medical home (OMH) can be a way to mitigate some financial risks by sharing savings with the payer through better global care of the patient, proactively preventing complications, emergency department (ED) visits, and hospitalizations. However, much of the medical home infrastructure that is required to reduced total costs of cancer care comes as an added expense to the provider. As best-of-practice quality standards are being elucidated and refined, we are now at a juncture where payers, providers, policymakers, and other stakeholders should work in concert to expand and implement the OMH framework into the variety of oncology practice environments to better equip them to assimilate into the new payment reform configurations of the future.

Handbook on data centers

CERN Document Server

Khan, Samee Ullah

2015-01-01

This handbook offers a comprehensive review of the state-of-the-art research achievements in the field of data centers. Contributions from international, leading researchers and scholars offer topics in cloud computing, virtualization in data centers, energy efficient data centers, and next generation data center architecture.  It also comprises current research trends in emerging areas, such as data security, data protection management, and network resource management in data centers. Specific attention is devoted to industry needs associated with the challenges faced by data centers, such as various power, cooling, floor space, and associated environmental health and safety issues, while still working to support growth without disrupting quality of service. The contributions cut across various IT data technology domains as a single source to discuss the interdependencies that need to be supported to enable a virtualized, next-generation, energy efficient, economical, and environmentally friendly data cente...

Utilization of a Marketing Strategy at Naval Regional Medical Center Great Lakes, Great Lakes, Illinois

Science.gov (United States)

1983-06-01

22 Analysis of the Mare.....................22 Development of the Marketing Mix .. .......... 29 A Marketing Mix --Recommendations...problem. Marketing strategy, marketing mix and ultimately the marketing orientation will allow hospitals to persevere and possibly thrive in a somewhat...market are currently being met at Naval Regional Medical Center Great Lakes. The fourth objective is to demonstrate an appropriate marketing mix for

Disruptive innovation in academic medical centers: balancing accountable and academic care.

Science.gov (United States)

Stein, Daniel; Chen, Christopher; Ackerly, D Clay

2015-05-01

Numerous academic medicine leaders have argued that academic referral centers must prepare for the growing importance of accountability-driven payment models by adopting population health initiatives. Although this shift has merit, execution of this strategy will prove significantly more problematic than most observers have appreciated. The authors describe how successful implementation of an accountable care health strategy within a referral academic medical center (AMC) requires navigating a critical tension: The academic referral business model, driven by tertiary-level care, is fundamentally in conflict with population health. Referral AMCs that create successful value-driven population health systems within their organizations will in effect disrupt their own existing tertiary care businesses. The theory of disruptive innovation suggests that balancing the push and pull of academic and accountable care within a single organization is achievable. However, it will require significant shifts in resource allocation and changes in management structure to enable AMCs to make the inherent difficult choices and trade-offs that will ensue. On the basis of the theories of disruptive innovation, the authors present recommendations for how academic health systems can successfully navigate these issues as they transition toward accountability-driven care.

Mandibular Fracture Patterns at a Medical Center in Central Taiwan: A 3-Year Epidemiological Review.

Science.gov (United States)

Lin, Fu-Yu; Wu, Chao-I; Cheng, Hsu-Tang

2017-12-01

Mandibular fractures constitute a major portion of maxillofacial trauma and may lead to considerable functional and aesthetic sequelae if treatment is inadequate or delayed. An epidemiology study on mandibular fractures may guide the preventive efforts of the Taiwan public health care system. Therefore, a retrospective review was conducted at a medical center in central Taiwan to evaluate the current mandibular fracture epidemiology.The medical records and digitized radiographs of 198 patients who received treatment for mandibular fractures during a 3-year period (from October 2010 to September 2013) at a medical center in central Taiwan were reviewed to obtain demographic and injury data.The average age was 29.4 years (3-82 years). Patients aged 21 to 30 years sustained the most mandibular fractures (62 patients, 31.3%). The overall sex distribution (male to female) ratio was 1.8. Motor-vehicle accidents (MVAs) were the most common mechanism of injury (162 patients, 82%), and scooter and motorcycle riders wearing partial-coverage helmets constituted the majority of patients. A chart review identified 198 patients with 335 mandibular fractures; 113 patients (57.1%) had multiple mandibular fractures. The most common fracture sites were the symphysis and parasymphysis regions (38.9%), followed by the condyle (26.0%), angle (14.3%), body (14.3%), and ramus (6.6%).MVAs are the major cause of mandibular fractures in central Taiwan, and patients aged Taiwan. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

NNDC Stand: Activities and Services of the National Nuclear Data Center

International Nuclear Information System (INIS)

Pritychenko, B.; Arcilla, R.; Burrows, T.W.; Dunford, C.L.; Herman, M.W.; McLane, V.; Oblozinsky, P.; Sonzogni, A.A.; Tuli, J.K.; Winchell, D.F.

2005-01-01

The National Nuclear Data Center (NNDC) collects, evaluates, and disseminates nuclear physics data for basic nuclear research, applied nuclear technologies including energy, shielding, medical and homeland security. In 2004, to answer the needs of nuclear data users community, NNDC completed a project to modernize data storage and management of its databases and began offering new nuclear data Web services. The principles of database and Web application development as well as related nuclear reaction and structure database services are briefly described

Comprehensive Revenue and Expense Data Collection Methodology for Teaching Health Centers: A Model for Accountable Graduate Medical Education Financing.

Science.gov (United States)

Regenstein, Marsha; Snyder, John E; Jewers, Mariellen Malloy; Nocella, Kiki; Mullan, Fitzhugh

2018-04-01

Despite considerable federal investment, graduate medical education financing is neither transparent for estimating residency training costs nor accountable for effectively producing a physician workforce that matches the nation's health care needs. The Teaching Health Center Graduate Medical Education (THCGME) program's authorization in 2010 provided an opportunity to establish a more transparent financing mechanism. We developed a standardized methodology for quantifying the necessary investment to train primary care physicians in high-need communities. The THCGME Costing Instrument was designed utilizing guidance from site visits, financial documentation, and expert review. It collects educational outlays, patient service expenses and revenues from residents' ambulatory and inpatient care, and payer mix. The instrument was fielded from April to November 2015 in 43 THCGME-funded residency programs of varying specialties and organizational structures. Of the 43 programs, 36 programs (84%) submitted THCGME Costing Instruments. The THCGME Costing Instrument collected standardized, detailed cost data on residency labor (n = 36), administration and educational outlays (n = 33), ambulatory care visits and payer mix (n = 30), patient service expenses (n =  26), and revenues generated by residents (n = 26), in contrast to Medicare cost reports, which include only costs incurred by residency programs. The THCGME Costing Instrument provides a model for calculating evidence-based costs and revenues of community-based residency programs, and it enhances accountability by offering an approach that estimates residency costs and revenues in a range of settings. The instrument may have feasibility and utility for application in other residency training settings.

Ethical acceptability of offering financial incentives for taking antipsychotic depot medication: patients' and clinicians' perspectives after a 12-month randomized controlled trial.

Science.gov (United States)

Noordraven, Ernst L; Schermer, Maartje H N; Blanken, Peter; Mulder, Cornelis L; Wierdsma, André I

2017-08-29

A randomized controlled trial 'Money for Medication'(M4M) was conducted in which patients were offered financial incentives for taking antipsychotic depot medication. This study assessed the attitudes and ethical considerations of patients and clinicians who participated in this trial. Three mental healthcare institutions in secondary psychiatric care in the Netherlands participated in this study. Patients (n = 169), 18-65 years, diagnosed with schizophrenia, schizoaffective disorder or another psychotic disorder who had been prescribed antipsychotic depot medication, were randomly assigned to receive 12 months of either treatment as usual plus a financial reward for each depot of medication received (intervention group) or treatment as usual alone (control group). Structured questionnaires were administered after the 12-month intervention period. Data were available for 133 patients (69 control and 64 intervention) and for 97 clinicians. Patients (88%) and clinicians (81%) indicated that financial incentives were a good approach to improve medication adherence. Ethical concerns were categorized according to the four-principles approach (autonomy, beneficence, non-maleficence, and justice). Patients and clinicians alike mentioned various advantages of M4M in clinical practice, such as increased medication adherence and improved illness insight; but also disadvantages such as reduced intrinsic motivation, loss of autonomy and feelings of dependence. Overall, patients evaluated financial incentives as an effective method of improving medication adherence and were willing to accept this reward during clinical treatment. Clinicians were also positive about the use of this intervention in daily practice. Ethical concerns are discussed in terms of patient autonomy, beneficence, non-maleficence and justice. We conclude that this intervention is ethically acceptable under certain conditions, and that further research is necessary to clarify issues of benefit

Effects of internal marketing on nurse job satisfaction and organizational commitment: example of medical centers in Southern Taiwan.

Science.gov (United States)

Chang, Ching-Sheng; Chang, Hsin-Hsin

2007-12-01

As nurses typically represent the largest percentage of employees at medical centers, their role in medical care is exceptionally important and becoming more so over time. The quality and functions of nurses impact greatly on medical care quality. The concept of internal marketing, with origins in the field of market research, argues that enterprises should value and respect their employees by treating them as internal customers. Such a marketing concept challenges traditional marketing methods, which focus on serving external customers only. The main objective of internal marketing is to help internal customers (employees) gain greater job satisfaction, which should promote job performance and facilitate the organization accomplishing its ultimate business objectives. A question in the medical service industry is whether internal marketing can similarly increase the job satisfaction of nurses and enhance their commitment to the organization. This study aimed to explore the relational model of nurse perceptions related to internal marketing, job satisfaction, and organizational commitment by choosing nurses from two medical centers in Southern Taiwan as research subjects. Of 450 questionnaire distributed, 300 valid questionnaires were returned, giving a response rate of 66.7%. After conducting statistical analysis and estimation using structural equation modeling, findings included: (1) job satisfaction has positive effects on organizational commitment; (2) nurse perceptions of internal marketing have positive effects on job satisfaction; and (3) nurse perceptions of internal marketing have positive effects on organizational commitment.

The design of neonatal incubators: a systems-oriented, human-centered approach.

Science.gov (United States)

Ferris, T K; Shepley, M M

2013-04-01

This report describes a multidisciplinary design project conducted in an academic setting reflecting a systems-oriented, human-centered philosophy in the design of neonatal incubator technologies. Graduate students in Architectural Design and Human Factors Engineering courses collaborated in a design effort that focused on supporting the needs of three user groups of incubator technologies: infant patients, family members and medical personnel. Design teams followed established human-centered design methods that included interacting with representatives from the user groups, analyzing sets of critical tasks and conducting usability studies with existing technologies. An iterative design and evaluation process produced four conceptual designs of incubators and supporting equipment that better address specific needs of the user groups. This report introduces the human-centered design approach, highlights some of the analysis findings and design solutions, and offers a set of design recommendations for future incubation technologies.

NREL's Education Center Programs | NREL

Science.gov (United States)

NREL's Education Center Programs NREL's Education Center Programs There are a variety of educational programs offered through NREL's education center to inspire our community to explore the science neighbors, campus and trail maps, and more. A photo of the NREL Education Center exterior. Programs for

A nationwide survey of patient centered medical home demonstration projects.

Science.gov (United States)

Bitton, Asaf; Martin, Carina; Landon, Bruce E

2010-06-01

The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Cross-sectional key-informant interviews. Leaders from existing PCMH demonstration projects with external payment reform. We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified--consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows.

The outcome of the first 1000 cases of LASIK performed at the king Hussein Medical Center

Energy Technology Data Exchange (ETDEWEB)

Abdallat, W [King Hussein Medical Centre, Amman (Jordan). Dept. of Ophthalmology

2011-07-01

The current study evaluates the refractive and visual outcome of patients who had laser in situ keratomileusis (LASIK) performed at the refractive center at King Hussein Medical centre in Jordan. The predictability of LASIK surgery in terms of refractive and visual outcome results is very good with mild regression in refraction over time. (author).

The outcome of the first 1000 cases of LASIK performed at the king Hussein Medical Center

International Nuclear Information System (INIS)

Abdallat, W

2011-01-01

The current study evaluates the refractive and visual outcome of patients who had laser in situ keratomileusis (LASIK) performed at the refractive center at King Hussein Medical centre in Jordan. The predictability of LASIK surgery in terms of refractive and visual outcome results is very good with mild regression in refraction over time. (author).

The Impact of Baccalaureate Medical Humanities on Subsequent Medical Training and Practice: A Physician-Educator's Perspective.

Science.gov (United States)

Barron, Lauren

2017-12-01

This reflective essay is an attempt to organize trends in feedback I have observed during ten years of coursework, conversations, and correspondence with former students associated with the Medical Humanities Program at Baylor University. Over the years, recurrent themes arise when speaking with alumni about whether and how their medical humanities experience intersects with their current training. I have identified five particular domains in which baccalaureate medical humanities training affects students' subsequent healthcare professions training and practice: context and complementarity, clinical relevance, reflective practice, professional preparedness and vocational calling. I created an instrument of open-ended questions for each of these categories and posted it to social media with an invitation for alumni to respond. This informal survey was conceived as an exploratory exercise with the intent to help generate a foundation for more formal qualitative research in these five domains. In this essay, I offer my own reflections together with those of former students on the impact of baccalaureate-level medical humanities training in order to illustrate the benefits in each domain for subsequent healthcare training and practice. The need for qualitative research that explores the impact of baccalaureate medical humanities merits collaboration between multiple centers of investigation across many disciplines, and across the divide between premedical and medical educators.

Calibration Laboratory for Medical Physics towards ISO/ IEC 17025 accreditation: Experience and challenges

International Nuclear Information System (INIS)

Asmaliza Hashim; Abdul Aziz Ramli; Muhammad Jamal Isa; Sharul Azlan Azizan

2011-01-01

Medical Physics Calibration Laboratory is laboratory where placed under Medical Physics Group, Radiation Healthy and Safety Division. This laboratory offers calibration services to their customers that covered doses calibration, tube voltan (kVp), exposure doses, sensitometer and densitometer. After 12 years of operation, it is the right time for this laboratory to upgrade their quality services based on ISO/ IEC 17025. Accreditation scope covered calibration for diagnostic doses only. Starting from 2009, serious effort was done to prepare the quality documents that covered quality manual, quality procedure and work orders. Meanwhile, several series of audit were done by Quality Management Center (QMC), now Innovation Management Center (IMC) with collaboration with Standard Department. This paper works revealed challenges and experience during the process toward ISO/ IEC 17025 accreditation. (author)

Patient-centered medical home transformation with payment reform: patient experience outcomes.

Science.gov (United States)

Heyworth, Leonie; Bitton, Asaf; Lipsitz, Stuart R; Schilling, Thad; Schiff, Gordon D; Bates, David W; Simon, Steven R

2014-01-01

To examine changes in patient experience across key domains of the patient-centered medical home (PCMH) following practice transformation with Lean quality improvement methodology inclusive of payment reform. Pre-intervention/post-intervention analysis of intervention with a comparison group, a quasi-experimental design. We surveyed patients following office visits at the intervention (n = 2502) and control (n = 1622) practices during the 15-month period before and 14-month period after PCMH Lean transformation (April-October 2009). We measured and compared pre-intervention and post-intervention levels of patient satisfaction and other indicators of patient-centered care. Propensity weights adjusted for potential case-mix differences in intervention and control groups; propensity-adjusted proportions accounted for physician-level clustering. More intervention patients were very satisfied with their care after the PCMH Lean intervention (68%) compared with pre-intervention (62%). Among control patients, there was no corresponding increase in satisfaction (63% very satisfied pre-intervention vs 64% very satisfied post-intervention). This comparison resulted in a statistical trend (P = .10) toward greater overall satisfaction attributable to the intervention. Post-intervention, patients in the intervention practice consistently rated indicators of patient-centered care higher than patients in the control practice, particularly in the personal physician and communication domain. In this domain, intervention patients reported superior provider explanations, time spent, provider concern, and follow-up instructions compared with control participants, whereas control group ratings fell in the post-intervention period (P for difference Lean enhancement with payment reform, patient experience was sustained or improved across key PCMH domains.

Managed medical education?

Science.gov (United States)

Hafferty, F W

1999-09-01

The forces of rationality and commodification, hallmarks of the managed care revolution, may soon breach the walls of organized medical education. Whispers are beginning to circulate that the cost of educating future physicians is too high. Simultaneously, managed care companies are accusing medical education of turning out trainees unprepared to practice in a managed care environment. Changes evident in other occupational and service delivery sectors of U.S. society as diverse as pre-college education and prisons provide telling insights into what may be in store for medical educators. Returning to academic medicine, the author reflects that because corporate managed care is already established in teaching hospitals, and because managed research (e.g., corporate-sponsored and -run drug trials, for-profit drug-study centers, and contract research organizations) is increasing, managed medical education could become a reality as well. Medical education has made itself vulnerable to the intrusion of corporate rationalizers because it has failed to professionalism at core of its curricula-something only it is able to do--and instead has focused unduly on the transmission of esoteric knowledge and core clinical skills, a process that can be carried out more efficiently, more effectively, and less expensively by other players in the medical education marketplace such as Kaplan, Compass, or the Princeton Review. The author explains why reorganizing medical education around professional values is crucial, why the AAMC's Medical School Objectives Project offers guidance in this area, why making this change will be difficult, and why medical education must lead in establishing how to document the presence and absence of such qualities as altruism and dutifulness and the ways that appropriate medical education can foster these and similar core competencies. "Anything less and organized medicine will acknowledged... that it has abandoned its social contract and entered the

Introducing quality assurance and medical audit into the UCSF medical center curriculum.

Science.gov (United States)

Barbaccia, J C

1976-05-01

The experience gained by a medical school faculty in developing and piloting a course for undergraduate medical students in medical care evaluation led to a similar effort for house staff. It is recognized that if the profession is to fulfill the demand by society for social accountability in the use of resources for health care, medical care assessment and quality assurance mechanisms must become an intimate part of the clinical experience of medical students and house officers. Teaching these subjects requires a theoretical framework; introduction of content and skills appropriate to the level of the student and continuation of progressively more advanced training throughout medical education; use of assessment and quality assurance techniques by clinician-teachers themselves to provide models for the student; and continued evolution of pedagogic approach and course content based on developments in the area.

Fall Injuries and Related Factors of Elderly Patients at a Medical Center in Taiwan

OpenAIRE

Tsai, Li-Yun; Tsay, Shiow-Luan; Hsieh, Ruey-Kuen; Yu, Shu; Tsai, Jung-Mei; Chien, Hui-Hsien; Liu, Shu-Jung

2014-01-01

Background: Elderly patients have a high incidence of falls and injuries in hospitals due to various reasons. The aims of this study were to explore the characteristics and factors associated with fall injuries among elderly patients. Methods: A retrospective survey study was conducted. Data were retrieved from the patient safety reporting system of a medical center in Taiwan query for patient fall incidents of elderly patients aged 65 years or older between 2010 and 2012. Statistics were ...

How valid are commercially available medical simulators?

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Stunt JJ

2014-10-01

Full Text Available JJ Stunt,1 PH Wulms,2 GM Kerkhoffs,1 J Dankelman,2 CN van Dijk,1 GJM Tuijthof1,2 1Orthopedic Research Center Amsterdam, Department of Orthopedic Surgery, Academic Medical Centre, Amsterdam, the Netherlands; 2Department of Biomechanical Engineering, Faculty of Mechanical, Materials and Maritime Engineering, Delft University of Technology, Delft, the Netherlands Background: Since simulators offer important advantages, they are increasingly used in medical education and medical skills training that require physical actions. A wide variety of simulators have become commercially available. It is of high importance that evidence is provided that training on these simulators can actually improve clinical performance on live patients. Therefore, the aim of this review is to determine the availability of different types of simulators and the evidence of their validation, to offer insight regarding which simulators are suitable to use in the clinical setting as a training modality. Summary: Four hundred and thirty-three commercially available simulators were found, from which 405 (94% were physical models. One hundred and thirty validation studies evaluated 35 (8% commercially available medical simulators for levels of validity ranging from face to predictive validity. Solely simulators that are used for surgical skills training were validated for the highest validity level (predictive validity. Twenty-four (37% simulators that give objective feedback had been validated. Studies that tested more powerful levels of validity (concurrent and predictive validity were methodologically stronger than studies that tested more elementary levels of validity (face, content, and construct validity. Conclusion: Ninety-three point five percent of the commercially available simulators are not known to be tested for validity. Although the importance of (a high level of validation depends on the difficulty level of skills training and possible consequences when skills are

"Bacterial infections in visceral leishmaniasis in Children’s Medical Center 1966-2000 "

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"Tabatabaei P "

2002-07-01

Full Text Available Background: Bacterial infections are seen in patients with visceral leishmaniasis. This study was conducted to determine the incidence of such infections and the more common infections agents. Materials and Methods: During the 15-years period in a prospective study from 1986 to 2000, 123 patients with visceral leishmaniasis were studied in the Children Medical Center. Results: From all the cases, 41 (33 percent patients had Also bacterial infections. Respiratory tract, urinary system, Middle ear were the most common sites of infection. Conclusion: When bacterial Infection is suspected in these patients, empiric antibiotic therapy should be started immediately after appropriate diagnostic procedures are taken.

Establishment of exposure dose assessment laboratory in National Radiation Emergency Medical Center (NREMC)

Energy Technology Data Exchange (ETDEWEB)

Yoo, Jae Ryong; Ha, Wi Ho; Yoon, Seok Won; Han, Eun Ae; Lee, Seung Sook [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)

2011-10-15

As unclear industry grown, 432 of the nuclear power plants are operating and 52 of NPPs are under construction currently. Increasing use of radiation or radioisotopes in the field of industry, medical purpose and research such as non-destructive examination, computed tomography and x-ray, etc. constantly. With use of nuclear or radiation has incidence possibility for example the Fukushima NPP incident, the Goiania accident and the Chernobyl Nuclear accident. Also the risk of terror by radioactive material such as Radiological Dispersal Device(RDD) etc. In Korea, since the 'Law on protection of nuclear facilities and countermeasure for radioactive preparedness was enacted in 2003, the Korean institute of Radiological and Medical Sciences(KIRAMS) was established for the radiation emergency medical response in radiological disaster due to nuclear accident, radioactive terror and so on. Especially National Radiation Emergency Medical Center(NREMC) has the duty that is protect citizens from nuclear, radiological accidents or radiological terrors through the emergency medical preparedness. The NREMC was established by the 39-article law on physical protection of nuclear material and facilities and measures for radiological emergencies. Dose assessment or contamination survey should be performed which provide the radiological information for medical response. For this reason, the NREMC establish and re-organized dose assessment system based on the existing dose assessment system of the NREMC recently. The exposure dose could be measured by physical and biological method. With these two methods, we can have conservative dose assessment result. Therefore the NREMC established the exposure dose assessment laboratory which was re-organized laboratory space and introduced specialized equipment for dose assessment. This paper will report the establishment and operation of exposure dose assessment laboratory for radiological emergency response and discuss how to enhance

Impact of type 1 diabetes mellitus on the family is reduced with the medical home, care coordination, and family-centered care.

Science.gov (United States)

Katz, Michelle L; Laffel, Lori M; Perrin, James M; Kuhlthau, Karen

2012-05-01

To examine whether the medical home, care coordination, or family-centered care was associated with less impact of type 1 diabetes mellitus (T1D) on families' work, finances, time, and school attendance. With the 2005 to 2006 National Survey of Children with Special Health Care Needs, we compared impact in children with T1D (n = 583) with that in children with other special health care needs (n = 39 944) and children without special health care needs (n = 4945). We modeled the associations of the medical home, care coordination, and family-centered care with family impact in T1D. Seventy-five percent of families of children with T1D reported a major impact compared with 45% of families of children with special health care needs (P families of children without special health care needs (P families of children with T1D, 35% reported restricting work, 38% reported financial impact, 41% reported medical expenses >$1000/year, 24% reported spending ≥11 hours/week caring or coordination care, and 20% reported ≥11 school absences/year. The medical home, care coordination, and family-centered care were associated with less work and financial impact. In childhood T1D, most families experience major impact. Better systems of health care delivery may help families reduce some of this impact. Copyright © 2012 Mosby, Inc. All rights reserved.

Commercial Crew Medical Ops

Science.gov (United States)

Heinbaugh, Randall; Cole, Richard

2016-01-01

Provide commercial partners with: center insight into NASA spaceflight medical experience center; information relative to both nominal and emergency care of the astronaut crew at landing site center; a basis for developing and sharing expertise in space medical factors associated with returning crew.

A Three-Year Experience of Medical Thoracoscopy at A Tertiary Care Center of Himalayan Region

Directory of Open Access Journals (Sweden)

Rakhee Sodhi

2016-03-01

Full Text Available Introduction: Medical thoracoscopy is a minimally invasive procedure for diagnosing and treating pleural diseases. Despite its proven role in diagnostic and therapeutic purposes, it is infrequently used, which could be because of cost of equipment and lack of training. We analyzed our initial 3 years record of thoracoscopy at Himalayan Institute of Medical Sciences, a tertiary care center in Himalayan region of north India. Materials and Methods: This cross-sectional study was to analyze our experience of medical thoracoscopy which was started in Jan 2011 at our center. All patients who underwent thoracoscopy during the period between Jan 2011 to Dec 2013 were included in the study. Thoracoscopy was performed for diagnosis of undiagnosed pleural effusions. Clinical, radiological, cytological & histopathological data of the patients were collected prospectively and analysed. Results: The diagnostic yield for a pleuroscopic pleural biopsy in our study was 87.23% (41/47. Malignancy was diagnosed histopathologically in 70.2% (33/47 patients (both primary & metastatic pleural carcinoma and tuberculosis in 10.6% (5/47. There was no mortality related to procedure. Only three patients had minor complications like subcutaneous emphysema which was mild and resolved by second post-procedure day. Pain at intercostal drain site was observed in some patients. Conclusion: Thoracoscopy is an easy outpatient procedure and an excellent diagnostic tool for pleural effusion of uncertain etiology. It has low complication rate even in settings where the procedure is just started. It should be included in the armamentarium of tools for management of pleural effusion.

Decision support for organ offers in liver transplantation.

Science.gov (United States)

Volk, Michael L; Goodrich, Nathan; Lai, Jennifer C; Sonnenday, Christopher; Shedden, Kerby

2015-06-01

Organ offers in liver transplantation are high-risk medical decisions with a low certainty of whether a better liver offer will come along before death. We hypothesized that decision support could improve the decision to accept or decline. With data from the Scientific Registry of Transplant Recipients, survival models were constructed for 42,857 waiting-list patients and 28,653 posttransplant patients from 2002 to 2008. Daily covariate-adjusted survival probabilities from these 2 models were combined into a 5-year area under the curve to create an individualized prediction of whether an organ offer should be accepted for a given patient. Among 650,832 organ offers from 2008 to 2013, patient survival was compared by whether the clinical decision was concordant or discordant with model predictions. The acceptance benefit (AB)--the predicted gain or loss of life by accepting a given organ versus waiting for the next organ--ranged from 3 to -22 years (harm) and varied geographically; for example, the average benefit of accepting a donation after cardiac death organ ranged from 0.47 to -0.71 years by donation service area. Among organ offers, even when AB was >1 year, the offer was only accepted 10% of the time. Patient survival from the time of the organ offer was better if the model recommendations and the clinical decision were concordant: for offers with AB > 0, the 3-year survival was 80% if the offer was accepted and 66% if it was declined (P decision support may improve patient survival in liver transplantation. © 2015 American Association for the Study of Liver Diseases.

A Survey of Intravenous Remifentanil Use for Labor Analgesia at Academic Medical Centers in the United States.

Science.gov (United States)

Aaronson, Jaime; Abramovitz, Sharon; Smiley, Richard; Tangel, Virginia; Landau, Ruth

2017-04-01

Remifentanil is most commonly offered when neuraxial labor analgesia is contraindicated. There is no consensus regarding the optimal administration, dosing strategy, or requirements for maternal monitoring, which may pose a patient safety issue. This exploratory survey evaluated the current practices regarding remifentanil use for labor analgesia at academic centers in the United States. Of 126 obstetric anesthesia directors surveyed, 84 (67%) responded. In 2014 to 2015, an estimated 36% (95% confidence interval: 25.7-46.3) of centers used remifentanil, most of which did so less than 5 times. Some serious maternal and neonatal respiratory complications occurred, emphasizing that clinical protocols and adequate monitoring are key to ensure maternal and neonatal safety.

Financial impact of tertiary care in an academic medical center.

Science.gov (United States)

Huber, T S; Carlton, L M; O'Hern, D G; Hardt, N S; Keith Ozaki, C; Flynn, T C; Seeger, J M

2000-06-01

To analyze the financial impact of three complex vascular surgical procedures to both an academic hospital and a department of surgery and to examine the potential impact of decreased reimbursements. The cost of providing tertiary care has been implicated as one potential cause of the financial difficulties affecting academic medical centers. Patients undergoing revascularization for chronic mesenteric ischemia, elective thoracoabdominal aortic aneurysm repair, and treatment of infected aortic grafts at the University of Florida were compared with those undergoing elective infrarenal aortic reconstruction and carotid endarterectomy. Hospital costs and profit summaries were obtained from the Clinical Resource Management Office. Departmental costs and profit summary were estimated based on the procedural relative value units (RVUs), the average clinical cost per RVU ($33.12), surgeon charges, and the collection rate for the vascular surgery division (30.2%) obtained from the Faculty Group Practice. Surgeon work effort was analyzed using the procedural work RVUs and the estimated total care time. The analyses were performed for all payors and the subset of Medicare patients, and the potential impact of a 15% reduction in hospital and physician reimbursement was analyzed. Net hospital income was positive for all but one of the tertiary care procedures, but net losses were sustained by the hospital for the mesenteric ischemia and infected aortic graft groups among the Medicare patients. In contrast, the estimated reimbursement to the department of surgery for all payors was insufficient to offset the clinical cost of providing the RVUs for all procedures, and the estimated losses were greater for the Medicare patients alone. The surgeon work effort was dramatically higher for the tertiary care procedures, whereas the reimbursement per work effort was lower. A 15% reduction in reimbursement would result in an estimated net loss to the hospital for each of the tertiary

Photo-medical valley. 'Photo medical research center'

International Nuclear Information System (INIS)

Kawanishi, Shunichi; Daido, Hiroyuki; Tajima, Toshiki

2008-01-01

To develop a much more compact cancer diagnosis and therapeutic instrument using high intensity laser technology, Japan Atomic Energy Agency (JAEA) has successfully proposed this novel effort to the Ministry of Education, Culture, Sports, Science and Technology (MEXT) program as the creation of a 'photo-medical industrial valley' base in 2007 fiscal year. In this report, a new laser techniques to drive controlled ion beams is described. It is very important approach to realize a laser-driven ion accelerator. (author)

Patient experience in a coordinated care model featuring diabetes self-management education integrated into the patient-centered medical home.

Science.gov (United States)

Janiszewski, Debra; O'Brian, Catherine A; Lipman, Ruth D

2015-08-01

The purpose of this study is to gain insight about patient experience of diabetes self-management education in a patient-centered medical home. Six focus groups consisting of 37 people with diabetes, diverse in race and ethnicity, were conducted at 3 sites. Participants described their experience in the program and their challenges in diabetes self-management; they also suggested services to meet their diabetes care needs. The most common theme was ongoing concerns about care and support. There was much discussion about the value of the support provided by health navigators integrated in the diabetes health care team. Frequent concerns expressed by participants centered on personal challenges in engaging in healthy lifestyle behaviors. Ongoing programmatic support of self-management goals was widely valued. Individuals who received health care in a patient-centered medical home and could participate in diabetes self-management education with integrated support valued both activities. The qualitative results from this study suggest need for more formalized exploration of effective means to meet the ongoing support needs of people with diabetes. © 2015 The Author(s).

Performance test of electron cyclotron resonance ion sources for the Hyogo Ion Beam Medical Center

Science.gov (United States)

Sawada, K.; Sawada, J.; Sakata, T.; Uno, K.; Okanishi, K.; Harada, H.; Itano, A.; Higashi, A.; Akagi, T.; Yamada, S.; Noda, K.; Torikoshi, M.; Kitagawa, A.

2000-02-01

Two electron cyclotron resonance (ECR) ion sources were manufactured for the accelerator facility at the Hyogo Ion Beam Medical Center. H2+, He2+, and C4+ were chosen as the accelerating ions because they have the highest charge to mass ratio among ion states which satisfy the required intensity and quality. The sources have the same structure as the 10 GHz ECR source at the Heavy Ion Medical Accelerator in Chiba except for a few improvements in the magnetic structure. Their performance was investigated at the Sumitomo Heavy Industries factory before shipment. The maximum intensity was 1500 μA for H2+, 1320 μA for He2+, and 580 μA for C4+ at the end of the ion source beam transport line. These are several times higher than required. Sufficient performance was also observed in the flatness and long-term stability of the pulsed beams. These test results satisfy the requirements for medical use.

Characterizing complexity in socio-technical systems: a case study of a SAMU Medical Regulation Center.

Science.gov (United States)

Righi, Angela Weber; Wachs, Priscila; Saurin, Tarcísio Abreu

2012-01-01

Complexity theory has been adopted by a number of studies as a benchmark to investigate the performance of socio-technical systems, especially those that are characterized by relevant cognitive work. However, there is little guidance on how to assess, systematically, the extent to which a system is complex. The main objective of this study is to carry out a systematic analysis of a SAMU (Mobile Emergency Medical Service) Medical Regulation Center in Brazil, based on the core characteristics of complex systems presented by previous studies. The assessment was based on direct observations and nine interviews: three of them with regulator of emergencies medical doctor, three with radio operators and three with telephone attendants. The results indicated that, to a great extent, the core characteristics of complexity are magnified) due to basic shortcomings in the design of the work system. Thus, some recommendations are put forward with a view to reducing unnecessary complexity that hinders the performance of the socio-technical system.

Research Priorities in Education from the Viewpoint of Authorities and Experts of Mashhad University of Medical Sciences

Directory of Open Access Journals (Sweden)

Sara Ghodusi Moghadam

2015-08-01

Offering the research in education challenges, besides conducting research topics, is a proposing towards the priorities, if considered to policymakers, reviewers and research projects approvers can be operated as a tool for optimal use of limited financial resources. * Corresponding Author: Neyshabur University of Medical Sciences, Educational Development Center. Email: Sa_ghodousi@yahoo.com

Managing medical and insurance information through a smart-card-based information system.

Science.gov (United States)

Lambrinoudakis, C; Gritzalis, S

2000-08-01

The continuously increased mobility of patients and doctors, in conjunction with the existence of medical groups consisting of private doctors, general practitioners, hospitals, medical centers, and insurance companies, pose significant difficulties on the management of patients' medical data. Inevitably this affects the quality of the health care services provided. The evolving smart card technology can be utilized for the implementation of a secure portable electronic medical record, carried by the patient herself/himself. In addition to the medical data, insurance information can be stored in the smart card thus facilitating the creation of an "intelligent system" supporting the efficient management of patient's data. In this paper we present the main architectural and functional characteristics of such a system. We also highlight how the security features offered by smart cards can be exploited in order to ensure confidentiality and integrity of the medical data stored in the patient cards.

Impact of a reengineered electronic error-reporting system on medication event reporting and care process improvements at an urban medical center.

Science.gov (United States)

McKaig, Donald; Collins, Christine; Elsaid, Khaled A

2014-09-01

A study was conducted to evaluate the impact of a reengineered approach to electronic error reporting at a 719-bed multidisciplinary urban medical center. The main outcome of interest was the monthly reported medication errors during the preimplementation (20 months) and postimplementation (26 months) phases. An interrupted time series analysis was used to describe baseline errors, immediate change following implementation of the current electronic error-reporting system (e-ERS), and trend of error reporting during postimplementation. Errors were categorized according to severity using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Medication Error Index classifications. Reported errors were further analyzed by reporter and error site. During preimplementation, the monthly reported errors mean was 40.0 (95% confidence interval [CI]: 36.3-43.7). Immediately following e-ERS implementation, monthly reported errors significantly increased by 19.4 errors (95% CI: 8.4-30.5). The change in slope of reported errors trend was estimated at 0.76 (95% CI: 0.07-1.22). Near misses and no-patient-harm errors accounted for 90% of all errors, while errors that caused increased patient monitoring or temporary harm accounted for 9% and 1%, respectively. Nurses were the most frequent reporters, while physicians were more likely to report high-severity errors. Medical care units accounted for approximately half of all reported errors. Following the intervention, there was a significant increase in reporting of prevented errors and errors that reached the patient with no resultant harm. This improvement in reporting was sustained for 26 months and has contributed to designing and implementing quality improvement initiatives to enhance the safety of the medication use process.

Lessons learned from a pharmacy practice model change at an academic medical center.

Science.gov (United States)

Knoer, Scott J; Pastor, John D; Phelps, Pamela K

2010-11-01

The development and implementation of a new pharmacy practice model at an academic medical center are described. Before the model change, decentralized pharmacists responsible for order entry and verification and clinical specialists were both present on the care units. Staff pharmacists were responsible for medication distribution and sterile product preparation. The decentralized pharmacists handling orders were not able to use their clinical training, the practice model was inefficient, and few clinical services were available during evenings and weekends. A task force representing all pharmacy department roles developed a process and guiding principles for the model change, collected data, and decided on a model. Teams consisting of decentralized pharmacists, decentralized pharmacy technicians, and team leaders now work together to meet patients' pharmacy needs and further departmental safety, quality, and cost-saving goals. Decentralized service hours have been expanded through operational efficiencies, including use of automation (e.g., computerized provider order entry, wireless computers on wheels used during rounds with physician teams). Nine clinical specialist positions were replaced by five team leader positions and four pharmacists functioning in decentralized roles. Additional staff pharmacist positions were shifted into decentralized roles, and the hospital was divided into areas served by teams including five to eight pharmacists. Technicians are directly responsible for medication distribution. No individual's job was eliminated. The new practice model allowed better alignment of staff with departmental goals, expanded pharmacy hours and services, more efficient medication distribution, improved employee engagement, and a staff succession plan.

The effect of work shift configurations on emergency medical dispatch center response.

Science.gov (United States)

Montassier, Emmanuel; Labady, Julien; Andre, Antoine; Potel, Gilles; Berthier, Frederic; Jenvrin, Joel; Penverne, Yann

2015-01-01

It has been proved that emergency medical dispatch centers (EMDC) save lives by promoting an appropriate allocation of emergency medical service resources. Indeed, optimal dispatcher call duration is pivotal to reduce the time gap between the time a call is placed and the delivery of medical care. However, little is known about the impact of work shift configurations (i.e., work shift duration and work shift rotation throughout the day) and dispatcher call duration. Thus, the objective of our study was to assess the effect of work shift configurations on dispatcher call duration. During a 1-year study period, we analyzed the dispatcher call durations for medical and trauma calls during the 4 different work shift rotations (day, morning, evening, and night) and during the 10-hour work shift of each dispatcher in the EMDC of Nantes. We extracted dispatcher call durations from our advanced telephone system, configured with CC Pulse + (Genesys, Alcatel Lucent), and collected them in a custom designed database (Excel, Microsoft). Afterward, we analyzed these data using linear mixed effects models. During the study period, our EMDC received 408,077 calls. Globally, the mean dispatcher call duration was 107 ± 45 seconds. Based on multivariate linear mixed effects models, the dispatcher call duration was affected by night work shift and work shift duration greater than 8 hours, increasing it by about 10 ± 1 seconds and 4 ± 1 seconds, respectively (both p work shift rotation and duration, with longer durations seen over night shifts and shifts over 8 hours. While these differences are small and may not have clinical significance, they may have implications for EMDC efficiency.

Patient-centered medical home cyberinfrastructure current and future landscape.

Science.gov (United States)

Finkelstein, Joseph; Barr, Michael S; Kothari, Pranav P; Nace, David K; Quinn, Matthew

2011-05-01

The patient-centered medical home (PCMH) is an approach that evolved from the understanding that a well-organized, proactive clinical team working in a tandem with well-informed patients is better able to address the preventive and disease management needs in a guideline-concordant manner. This approach represents a fundamental shift from episodic acute care models and has become an integral part of health reform supported on a federal level. The major aspects of PCMH, especially pertinent to its information infrastructure, have been discussed by an expert panel organized by the Agency for Healthcare Research and Quality at the Informatics for Consumer Health Summit. The goal of this article is to summarize the panel discussions along the four major domains presented at the summit: (1) PCMH as an Evolving Model of Healthcare Delivery; (2) Health Information Technology (HIT) Applications to Support the PCMH; (3) Current HIT Landscape of PCMH: Challenges and Opportunities; and (4) Future HIT Landscape of PCMH: Federal Initiatives on Health Informatics, Legislation, and Standardization. Copyright © 2011 American Journal of Preventive Medicine. All rights reserved.

Development and evaluation of a multidisciplinary controlled substances committee within a patient-centered medical home.

Science.gov (United States)

Gernant, Stephanie A; Bastien, Rachel; Lai, Andrea

2015-01-01

To present the development of a multidisciplinary controlled substances committee and describe its effectiveness in relation to prescribers' acceptance of committee recommendations, the number of premature deaths associated with controlled substances, and prescribers' need for education on controlled substances. A patient-centered medical home and accountable care organization in Maine that serves more than 60,000 patients across a large rural area, 70% of whom are classified as lower income. A multidisciplinary group of prescribers and PharmD residents created a committee to influence organizational culture regarding controlled substances. The Controlled Substances Initiative Committee (CSIC) updated institutional policies, developed provider education, and made personalized patient recommendations to prescribers. The primary outcome was average change in daily morphine equivalent dose (MED) in patients for whom CSIC recommended a dose reduction to the patient's prescriber. Secondary outcomes included the proportion of patients who died of a known overdose or suspected drug-related death during 2012-2013 or 2013-2014. In addition, prescriber beliefs about controlled substances were measured via a needs assessment. The average daily MED for patients whom CSIC recommended dose reduction was lower after 3 months compared with at baseline (175.5 ± 344.3 mg vs. 292.7 ± 466.5 mg; P vs. 11.1%; P = 1.00). However, a greater number of patients had a suspected drug-related death during 2013-2014 compared with during 2012-2013 (0% vs. 27.3%; P = 0.05). A multidisciplinary controlled substances committee may improve patient safety and outcomes by offering prescriber support and helping alter prescribing culture.

Effects of a pain education program in Complementary and Alternative Medicine treatment utilization at a VA medical center.

Science.gov (United States)

Cosio, David; Lin, Erica H

2015-06-01

Past studies have shown that U.S. Veterans are consumers of CAM. However, more than 75% of Veteran non-users report they would utilize these treatment options if made available. Thus, Veterans may not be fully aware of the CAM options currently available to them in the current U.S. VA health care system. The current study tested the hypothesis that Veterans would report an increase in CAM utilization after completing a formal pain education program in a VA medical center. The study used a quasi-experimental, one-group, pre/post-test design. Midwestern, U.S. VA Medical Center. The responses from 103 Veterans who elected to participate in the program and the assessment measures were included in the outcome analyses. "Pain Education School" is a 12-week, educational program that is open to all Veterans and their families. It is a comprehensive program that introduces patients to 23 different disciplines at the VA Medical Center that deal with chronic, non-cancer pain. An adaptation of the Complementary and Alternative Medicine Questionnaire(©), SECTION A: Use of Alternative Health Care Providers. There was a significant difference found in overall utilization of CAM after completing the pain education program. The most utilized CAM modality was the chiropractor; the least utilized were hypnosis and aromatherapy. Not all health care systems or providers may have access to an education-focused, professionally driven program as an amenity. However, lessons can be learned from this study in terms of what pain providers may be able to accomplish in their practice. Published by Elsevier Ltd.

[Causes of death in patients with HIV infection in two Tunisian medical centers].

Science.gov (United States)

Chelli, Jihène; Bellazreg, Foued; Aouem, Abir; Hattab, Zouhour; Mesmia, Hèla; Lasfar, Nadia Ben; Hachfi, Wissem; Masmoudi, Tasnim; Chakroun, Mohamed; Letaief, Amel

2016-01-01

Antiretroviral tritherapy has contributed to a considerable reduction in HIV-related mortality. The causes of death are dominated by opportunistic infections in developing countries and by cardiovascular diseases and cancer in developed countries. To determine the causes and risk factors associated with death in HIV-infected patients in two Tunisian medical centers. cross-sectional study of HIV-infected patients over 15 years treated at Sousse and Monastir medical centers between 2000 and 2014. Death was considered related to HIV if its primary cause was AIDS-defining illness or if it was due to an opportunistic infection of unknown etiology with CD4 cause wasn't an AIDS defining illness or if it was due to an unknown cause if no information was available. Two hundred thirteen patients, 130 men (61%) and 83 women (39%), average age 40 ± 11 years were enrolled in the study. Fifty four patients died, the mortality rate was 5.4/100 patients/year. Annual mortality rate decreased from 5.8% in 2000-2003 to 2.3% in 2012-2014. Survival was 72% at 5 years and 67% at 10 years. Death events were associated with HIV in 70.4% of cases. The leading causes of death were pneumocystis carinii pneumonia and cryptococcal meningitis in 6 cases (11%) each. Mortality risk factors were a personal history of opportunistic infections, duration of antiretroviral therapy < 12 months and smoking. Strengthening screening, early initiation of antiretroviral therapy and fight against tobacco are needed to reduce mortality in patients infected with HIV in Tunisia.

PACS and its hospital-wide implementation: A case study at the Madigan Army Medical Center

International Nuclear Information System (INIS)

Choi, Hyung Sik; Kim, Yong Min; Smith, Donald V.; Bender, Gregory N.

1993-01-01

PACS represents the future of radiology in modern hospitals. Workstations and databases can be developed to substantially increase clinician's productivity, improve diagnostic accuracy, and make a large amount of knowledge and patient information available on-line to the physician. Currently, there are several hospitals in the process of implementing a total PACS system. They include Madigan Army Medical Center (Tacoma, Washington), VA Hospital in Baltimore, and Hammersmith Hospital in London (1). In order to provide the radiologist, the clinicians, and other health personnel in Korea with the general concept of PACS and its up-to-date status report, we describe the MDIS system being implemented in MAMC (Madigan Army Medical Center) which is the first hospital-wide large-scale PACS in the world. The major PACS components in MAMC have been installed since March 1992 and the full system implementation will be completed by summer 1993. The goal of the MDIS system in MAMC is to increase to more than 90% filmless by the end of 1993. In this paper, we discuss the introduction and background of PACS and its potential benefits, the current status of PACS installation in MAMC and the future plan, and the flow of image data and text information in MAMC

Assessment of diabetic teleretinal imaging program at the Portland Department of Veterans Affairs Medical Center.

Science.gov (United States)

Tsan, Grace L; Hoban, Keely L; Jun, Weon; Riedel, Kevin J; Pedersen, Amy L; Hayes, John

2015-01-01

We conducted a retrospective chart review of 200 diabetic patients who had teleretinal imaging performed between January 1, 2010, and January 1, 2011, at Portland Department of Veterans Affairs (VA) Medical Center outpatient clinics to assess the effectiveness of the diabetic teleretinal imaging program. Twenty patients (10%) had diabetic retinopathy. Ninety percent of the available teleretinal imaging studies were of adequate quality for interpretation. In accordance with local VA policy at that time, all teleretinal imaging patients should have been referred for a dilated retinal examination the following year. Image readers referred 97.5% of the patients to eye clinics for subsequent eye examinations, but the imagers scheduled appointments for only 80% of these patients. The redundancy rate, i.e., patients who had an eye examination within the past 6 mo, was 11%; the duplicate recall rate, i.e., patients who had a second teleretinal imaging performed within 1 yr of the eye examination, was 37%. Rates of timely diabetic eye examinations at clinics with teleretinal imaging programs, particularly when teleretinal imaging and eye clinics were colocated at the same community-based outpatient clinic, were higher than those without a teleretinal imaging program. We concluded that the Portland VA Medical Center's teleretinal imaging program was successful in increasing the screening rate for diabetic retinopathy.

Evaluation of Managerial Needs for Palliative Care Centers: Perspectives of Medical Directors.

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Kafadar, Didem; Ince, Nurhan; Akcakaya, Adem; Gumus, Mahmut

2015-01-01

Palliative therapies have an important role in increasing the quality of healthcare and in dealing with physical and psychosocial problems due to cancer. We here aimed to evaluate the managerial perspectives and opinions of the hospital managers and clinical directors about specialized palliative care centers. This study was conducted in two large-scale hospitals in which oncology care is given with medical directors (n:70). A questionnaire developed by the researchers asking about demographic characteristics and professional experience, opinions and suggestions of medical directors about providing and integrating palliative care into healthcare was used and responses were analyzed. Potential barriers in providing palliative care (PC) and integrating PC into health systems were perceived as institutional by most of the doctors (97%) and nurses (96%). Social barriers were reported by 54% of doctors and 82% of nurses. Barriers due to interest and knowledge of health professionals about PC were reported by 76% of doctors and 75% of nurses. Among encouragement ideas to provide PC were dealing with staff educational needs (72%), improved working conditions (77%) and establishing a special PC unit (49)%. An independent PC unit was suggested by 27.7% of participants and there was no difference between the hospitals. To overcome the barriers for integration of PC into health systems, providing education for health professionals and patient relatives, raising awareness in society, financial arrangements and providing infrastructure were suggested. The necessity for planning and programming were emphasized. In our study, the opinions and perspectives of hospital managers and clinical directors were similar to current approaches. Managerial needs for treating cancer in efficient cancer centers, increasing the capacity of health professionals to provide care in every stage of cancer, effective education planning and patient care management were emphasized.

Innovative Services Offered by School-Based Health Centers in New York City

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Sisselman, Amanda; Strolin-Goltzman, Jessica; Auerbach, Charles; Sharon, Lisa

2012-01-01

School-based health centers (SBHCs) continue to provide essential health care services to children and families in underserved neighborhoods across the country. Preliminary studies show that students who use SBHCs have better attendance rates as well as higher rates of academic achievement and attachment to the learning environment. Few studies,…

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Medication Errors in Hospitals: A Study of Factors Affecting Nursing Reporting in a Selected Center Affiliated with Shahid Beheshti University of Medical Sciences

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HamidReza Mirzaee

2015-10-01

Full Text Available Background: Medication errors are mentioned as the most common important challenges threatening healthcare system in all countries worldwide. This study is conducted to investigate the most significant factors in refusal to report medication errors among nursing staff.Methods: The cross-sectional study was conducted on all nursing staff of a selected Education& Treatment Center in 2013. Data was collected through a teacher made questionnaire. The questionnaires’ face and content validity was confirmed by experts and for measuring its reliability test-retest was used. Data was analyzed by descriptive and analytic statistics. 16th  version of SPSS was also used for related statistics.Results: The most important factors in refusal to report medication errors respectively are: lack of reporting system in the hospital(3.3%, non-significance of reporting medication errors to hospital authorities and lack of appropriate feedback(3.1%, and lack of a clear definition for a medication error (3%. there was a significant relationship between the most important factors of refusal to report medication errors and work shift (p:0.002, age(p:0.003, gender(p:0.005, work experience(p<0.001 and employment type of nurses(p:0.002.Conclusion: Factors pertaining to management in hospitals as well as the fear of the consequences of reporting are two broad fields among the factors that make nurses not report their medication errors. In this regard, providing enough education to nurses, boosting the job security for nurses, management support and revising related processes and definitions are some factors that can help decreasing medication errors and increasing their report in case of occurrence.

The Comparison between Teacher Centered and Student Centered Educational Methods

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M Anvar

2009-02-01

Full Text Available Background and Purpose: Various approaches to learning are suggested & practiced. The traditional medical education were more teacher centered oriented . In this method the students’ involvement in the process of learning is not remarkable, but the new approach to medical education supports the students involvement. This study evaluated the various method of lecturing considering students involvements.Methods: One hundred two first year medical and nursing students involved in this study and their opinion about these two methods of learning were obtained by filling of a questionnaire. The subject of the lectures was “general psychology” which was carried out 50% by the students and 50% by the teacher. The statistical analysis was carried out by SPSS program.Results: Considering students opinion in student-centered method the various aspect of learning such as mutual understanding, use of textbooks and references were significantly increased , whereasother aspects of learning such as self esteem, study time, innovation, and study attitude though were improved, but were not significant as compared with teacher centered method. In teacher-centeredmethod the understanding of the subjects was significantly increased .Other aspects of learning such as motivation and concentration were improved but not significantly as compared with studentcentered method.Conclusion: As the result showed student centered method was favored in several aspects of learning while in teacher centered method only understanding of the subject was better . Careful choice of teaching method to provide a comprehensive learning experience should take into account these differences.Key words: TEACHER CENTERED, STUDENT CENTERED, LEARNING

Intestinal parasitism in preschool and school students treated in the EsSalud Medical Center of Celendín, Cajamarca

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Jimmy Rinaldo Morales Del Pino

2016-03-01

Full Text Available OBJETIVES: Intestinal parasitism in preschool and school students treated in the EsSalud Medical Center of Celendín, Cajamarca MATERIAL AND METHODS: Observational, descriptive, cross-sectional research, conducted between July 2015 and January 2016 in the clinical laboratory service of EsSalud Medical Center of Celendín, Cajamarca. A data collection sheet was used for each participant to collect clinical data, demographic data and personal interaction. Parasitological samples of 96 children were processed by using direct examination, test of Graham and spontaneous sedimentation technique. Univariate analysis was used to find frequencies, percentages and standard deviations, and for the bivariate analysis we used Chi-square and Fisher's exact tests to associate the degree of parasitism with each variable obtained. RESULTS: The prevalence was 90.6% (87/96. Blastocystis hominis 81.2%, iodamoeba bütschlii 6.3%, Endolimax nana 19.8%, Entamoeba coli 35.4%, Chilomastix mesnilii 13.5%, Giardia lamblia 9.4%, Enterobius vermicularis 16.7% was found and Ascaris lumbricoides 1.0%. 20.8% (20/96 of the participants had similar structures to Urbanorum spp. Multiparasitism predominated (60.4% and there was a statistically significant association between the level of education and parasitical degree (p = 0.017. CONCLUSIONS: There was a high prevalence of parasitic infections in children in preschool and school age of Celendín district attended at the EsSalud medical center being Blastocystis hominis parasite the most predominant.

Paralympic medical services for the 2010 paralympic winter games.

Science.gov (United States)

Taunton, Jack; Wilkinson, Michael; Celebrini, Rick; Stewart, Robert; Stasyniuk, Treny; Van de Vliet, Peter; Willick, Stuart; Ferrer, Josep Martinez

2012-01-01

To present the planning and medical encounters for the 2010 Paralympic Winter Games. Prospective medical encounter study. 2010 Paralympic Winter Games. Athletes, coaches, officials, workforce, volunteers, and media. Sport type: alpine, Nordic, and sledge hockey and curling. Participant type: athlete, workforce, and spectators. Terrain and speed. Medical encounters entered in database at competitive (alpine skiing, biathlon, cross-country skiing, sledge hockey, and curling) and noncompetitive (Whistler and Vancouver Polyclinics, presentation centers, opening and closing ceremonies, media center, Paralympic Family Hotel) venues. Forty-two nations participated with 1350 Paralympic athletes, coaches, and officials. There were 2590 accredited medical encounters (657 athletes, 25.4%; 682 International Federation/National Paralympic Committee officials, 26.3%; 57 IPC, 2.2%; 8 media, 0.3%; 1075 workforce, 41.5%; 111 others, 4.3%) and 127 spectator encounters for a total of 2717 encounters. During the preopening period medical services saw 201 accredited personnel. The busiest venues during the Paralympic Games were the Whistler (1633 encounters) and Vancouver (748 encounters) Polyclinics. Alpine, sledge hockey, and curling were the busiest competitive venues. The majority of medical encounters were musculoskeletal (44.6%, n = 1156). Medical services recorded 1657 therapy treatments, 977 pharmaceutical prescriptions dispensed, 204 dental treatments, 353 imaging examinations (more than 50% from alpine skiing), and 390 laboratory tests. There were 24 ambulance transfers with 7 inpatient hospitalizations for a total of 24 inpatient days and 4 outpatient visits. The mandate to have minimal impact on the health services of Vancouver and the Olympic Corridor while offering excellent medical services to the Games was accomplished. This data will be valuable to future organizing committees.

The growth of medical groups paid through capitation in California.

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Robinson, J C; Casalino, L P

1995-12-21

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

Ranking Spain's medical schools by their performance in the national residency examination.

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Lopez-Valcarcel, B G; Ortún, V; Barber, P; Harris, J E; García, B

2013-12-01

Medical school graduates in Spain must take a uniform national exam (called "examen MIR") in order to enter postgraduate training in a specialty. Its results offer a unique opportunity to rank medical schools according to this exam. We measured differences in the MIR exam results among Spanish medical schools and assessed the stability of the MIR-based rankings for the period 2003-2011. In the year 2011 a total of 6873 residency positions nationwide were offered by the Spanish Ministry of Health, Social Services and Equality. These positions covered 47 specialties distributed over 231 training centers. A total of 11,550 medical graduates (including 1997 foreign graduates) took the MIR examination. Marked differences among medical schools were evident. The median graduate from medical school #1 and #29 occupied the positions 1477 and 5383, respectively. These figures correspond to a standardized ranking of 21 out of 100 for medical school #1 (that is, 1477/6873; half of medical school #1 obtained better [below position 21%] and half worse [over position 21%] results) and a standardized ranking of 70 out of 100 for medical school #29. While 81% of the medical school #1 graduates were amongst the best 3000 MIR exams and only 5% above the 5000 position the corresponding figures for medical school #29 graduates were 21% and 44%, respectively. The ranking position of the 29 medical schools was very stable between the years 2003 and 2011. There are marked differences in medical schools in Spain and these differences are very consistent over the years 2003-2011. Copyright © 2013 Elsevier España, S.L. All rights reserved.

How to market an affiliation. St. Elizabeth Hospital and Mercy Medical Center affiliate to create Affinity Health System.

Science.gov (United States)

1996-01-01

When Wisconsin's St. Elizabeth Hospital and Mercy Medical Center affiliated to create Affinity Health System, Inc., strategic planning and a solid marketing plan carefully executed were instrumental in its success. A corporate identity campaign and product line identification were follow-up phases to the merger approval.

Advances in medical education and practice: role of massive open online courses

Directory of Open Access Journals (Sweden)

Goldberg LR

2017-08-01

Full Text Available Lynette R Goldberg,1 Leonard A Crocombe2 1Wicking Dementia Research and Education Centre, Faculty of Health, 2Centre for Rural Health, Faculty of Health Sciences, University of Tasmania, Hobart, TAS, Australia Abstract: Massive open online courses (MOOCs are increasingly available in the area of health and medicine. These MOOCs are offered through various commercial and noncommercial online platforms. When offered through reputable institutions, they can provide valuable access to reliable information without the constraints of time, geographical location, or level of education. Most current courses appear introductory in nature. In its drive for quality health care, the National Academy of Medicine has prioritized a focus on known chronic care conditions. Many of these conditions are shared internationally. Among its initiatives, the academy encourages consumer and professional groups, patients, clinicians, health care organizations, and universities to work together to identify evidence-based care processes consistent with best practices, organize major prevention programs to target key associated health risk behaviors, and develop systems to measure and evaluate improvements in the provision of patient- and family-centered health care. Carefully designed and collaboratively developed MOOCs would appear a valuable resource to contribute to these initiatives. Such MOOCs can, 1 increase the health literacy of the public with regard to the prevention and treatment of known chronic care conditions, 2 provide ready access to continuing professional, and interprofessional, education, and 3 explore innovative teaching models for student learning focused on patient- and family-centered care. MOOCs would also appear helpful to facilitate effective communication among international communities of patients and clinicians, including student clinicians, with shared interests. Further, the accumulation of MOOC data through large-scale measurement and

Hospitalist and Internal Medicine Leaders' Perspectives of Early Discharge Challenges at Academic Medical Centers.

Science.gov (United States)

Patel, Hemali; Fang, Margaret C; Mourad, Michelle; Green, Adrienne; Wachter, Robert M; Murphy, Ryan D; Harrison, James D

2018-06-01

Improving early discharges may improve patient flow and increase hospital capacity. We conducted a national survey of academic medical centers addressing the prevalence, importance, and effectiveness of early-discharge initiatives. We assembled a list of hospitalist and general internal medicine leaders at 115 US-based academic medical centers. We emailed each institutional representative a 30-item online survey regarding early-discharge initiatives. The survey included questions on discharge prioritization, the prevalence and effectiveness of early-discharge initiatives, and barriers to implementation. We received 61 responses from 115 institutions (53% response rate). Forty-seven (77%) "strongly agreed" or "agreed" that early discharge was a priority. "Discharge by noon" was the most cited goal (n = 23; 38%) followed by "no set time but overall goal for improvement" (n = 13; 21%). The majority of respondents reported early discharge as more important than obtaining translators for non-English-speaking patients and equally important as reducing 30-day readmissions and improving patient satisfaction. The most commonly reported factors delaying discharge were availability of postacute care beds (n = 48; 79%) and patient-related transport complications (n = 44; 72%). The most effective early discharge initiatives reported involved changes to the rounding process, such as preemptive identification and early preparation of discharge paperwork (n = 34; 56%) and communication with patients about anticipated discharge (n = 29; 48%). There is a strong interest in increasing early discharges in an effort to improve hospital throughput and patient flow. © 2017 Society of Hospital Medicine.

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.

Swine-Flu Scare Offers Lessons for Study-Abroad Programs

Science.gov (United States)

Fischer, Karin

2009-01-01

Reports of swine flu have led some colleges to pull students and faculty members out of Mexico, the epicenter of the outbreak, and to cancel study-abroad programs there. But even as the number of new cases appears to be falling, the health scare offers some lasting lessons for colleges, says Gary Rhodes, director of the Center for Global Education…

Advantages and Disadvantages of the Patient-Centered Medical Home: A Critical Analysis and Lessons Learned.

Science.gov (United States)

Budgen, Jacqueline; Cantiello, John

This article provides a detailed examination of the pros and cons associated with patient-centered medical homes (PCMHs). Opinions and findings from those who have studied PCMHs and those who have been directly involved with this type of health care model are outlined. Key lessons from providers are detailed, and critical success factors are highlighted. This synthesized analysis serves to lend evidence to health care managers and providers who are considering implementation of the PCMH model.

Implementing the patient-centered medical home model for chronic disease care in small medical practices: practice group characteristics and physician understanding.

Science.gov (United States)

Baxter, Louisa; Nash, David B

2013-01-01

Strengthening primary care may improve health outcomes and restrain spending. The patient-centered medical home (PCMH) model is endorsed as a tool to achieve this. Early evaluations in large group practices demonstrate improvements in some health outcomes. Evidence is lacking from small medical practices that deliver the majority of primary health care. This was a national survey of 200 physicians that explored perceptions of PCMH. There was considerable interest in adoption of the model; however, providing PCMH care was seen as an extension of traditional roles that requires additional reimbursement. No differentiation was made among a variety of payment models to do this. All joint principle components of the model were identified as important: extending access and information technology were the most contentious. There was consensus that PCMH might improve the quality of primary care; however, tension between wider societal benefits and rising costs for individual practices was a challenge to implementation.

Clinical trials of boron neutron capture therapy [in humans] [at Beth Israel Deaconess Medical Center][at Brookhaven National Laboratory

International Nuclear Information System (INIS)

Wallace, Christine

2001-01-01

Assessment of research records of Boron Neutron Capture Therapy was conducted at Brookhaven National Laboratory and Beth Israel Deaconess Medical Center using the Code of Federal Regulations, FDA Regulations and Good Clinical Practice Guidelines. Clinical data were collected FR-om subjects' research charts, and differences in conduct of studies at both centers were examined. Records maintained at Brookhaven National Laboratory were not in compliance with regulatory standards. Beth Israel's records followed federal regulations. Deficiencies discovered at both sites are discussed in the reports

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Special offers for our members       Go Sport in Val Thoiry is offering 15% discount on all purchases made in the shop upon presentation of the Staff Association membership card (excluding promotions, sale items and bargain corner, and excluding purchases using Go Sport  and Kadéos gift cards. Only one discount can be applied to each purchase).  

Medical tourism

Directory of Open Access Journals (Sweden)

Abbas Ghanbari

2014-08-01

Full Text Available Medical tourism is considered as one of the tourism dimensions and it can contribute to the stabilized and dynamic development of a country's economy. Since it is cost-effective industry, most developing countries have focused on this industry and they are planning to develop this industry. Not only does Zanjan province, as the central region in medicine services, enjoy different kinds of variety and acceptable medical specialties but also it has historical, natural, and religious tourism potentials. In this survey, the researcher investigated the existing potentials of Zanjan province based on descriptive - analytical tourism in offering and providing medical services and accommodation. The survey reports that offered services in tourism were not acceptable and satisfactory.

Reduction of medication costs after detoxification for medication-overuse headache.

Science.gov (United States)

Shah, Asif M; Bendtsen, Lars; Zeeberg, Peter; Jensen, Rigmor H

2013-04-01

To examine whether detoxifying patients with medication-overuse headache can reduce long-term medication costs. Direct costs of medications in medication-overuse headache have been reported to be very high but have never been calculated on the basis of exact register data. Long-term economic savings obtained by detoxification have never been investigated. We conducted a registry-based observational retrospective follow-up study on 336 medication-overuse headache patients treated and discharged from the Danish Headache Center over a 2-year period. By means of the Danish Register of Medicinal Product Statistics, we collected information on the costs and use of prescription-only medication 1 year before admission and 1 year after discharge from Danish Headache Center. The average medication costs per patient per year decreased with 24%, from US$971 before treatment to US$737 after (P = .001), and the average medication use decreased with 14.4% (P = .02). Savings were most pronounced for patients overusing triptans. In this group, the average medication costs per patient per year decreased with 43% (P headache at a tertiary headache center has a long-lasting effect on the medication costs and use, in particular among patients overusing triptans. The results may not be generalizable to all countries and may be sensitive to the costs of triptans. © 2012 American Headache Society.

VA announces aggressive new approach to produce rapid improvements in VA medical centers

Directory of Open Access Journals (Sweden)

Robbins RA

2018-02-01

Full Text Available No abstract available. Article truncated at 150 words. The U.S. Department of Veterans Affairs (VA announced steps that it is taking as part of an aggressive new approach to produce rapid improvements at VA’s low-performing medical facilities nationwide (1. VA defines its low-performing facilities as those medical centers that receive the lowest score in its Strategic Analytics for Improvement and Learning (SAIL star rating system, or a one-star rating out of five. The SAIL star rating was initiated in 2016 and uses a variety of measures including mortality, length of hospital stay, readmission rates, hospital complications, physician productivity and efficiency. A complete listing of the VA facilities, their star ratings and the metrics used to determine the ratings is available through the end of fiscal year 2017 (2. Based on the latest ratings, the VA currently has 15 one-star facilities including Denver, Loma Linda, and Phoenix in the Southwest (Table 1. Table 1. VA facilities with one-star ratings …

Planning for the Mercy Center for Breast Health.

Science.gov (United States)

Olivares, V Ed

2002-01-01

During the last months of 2000, administrators at the Mercy San Juan Medical Center in Carmichael, Calif., convened a steering committee to plan the Mercy Center for Breast Health. The Steering Committee was composed of the director of ancillary and support services, the oncology clinical nurse specialist, the RN manager of the oncology nursing unit, the RN surgery center manager, and me, the manager of imaging services. The committee was responsible for creating a new business with five specific objectives: to position the Center as a comprehensive diagnostic and resource center for women; to generate physician referrals to the Breast Center through various vehicles; to create awareness of the Breast Center's capabilities among area radiologists; to create awareness of the Breast Center among employees of six sister facilities; to create "brand awareness" for the Mercy Center for Breast Health among referring physicians and patients who could use competing centers in the area. The Steering Committee's charter was to design a center with a feminine touch and ambience and to provide a "one-stop shopping" experience for patients. A major component of the Breast Center is the Dianne Haselwood Resource Center, which provides patients with educational support and information. The Steering Committee brought its diverse experience and interests to bear on arranging for equipment acquisition, information and clerical systems, staffing, clinic office design, patient care and marketing. Planning the Mercy Center for Breast Health has been a positive challenge that brought together many elements of the organization and people from different departments and specialties to create a new business venture. Our charge now is to grow and to live up to our vision of offering complete breast diagnostic, education and support services in one location.

A Nationwide Survey of Patient Centered Medical Home Demonstration Projects

Science.gov (United States)

Bitton, Asaf; Martin, Carina

2010-01-01

Background The patient centered medical home has received considerable attention as a potential way to improve primary care quality and limit cost growth. Little information exists that systematically compares PCMH pilot projects across the country. Design Cross-sectional key-informant interviews. Participants Leaders from existing PCMH demonstration projects with external payment reform. Measurements We used a semi-structured interview tool with the following domains: project history, organization and participants, practice requirements and selection process, medical home recognition, payment structure, practice transformation, and evaluation design. Results A total of 26 demonstrations in 18 states were interviewed. Current demonstrations include over 14,000 physicians caring for nearly 5 million patients. A majority of demonstrations are single payer, and most utilize a three component payment model (traditional fee for service, per person per month fixed payments, and bonus performance payments). The median incremental revenue per physician per year was $22,834 (range $720 to $91,146). Two major practice transformation models were identified—consultative and implementation of the chronic care model. A majority of demonstrations did not have well-developed evaluation plans. Conclusion Current PCMH demonstration projects with external payment reform include large numbers of patients and physicians as well as a wide spectrum of implementation models. Key questions exist around the adequacy of current payment mechanisms and evaluation plans as public and policy interest in the PCMH model grows. Electronic supplementary material The online version of this article (doi:10.1007/s11606-010-1262-8) contains supplementary material, which is available to authorized users. PMID:20467907

Medical Humanities Teaching in North American Allopathic and Osteopathic Medical Schools.

Science.gov (United States)

Klugman, Craig M

2017-11-07

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools' websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 (as of June 2016) member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey sought information on required and elective humanities content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools (145 AAMC; 31 AACOM). 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean (MD 45.4; DO 37.1) and 30 (MD 29; DO 37.5) median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students.

Needs Assessment for Research Use of High-Throughput Sequencing at a Large Academic Medical Center.

Directory of Open Access Journals (Sweden)

Albert Geskin

Full Text Available Next Generation Sequencing (NGS methods are driving profound changes in biomedical research, with a growing impact on patient care. Many academic medical centers are evaluating potential models to prepare for the rapid increase in NGS information needs. This study sought to investigate (1 how and where sequencing data is generated and analyzed, (2 research objectives and goals for NGS, (3 workforce capacity and unmet needs, (4 storage capacity and unmet needs, (5 available and anticipated funding resources, and (6 future challenges. As a precursor to informed decision making at our institution, we undertook a systematic needs assessment of investigators using survey methods. We recruited 331 investigators from over 60 departments and divisions at the University of Pittsburgh Schools of Health Sciences and had 140 respondents, or a 42% response rate. Results suggest that both sequencing and analysis bottlenecks currently exist. Significant educational needs were identified, including both investigator-focused needs, such as selection of NGS methods suitable for specific research objectives, and program-focused needs, such as support for training an analytic workforce. The absence of centralized infrastructure was identified as an important institutional gap. Key principles for organizations managing this change were formulated based on the survey responses. This needs assessment provides an in-depth case study which may be useful to other academic medical centers as they identify and plan for future needs.

Performance enhancement using a balanced scorecard in a Patient-centered Medical Home.

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Fields, Scott A; Cohen, Deborah

2011-01-01

Oregon Health & Science University Family Medicine implemented a balanced scorecard within our clinics that embraces the inherent tensions between care quality, financial productivity, and operational efficiency. This data-driven performance improvement process involved: (1) consensus-building around specific indicators to be measured, (2) developing and refining the balanced scorecard, and (3) using the balanced scorecard in the quality improvement process. Developing and implementing the balanced scorecard stimulated an important culture shift among clinics; practice members now actively use data to recognize successes, understand emerging problems, and make changes in response to these problems. Our experience shows how Patient-centered Medical Homes can be enhanced through use of information technology and evidence-based tools that support improved decision making and performance and help practices develop into learning organizations.

International medical students--a survey of perceived challenges and established support services at medical faculties.

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Huhn, D; Junne, F; Zipfel, S; Duelli, R; Resch, F; Herzog, W; Nikendei, C

2015-01-01

Medical students with a non-German background face several challenges during their studies. Besides support given by foreign student offices further specific projects for international students have been developed and are offered by medical faculties. However, so far, neither a systematic survey of the faculties' perceived problems nor of the offered support exists. All study deaneries of medical faculties in Germany were contacted between April and October 2013 and asked for their participation in a telephone interview. Interview partners were asked about 1.) The percentage of non-German students at the medical faculty; 2.) The perceived difficulties and problems of foreign students; 3.) The offers for non-German students; and 4.) The specification of further possibilities of support. Given information was noted, frequencies counted and results interpreted via frequency analysis. Only 39% of the medical faculties could give detailed information about the percentage of non-German students. They reported an average share of 3.9% of students with an EU migration background and 4.9% with a non-EU background. Most frequently cited offers are student conducted tutorials, language courses and tandem-programs. The most frequently reported problem by far is the perceived lack of language skills of foreign students at the beginning of their studies. Suggested solutions are mainly the development of tutorials and the improvement of German medical terminology. Offers of support provided by medical faculties for foreign students vary greatly in type and extent. Support offered is seen to be insufficient in coping with the needs of the international students in many cases. Hence, a better coverage of international students as well as further research efforts to the specific needs and the effectiveness of applied interventions seem to be essential.

Availability of endovascular therapies for cerebrovascular disease at primary stroke centers.

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Alberts, Mark J; Range, Jean; Spencer, William; Cantwell, Vicki; Hampel, M J

2017-02-01

Background Endovascular therapies (EVTs) are useful for treating cerebrovascular disease. There are few data about the availability of such services at primary stroke centers (PSCs). Our hypothesis was that some of these services may be available at some PSCs. Methods We conducted an internet-based survey of hospitals certified as PSCs by the Joint Commission. The survey inquired about EVTs such as intra-arterial (IA) lytics, IA mechanical clot removal, coiling of aneurysms, and cervical arterial stenting, physician training, coverage models, hospital type, and outcomes. Chi-square analyses were used to detect differences between academic and community PSCs. Results Data were available from 352 PSCs, of which 75% were community hospitals, 23% academic medical centers, and 80% were non-profit; almost half (48%) see 300 or more patients annually with ischemic stroke. A majority (60%) provided some or all EVTs on site, while 29% had none on site and no plans to add them. Among the respondents offering EVTs, 95% offered stenting of neck vessels, 86% IA lytics, 80% IA mechanical, and 74% aneurysm coiling. The majority (>55%) that did offer such services provided them 24/7/365. Most endovascular coverage was provided by interventional neuroradiologists (60%), fellowship trained endovascular neurosurgeons (42%), and interventional radiologists (41%). The majority of hospitals (81%) did not participate in an audited national registry. Conclusions A variety of EVT services are offered at many PSCs by interventionalists with diverse types of training. The availability of such services is clinically relevant now with the proven efficacy of mechanical thrombectomy for ischemic stroke.

Technologies in the patient-centered medical home: examining the model from an enterprise perspective.

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Hughes, Cortney L; Marshall, Capt Robert; Murphy, Edward; Mun, Seong K

2011-01-01

Fee-for-service reimbursement has fragmented the healthcare system. Providers are paid based on the number of services rendered instead of quality, leading to the cost of care rising at a faster rate than its value. One approach to counter this is the Patient-Centered Medical Home (PCMH), a primary care model that emphasizes team-based medicine, a partnership between patients and providers, and expanded access and communication. The transition to PCMH is facilitated by innovative technologies, such as telemedicine for additional services, electronic medical records to document patients' health needs, and online portals for electronic visits and communication between patients and providers. Implementing these technologies involves tremendous investment of funds and time from practices and healthcare organizations. Although PCMH does not require such technologies, they facilitate its success, as care coordination and population management necessitated by the model are difficult to do without. This article argues that there is a paradox in PCMH and technology is at its center. Although PCMH intends to be cost effective by reducing hospital admissions and ER visits through providing better preventative services, it is actually a financial risk due to the very real upfront costs of implementing and sustaining technologies needed to carry out the intent of the PCMH model, which may not be made up immediately, if ever. This article delves into the rationale behind why payers, providers, and patients have adopted PCMH regardless of this risk and in doing so, maps out the roles that innovative technologies play in the conversion to PCMH.

Adherence to clinical practice guidelines for the treatment of candidemia at a Veterans Affairs Medical Center

OpenAIRE

Ashong, Chester N.; Hunter, Andrew S.; Mansouri, M. David; Cadle, Richard M.; Hamill, Richard J.; Musher, Daniel M.

2017-01-01

Objectives: The primary objective of this study was to examine the appropriateness of candidemia management at a Veterans Affairs Medical Center as recommended by the 2009 Infectious Diseases Society of America (IDSA) guidelines for treatment of Candida infections. Methods: A retrospective analysis of 94 adult patients with blood cultures positive for Candida spp. was performed. Patients were stratified by severity of disease into two groups: non-neutropenic, mild-moderate disease (Group 1, n...

Nanomedicine concepts in the general medical curriculum: initiating a discussion

Directory of Open Access Journals (Sweden)

Sweeney AE

2015-12-01

Full Text Available Aldrin E Sweeney Center for Teaching & Learning, Ross University School of Medicine, Roseau, Commonwealth of Dominica Abstract: Various applications of nanoscale science to the field of medicine have resulted in the ongoing development of the subfield of nanomedicine. Within the past several years, there has been a concurrent proliferation of academic journals, textbooks, and other professional literature addressing fundamental basic science research and seminal clinical developments in nanomedicine. Additionally, there is now broad consensus among medical researchers and practitioners that along with personalized medicine and regenerative medicine, nanomedicine is likely to revolutionize our definitions of what constitutes human disease and its treatment. In light of these developments, incorporation of key nanomedicine concepts into the general medical curriculum ought to be considered. Here, I offer for consideration five key nanomedicine concepts, along with suggestions regarding the manner in which they might be incorporated effectively into the general medical curriculum. Related curricular issues and implications for medical education also are presented. Keywords: medical education, basic science, teaching, learning, assessment, nanoscience curriculum, nanomedicine concepts

Medical student and medical school teaching faculty perceptions of conflict of interest.

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Andresen, Nicholas S; Olson, Tyler S; Krasowski, Matthew D

2017-07-11

Attitudes towards conflict of interest (COI) and COI policy are shaped during medical school and influence both the education of medical students and their future medical practice. Understanding the current attitudes of medical students and medical school teaching faculty may provide insight into what is taught about COI and COI policy within the 'hidden' medical curriculum. Differences between medical student and medical school teaching faculty perceptions of COI and COI policy have not been compared in detail. The authors surveyed first year medical students and medical school teaching faculty at one academic medical center. The response rate was 98.7% (150/152) for students and 34.2% (69/202) for faculty. Students were less likely than faculty to agree that lecturers should disclose COI to any learners (4.06 vs. 4.31, p = 0.01), but more likely to agree that COI disclosure decreases the presentation of biased material (3.80 vs. 3.21, p < 0.001). Student and faculty responses for all other questions were not different. Many of these responses suggest student and faculty support for stronger COI policy at academic medical centers. Students and faculty perceptions regarding COI and COI policy are largely similar, but differ in terms of the perceived effectiveness of COI disclosure. This study also suggests that medical students and medical school teaching faculty support for stronger COI policy at academic medical centers.

Nurses' perception of ethical climate at a large academic medical center.

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Lemmenes, Donna; Valentine, Pamela; Gwizdalski, Patricia; Vincent, Catherine; Liao, Chuanhong

2016-09-07

Nurses are confronted daily with ethical issues while providing patient care. Hospital ethical climates can affect nurses' job satisfaction, organizational commitment, retention, and physician collaboration. At a metropolitan academic medical center, we examined nurses' perceptions of the ethical climate and relationships among ethical climate factors and nurse characteristics. We used a descriptive correlational design and nurses (N = 475) completed Olson's Hospital Ethical Climate Survey. Data were analyzed using STATA. Approvals by the Nursing Research Council and Institutional Review Board were obtained; participants' rights were protected. Nurses reported an ethical climate total mean score of 3.22 ± 0.65 that varied across factors; significant differences were found for ethical climate scores by nurses' age, race, and specialty area. These findings contribute to what is known about ethical climate and nurses' characteristics and provides the foundation to develop strategies to improve the ethical climate in work settings. © The Author(s) 2016.

Impacts of Initial Transformation to a Patient-Centered Medical Home on Diabetes Outcomes in Federally Qualified Health Centers in Florida.

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Kinsell, Heidi S; Hall, Allyson G; Harman, Jeffrey S; Tewary, Sweta; Brickman, Andrew

2017-10-01

Federally qualified health centers (FQHCs) in Florida see large numbers of vulnerable patients with diabetes. Patient-centered medical home (PCMH) models can lead to improvements in health for patients with chronic conditions and cost savings for providers. Therefore, FQHCs are increasingly moving to PCMH models of care. The study objective was to examine the effects of initial transformation to a level 3 National Committee for Quality Assurance (NCQA) certified PCMH in 2011, on clinical diabetes outcomes among 27 clinic sites from a network of FQHCs in Florida. We used de-identified, longitudinal electronic health record (EHR) data from 2010-2012 and multivariate logistic regression to analyze the effects of initial transformation on the odds of having well-controlled HbA1c, body mass index (BMI), and blood pressure (BP) among vulnerable patients with diabetes. Models controlled for clustering by year, patient, and organizational characteristics. Overall, transformation to a PCMH was associated with 19% greater odds of having well-controlled HbA1c values with no statistically significant impact on BMI or BP. Subanalyses showed transformation had less of an effect on BP for African American patients and HbA1c control for Medicare enrollees but a greater effect on weight control for patients older than 35 years. Transformation to a PCMH in FQHCs appears to improve the health of vulnerable patients with diabetes, with less improvement for subsets of patients. Future research should seek to understand the heterogeneous effects of patient-centered transformation on various subgroups.

Barriers to Offering Vasectomy at Publicly Funded Family Planning Organizations in Texas.

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White, Kari; Campbell, Anthony; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E

2017-05-01

Few publicly funded family planning clinics in the United States offer vasectomy, but little is known about the reasons this method is not more widely available at these sources of care. Between February 2012 and February 2015, three waves of in-depth interviews were conducted with program administrators at 54 family planning organizations in Texas. Participants described their organization's vasectomy service model and factors that influenced how frequently vasectomy was provided. Interview transcripts were coded and analyzed using a theme-based approach. Service models and barriers to providing vasectomy were compared by organization type (e.g., women's health center, public health clinic) and receipt of Title X funding. Two thirds of organizations did not offer vasectomy on-site or pay for referrals with family planning funding; nine organizations frequently provided vasectomy. Organizations did not widely offer vasectomy because they could not find providers that would accept the low reimbursement for the procedure or because they lacked funding for men's reproductive health care. Respondents often did not perceive men's reproductive health care as a service priority and commented that men, especially Latinos, had limited interest in vasectomy. Although organizations of all types reported barriers, women's health centers and Title X-funded organizations more frequently offered vasectomy by conducting tailored outreach to men and vasectomy providers. A combination of factors operating at the health systems and provider level influence the availability of vasectomy at publicly funded family planning organizations in Texas. Multilevel approaches that address key barriers to vasectomy provision would help organizations offer comprehensive contraceptive services.

A primer on endoscopic electronic medical records.

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Atreja, Ashish; Rizk, Maged; Gurland, Brooke

2010-02-01

Endoscopic electronic medical record systems (EEMRs) are now increasingly utilized in many endoscopy centers. Modern EEMRs not only support endoscopy report generation, but often include features such as practice management tools, image and video clip management, inventory management, e-faxes to referring physicians, and database support to measure quality and patient outcomes. There are many existing software vendors offering EEMRs, and choosing a software vendor can be time consuming and confusing. The goal of this article is inform the readers about current functionalities available in modern EEMR and provide them with a framework necessary to find an EEMR that is best fit for their practice.

Cultural Awareness Among Nursing Staff at an Academic Medical Center.

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McElroy, Jennifer; Smith-Miller, Cheryl A; Madigan, Catherine K; Li, Yin

2016-03-01

The goal is to identify areas for targeted improvement in regard to cultural awareness and competence among nursing staff and in the work environment. Many facilities have initiated programs to facilitate cultural competence development among nursing staff; however, there has been little examination of the effect of these initiatives, assessment of experienced nurses' cultural awareness, or investigation of nurse leader's role in promoting cultural competence in the literature. In this cross-sectional descriptive study, a cultural awareness survey was modified and electronically distributed to all registered nurses and assistive personnel at an academic medical center. The modified survey instrument showed good reliability and validity among the study population. Most nursing staff exhibited a moderate to high level of cultural awareness and held positive opinions about nursing leadership and the work environment with regard to cultural issues. In increasingly diverse work environments, assessing the cultural awareness of nursing staff enables nurse leaders to evaluate efforts in promoting cultural competence and to identify specific areas in which to target staff development efforts and leadership training.

International medical students – a survey of perceived challenges and established support services at medical faculties

Directory of Open Access Journals (Sweden)

Huhn, D.

2015-02-01

Full Text Available Introduction: Medical students with a non-German background face several challenges during their studies. Besides support given by foreign student offices further specific projects for international students have been developed and are offered by medical faculties. However, so far, neither a systematic survey of the faculties’ perceived problems nor of the offered support exists.Method: All study deaneries of medical faculties in Germany were contacted between April and October 2013 and asked for their participation in a telephone interview. Interview partners were asked about 1. The percentage of non-German students at the medical faculty; 2. The perceived difficulties and problems of foreign students; 3. The offers for non-German students; and 4. The specification of further possibilities of support. Given information was noted, frequencies counted and results interpreted via frequency analysis.Results: Only 39% of the medical faculties could give detailed information about the percentage of non-German students. They reported an average share of 3.9% of students with an EU migration background and 4.9% with a non-EU background. Most frequently cited offers are student conducted tutorials, language courses and tandem-programs. The most frequently reported problem by far is the perceived lack of language skills of foreign students at the beginning of their studies. Suggested solutions are mainly the development of tutorials and the improvement of German medical terminology.Discussion: Offers of support provided by medical faculties for foreign students vary greatly in type and extent. Support offered is seen to be insufficient in coping with the needs of the international students in many cases. Hence, a better coverage of international students as well as further research efforts to the specific needs and the effectiveness of applied interventions seem to be essential.

International medical students – a survey of perceived challenges and established support services at medical faculties

Science.gov (United States)

Huhn, D.; Junne, F.; Zipfel, S.; Duelli, R.; Resch, F.; Herzog, W.; Nikendei, C.

2015-01-01

Introduction: Medical students with a non-German background face several challenges during their studies. Besides support given by foreign student offices further specific projects for international students have been developed and are offered by medical faculties. However, so far, neither a systematic survey of the faculties’ perceived problems nor of the offered support exists. Method: All study deaneries of medical faculties in Germany were contacted between April and October 2013 and asked for their participation in a telephone interview. Interview partners were asked about 1.) The percentage of non-German students at the medical faculty; 2.) The perceived difficulties and problems of foreign students; 3.) The offers for non-German students; and 4.) The specification of further possibilities of support. Given information was noted, frequencies counted and results interpreted via frequency analysis. Results: Only 39% of the medical faculties could give detailed information about the percentage of non-German students. They reported an average share of 3.9% of students with an EU migration background and 4.9% with a non-EU background. Most frequently cited offers are student conducted tutorials, language courses and tandem-programs. The most frequently reported problem by far is the perceived lack of language skills of foreign students at the beginning of their studies. Suggested solutions are mainly the development of tutorials and the improvement of German medical terminology. Discussion: Offers of support provided by medical faculties for foreign students vary greatly in type and extent. Support offered is seen to be insufficient in coping with the needs of the international students in many cases. Hence, a better coverage of international students as well as further research efforts to the specific needs and the effectiveness of applied interventions seem to be essential. PMID:25699112

Treatment Outcomes From a Specialist Model for Treating Tobacco Use Disorder in a Medical Center.

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Burke, Michael V; Ebbert, Jon O; Schroeder, Darrell R; McFadden, David D; Hays, J Taylor

2015-11-01

Cigarette smoking causes premature mortality and multiple morbidity; stop smoking improves health. Higher rates of smoking cessation can be achieved through more intensive treatment, consisting of medication and extended counseling of patients, but there are challenges to integrating these interventions into healthcare delivery systems. A care model using a master-level counselor trained as a tobacco treatment specialist (TTS) to deliver behavioral intervention, teamed with a supervising physician/prescriber, affords an opportunity to integrate more intensive tobacco dependence treatment into hospitals, clinics, and other medical systems. This article analyzes treatment outcomes and predictors of abstinence for cigarette smokers being treated using the TTS-physician team in a large outpatient clinic over a 7-year period.This is an observational study of a large cohort of cigarette smokers treated for tobacco dependence at a medical center. Patients referred by the primary healthcare team for a TTS consult received a standard assessment and personalized treatment planning guided by a workbook. Medication and behavioral plans were developed collaboratively with each patient. Six months after the initial assessment, a telephone call was made to ascertain a 7-day period of self-reported abstinence. The univariate association of each baseline patient characteristic with self-reported tobacco abstinence at 6 months was evaluated using the chi-squared test. In addition, a multiple logistic regression analysis was performed with self-reported tobacco abstinence as the dependent variable and all baseline characteristics included as explanatory variables.Over a period of 7 years (2005-2011), 6824 cigarette smokers who provided general research authorization were seen for treatment. The 6-month self-reported abstinence rate was 28.1% (95% confidence interval: 27.7-30.1). The patients most likely to report abstinence were less dependent, more motivated to quit, and did not

The Patient-Centered Medical Home: Preparation of the Workforce, More Questions than Answers.

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Reynolds, P Preston; Klink, Kathleen; Gilman, Stuart; Green, Larry A; Phillips, Russell S; Shipman, Scott; Keahey, David; Rugen, Kathryn; Davis, Molly

2015-07-01

As American medicine continues to undergo significant transformation, the patient-centered medical home (PCMH) is emerging as an interprofessional primary care model designed to deliver the right care for patients, by the right professional, at the right time, in the right setting, for the right cost. A review of local, state, regional and national initiatives to train professionals in delivering care within the PCMH model reveals some successes, but substantial challenges. Workforce policy recommendations designed to improve PCMH effectiveness and efficiency include 1) adoption of an expanded definition of primary care, 2) fundamental redesign of health professions education, 3) payment reform, 4) responsiveness to local needs assessments, and 5) systems improvement to emphasize quality, population health, and health disparities.

Developing a Shared Patient-Centered, Web-Based Medication Platform for Type 2 Diabetes Patients and Their Health Care Providers: Qualitative Study on User Requirements.

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Bernhard, Gerda; Mahler, Cornelia; Seidling, Hanna Marita; Stützle, Marion; Ose, Dominik; Baudendistel, Ines; Wensing, Michel; Szecsenyi, Joachim

2018-03-27

Information technology tools such as shared patient-centered, Web-based medication platforms hold promise to support safe medication use by strengthening patient participation, enhancing patients' knowledge, helping patients to improve self-management of their medications, and improving communication on medications among patients and health care professionals (HCPs). However, the uptake of such platforms remains a challenge also due to inadequate user involvement in the development process. Employing a user-centered design (UCD) approach is therefore critical to ensure that user' adoption is optimal. The purpose of this study was to identify what patients with type 2 diabetes mellitus (T2DM) and their HCPs regard necessary requirements in terms of functionalities and usability of a shared patient-centered, Web-based medication platform for patients with T2DM. This qualitative study included focus groups with purposeful samples of patients with T2DM (n=25), general practitioners (n=13), and health care assistants (n=10) recruited from regional health care settings in southwestern Germany. In total, 8 semistructured focus groups were conducted. Sessions were audio- and video-recorded, transcribed verbatim, and subjected to a computer-aided qualitative content analysis. Appropriate security and access methods, supported data entry, printing, and sending information electronically, and tracking medication history were perceived as the essential functionalities. Although patients wanted automatic interaction checks and safety alerts, HCPs on the contrary were concerned that unspecific alerts confuse patients and lead to nonadherence. Furthermore, HCPs were opposed to patients' ability to withhold or restrict access to information in the platform. To optimize usability, there was consensus among participants to display information in a structured, chronological format, to provide information in lay language, to use visual aids and customize information content, and align

The role of the pharmacist in patient-centered medical home practices: current perspectives

Directory of Open Access Journals (Sweden)

Lewis NJW

2014-06-01

Full Text Available Nancy JW Lewis,1 Leslie A Shimp,2 Stuart Rockafellow,2 Jeffrey M Tingen,2 Hae Mi Choe,3 Marie A Marcelino21Private consultancy practice, Rochester Hills, MI, USA; 2Clinical, Social and Administrative Department, University of Michigan College of Pharmacy, Ann Arbor, MI, USA; 3Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USAAbstract: Patient-centered medical homes (PCMHs are the centerpiece of primary care transformation in the US. They are intended to improve care coordination and communication, enhance health care quality and patient experiences, and lower health care costs by linking patients to a physician-led interdisciplinary health care team. PCMHs are widely supported by health care associations, payers, and employers. Health care accreditation organizations have created performance measures that promote the adoption of PCMH core attributes. Public and private payers are increasingly providing incentives and bonuses related to performance measure status. Evidence-based prescription, medication adherence, medication use coordination, and systems to support medication safety are all necessary components of PCMHs. Pharmacists have unique knowledge and skills that can complement the care provided by other PCMH team members. Their experience in drug therapy assessments, medication therapy management, and population health has documented benefits, both in terms of patient health outcomes and health care costs. Through collaborative care, pharmacists can assist physicians and other prescribers in medication management and thus improve prescriber productivity and patient access to care. Pharmacists are engaged in PCMHs through both employment and contractual arrangements. While some pharmacists serve a unique PCMH, others work within practice networks that serve practices within a geographical area. Financial support for pharmacist-provided services includes university funding, external grant funding

Seroprevalence of fascioliasis, toxocariasis, strongyloidiasis and cysticercosis in blood samples diagnosed in Medic Medical Center Laboratory, Ho Chi Minh City, Vietnam in 2012.

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Nguyen, Toan; Cheong, Fei Wen; Liew, Jonathan Wee Kent; Lau, Yee Ling

2016-09-05

Despite the global effort against neglected tropical diseases (NTDs), developing countries with middle to low income are still burdened by them. Vietnam has been undergoing substantial economic growth and urbanization, but underprivileged people living in rural and suburban areas are still having little access to public health infrastructure and proper sanitation. Hitherto, limited information is available for seroprevalence and risk factors of several parasitic diseases in Vietnam. A retrospective study was performed on diagnostic results of Fasciola spp., Toxocara spp., Strongyloides stercoralis and Taenia solium IgG ELISA tests from Medic Medical Center Laboratory, Ho Chi Minh City in 2012. The data were first stratified before statistical analyses were performed. Seroprevalence of fascioliasis, toxocariasis, strongyloidiasis and cysticercosis was determined and the age and gender risk factors were evaluated. Seroprevalence of fascioliasis, toxocariasis, strongyloidiasis and cysticercosis was 5.9 % (590/10,084; 95 % CI: 5.44-6.36), 45.2 % (34,995/77,356; 95 % CI: 44.85-45.55), 7.4 % (3,174/42,920; 95 % CI: 7.15-7.65) and 4.9 % (713/14,601; 95 % CI: 4.55-5.25), respectively. Co-exposure to multiple parasites was detected in 890 males (45.7 %; 95 % CI: 43.49-47.91) and 1,059 females (54.3 %; 95 % CI: 52.09-56.51). Social structure and differences in behavioural factors caused the gender factor to have a significant effect on the prevalence of all the diseases, while the seropositivity for fascioliasis and strongyloidiasis were age group-related. The seroprevalence of fascioliasis, toxocariasis, strongyloidiasis and cysticercosis in the blood samples diagnosed in Medic Medical Center Laboratory, Ho Chi Minh City, in year 2012 were comparatively high. The Vietnamese customs and cultures, dietary habits and agricultural practices exposed them to high risk of contracting NTDs. Despite the possibility of false positive results due to antigenic cross

Long-term treatment outcomes of acromegaly patients presenting biochemically-uncontrolled at a tertiary pituitary center.

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Carmichael, John D; Broder, Michael S; Cherepanov, Dasha; Chang, Eunice; Mamelak, Adam; Said, Qayyim; Neary, Maureen P; Bonert, Vivien

2017-08-04

Acromegaly is a rare, slowly progressive disorder resulting from excessive growth hormone (GH) production by a pituitary somatotroph tumor. The objective of this study was to examine acromegaly treatment outcomes during long-term care at a specialized pituitary center in patients presenting with lack of biochemical control. Data came from an acromegaly registry at the Cedars-Sinai Medical Center Pituitary Center (center). Acromegaly patients included in this study were those who presented biochemically-uncontrolled for care at the center. Biochemical control status, based on serum insulin-like growth factor-1 values, was determined at presentation and at study end. Patient characteristics and acromegaly treatments were reported before and after presentation by presenting treatment status and final biochemical control status. Data on long-term follow-up were recorded from 1985 through June 2013. Seventy-four patients presented uncontrolled: 40 untreated (54.1%) and 34 (45.9%) previously-treated. Mean (SD) age at diagnosis was 43.2 (14.7); 32 (43.2%) were female patients. Of 65 patients with tumor size information, 59 (90.8%) had macroadenomas. Prior treatments among the 34 previously-treated patients were pituitary surgery alone (47.1%), surgery and medication (41.2%), and medication alone (11.8%). Of the 40 patients without prior treatment, 82.5% achieved control by study end. Of the 34 with prior treatment, 50% achieved control by study end. This observational study shows that treatment outcomes of biochemically-uncontrolled acromegaly patients improve with directed care, particularly for those that initially present untreated. Patients often require multiple modalities of treatment, many of which are offered with the highest quality at specialized pituitary centers. Despite specialized care, some patients were not able to achieve biochemical control with methods of treatment that were available at the time of their treatment, showing the need for additional

Biomedical optics centers: forty years of multidisciplinary clinical translation for improving human health

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Tromberg, Bruce J.; Anderson, R. Rox; Birngruber, Reginald; Brinkmann, Ralf; Berns, Michael W.; Parrish, John A.; Apiou-Sbirlea, Gabriela

2016-12-01

Despite widespread government and public interest, there are significant barriers to translating basic science discoveries into clinical practice. Biophotonics and biomedical optics technologies can be used to overcome many of these hurdles, due, in part, to offering new portable, bedside, and accessible devices. The current JBO special issue highlights promising activities and examples of translational biophotonics from leading laboratories around the world. We identify common essential features of successful clinical translation by examining the origins and activities of three major international academic affiliated centers with beginnings traceable to the mid-late 1970s: The Wellman Center for Photomedicine (Mass General Hospital, USA), the Beckman Laser Institute and Medical Clinic (University of California, Irvine, USA), and the Medical Laser Center Lübeck at the University of Lübeck, Germany. Major factors driving the success of these programs include visionary founders and leadership, multidisciplinary research and training activities in light-based therapies and diagnostics, diverse funding portfolios, and a thriving entrepreneurial culture that tolerates risk. We provide a brief review of how these three programs emerged and highlight critical phases and lessons learned. Based on these observations, we identify pathways for encouraging the growth and formation of similar programs in order to more rapidly and effectively expand the impact of biophotonics and biomedical optics on human health.

Development of a clinical information tool for the electronic medical record: a case study.

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Epstein, Barbara A; Tannery, Nancy H; Wessel, Charles B; Yarger, Frances; LaDue, John; Fiorillo, Anthony B

2010-07-01

What is the process of developing a clinical information tool to be embedded in the electronic health record of a very large and diverse academic medical center? The development took place at the University of Pittsburgh Health Sciences Library System. The clinical information tool developed is a search box with subject tabs to provide quick access to designated full-text information resources. Each subject tab offers a federated search of a different pool of resources. Search results are organized "on the fly" into meaningful categories using clustering technology and are directly accessible from the results page. After more than a year of discussion and planning, a clinical information tool was embedded in the academic medical center's electronic health record. The library successfully developed a clinical information tool, called Clinical-e, for use at the point of care. Future development will refine the tool and evaluate its impact and effectiveness.

Enhanced Performance of Community Health Service Centers during Medical Reforms in Pudong New District of Shanghai, China: A Longitudinal Survey.

Science.gov (United States)

Sun, Xiaoming; Li, Yanting; Liu, Shanshan; Lou, Jiquan; Ding, Ye; Liang, Hong; Gu, Jianjun; Jing, Yuan; Fu, Hua; Zhang, Yimin

2015-01-01

The performance of community health service centers (CHSCs) has not been well monitored and analysed since China's latest community health reforms in 2009. The aim of the current investigation was to evaluate the performing trends of the CHSCs and to analyze the main factors that could affect the performance in Pudong new district of Shanghai, China. A regional performance assessment indicator system was applied to the evaluation of Pudong CHSCs' performance from 2011 to 2013. All of the data were sorted out by a panel, and analyzed using descriptive statistics and a generalized estimating equation model. We found that the overall performance increased annually, with a growing number of CHSCs achieving high scores. Significant differences were observed in institutional management, public health services, basic medical services and comprehensive satisfaction during the period of three years. However, we found no differences in the service scores of Chinese traditional medicine (CTM). The investigation also demonstrated that the key factors affecting performance were the location, information system level, family GP program and medical association program rather than the size of the center. However, the medical association participation appeared to have a significant negative effect on performance. It can be concluded from the three-year investigation that the overall performance was improved, but that it could have been further enhanced, especially in institutional management and basic medical service; therefore, it is imperative that CHSCs undertake approaches such as optimizing the resource allocation and utilization, reinforcing the establishment of the information system level, extending the family GP program to more local communities, and promoting the medical association initiative.

Offers

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Staff Association

2014-01-01

New offers : Discover the theater Galpon in Geneva. The Staff Association is happy to offer to its members a discount of 8.00 CHF on a full-price ticket (tickets of 15.00 CHF instead of 22.00 CHF) so do not hesitate anymore (mandatory reservation by phone + 4122 321  21 76 as tickets are quickly sold out!). For further information, please see our website: http://staff-association.web.cern.ch/fr/content/th%C3%A9%C3%A2tre-du-galpon  

Medical Surveillance for a Soldier Centered Battlespace Awareness

National Research Council Canada - National Science Library

Schmorrow, Dylan D; Solhan, George; Kruse, Amy A

2004-01-01

.... Medical technologies have progressed to the degree that portable, rugged, and wireless designs can be conceived of that could give coalition commanders and medical personnel a view of the health...

A Statistical Analysis of the Relationship of Distance and Mode of Transportation on Length of Stay at Brooke Army Medical Center

National Research Council Canada - National Science Library

Hagen, John

1997-01-01

.... Transportation Command's (TRANSCOM) aeromedical evacuation system, to determine their influence on length of hospital stay at Brooke Army Medical Center in FY 1996 in order to better understand the irnpact these patients have on utilization management...

Facilitating primary care provider use in a patient-centered medical home intervention study for chronic hemodialysis patients.

Science.gov (United States)

Chukwudozie, Ifeanyi Beverly; Fitzgibbon, Marian L; Schiffer, Linda; Berbaum, Michael; Gilmartin, Cheryl; David, Pyone; Ekpo, Eson; Fischer, Michael J; Porter, Anna C; Aziz-Bradley, Alana; Hynes, Denise M

2018-05-23

Patients with chronic kidney disease have a high disease burand may benefit from primary care services and care coord A medical home model with direct access to primary care services is one approach that may address this need, yet has not been examined. As a substudy of the Patient-Centered Outcomes Research Institute (PCORI) patient-centered medical home for kidney disease (PCMH-KD) health system intervention study, we examined the uptake of free primary care physician (PCP) services. The PCORI PCMH-KD study was an initial step toward integrating PCPs, a nurse coordinator, a pharmacist, and community health workers (CHWs) within the health care delivery team. Adult chronic hemodialysis (CHD) at two urban dialysis centers were enrolled in the intervention. We examined trends and factors associated with the use of the PCMH-KD PCP among two groups of patients based on their report of having a regular physician for at least six months (established-PCP) or not (no-PCP). Of the 173 enrolled patients, 91 (53%) patients had at least one visit with the PCMH-KD PCP. The rate of visits was higher in those in the no-PCP group compared with those in the established-PCP group (62% vs. 41%, respectively). Having more visits with the CHW was positively associated with having a visit with the PCMH-KD PCPs for both groups. Embedded CHWs within the care team played a role in facilithe uptake of PCMH-KD PCP. Lessons from this health system intervention can inform future approaches on the integration of PCPs and care coordination for CHD patients.

Establishing the need and identifying goals for a curriculum in medical business ethics: a survey of students and residents at two medical centers in Missouri.

Science.gov (United States)

Kraus, Elena M; Bakanas, Erin; Gursahani, Kamal; DuBois, James M

2014-10-09

In recent years, issues in medical business ethics (MBE), such as conflicts of interest (COI), Medicare fraud and abuse, and the structure and functioning of reimbursement systems, have received significant attention from the media and professional associations in the United States. As a result of highly publicized instances of financial interests altering physician decision-making, major professional organizations and government bodies have produced reports and guidelines to encourage self-regulation and impose rules to limit physician relationships with for-profit entities. Nevertheless, no published curricula exist in the area of MBE. This study aimed to establish a baseline level of knowledge and the educational goals medical students and residents prioritize in the area of MBE. 732 medical students and 380 residents at two academic medical centers in the state of Missouri, USA, completed a brief survey indicating their awareness of major MBE guidance documents, knowledge of key MBE research, beliefs about the goals of an education in MBE, and the areas of MBE they were most interested in learning more about. Medical students and residents had little awareness of recent and major reports on MBE topics, and had minimal knowledge of basic MBE facts. Residents scored statistically better than medical students in both of these areas. Medical students and residents were in close agreement regarding the goals of an MBE curriculum. Both groups showed significant interest in learning more about MBE topics with an emphasis on background topics such as "the business aspects of medicine" and "health care delivery systems". The content of major reports by professional associations and expert bodies has not trickled down to medical students and residents, yet both groups are interested in learning more about MBE topics. Our survey suggests potentially beneficial ways to frame and embed MBE topics into the larger framework of medical education.

A cross-sectional survey examining the extent to which interprofessional education is used to teach nursing, pharmacy and medical students in Australian and New Zealand universities.

Science.gov (United States)

Lapkin, Samuel; Levett-Jones, Tracy; Gilligan, Conor

2012-09-01

The current status of interprofessional education (IPE) in Australian and New Zealand universities is largely unexamined despite its generally acknowledged benefit. Data are also limited about the use of IPE in teaching medication safety to nursing, pharmacy and medical students. For this reason a web-based cross-sectional survey was used to gather information from Australian and New Zealand universities offering nursing, pharmacy or medical programs. Responses were received from 31 of the 43 (72%) target universities. Eighty percent of the participants indicated that they currently offer IPE experiences, but only 24% of these experiences met the accepted definition of IPE. Of the participants who offer IPE as defined by Center for the Advancement of Interprofessional Education, only 50% use it to teach medication safety. Timetabling restrictions and lack of appropriate teaching and learning resources were identified as the main barriers to implementation of IPE. All participants reported that staff development, multi-media and e-learning resources would be beneficial to IPE initiatives and the teaching of medication safety. Innovative approaches will be needed to overcome the barriers and facilitate the uptake of quality IPE more broadly. Web-based and e-learning options promise a possible way forward, particularly in the teaching of medication safety to nursing, pharmacy and medical students.

Perspective: Medical education in medical ethics and humanities as the foundation for developing medical professionalism.

Science.gov (United States)

Doukas, David J; McCullough, Laurence B; Wear, Stephen

2012-03-01

Medical education accreditation organizations require medical ethics and humanities education to develop professionalism in medical learners, yet there has never been a comprehensive critical appraisal of medical education in ethics and humanities. The Project to Rebalance and Integrate Medical Education (PRIME) I Workshop, convened in May 2010, undertook the first critical appraisal of the definitions, goals, and objectives of medical ethics and humanities teaching. The authors describe assembling a national expert panel of educators representing the disciplines of ethics, history, literature, and the visual arts. This panel was tasked with describing the major pedagogical goals of art, ethics, history, and literature in medical education, how these disciplines should be integrated with one another in medical education, and how they could be best integrated into undergraduate and graduate medical education. The authors present the recommendations resulting from the PRIME I discussion, centered on three main themes. The major goal of medical education in ethics and humanities is to promote humanistic skills and professional conduct in physicians. Patient-centered skills enable learners to become medical professionals, whereas critical thinking skills assist learners to critically appraise the concept and implementation of medical professionalism. Implementation of a comprehensive medical ethics and humanities curriculum in medical school and residency requires clear direction and academic support and should be based on clear goals and objectives that can be reliably assessed. The PRIME expert panel concurred that medical ethics and humanities education is essential for professional development in medicine.

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2011-01-01

Are you a member of the Staff Association? Did you know that as a member you can benefit from the following special offers: BCGE (Banque Cantonale de Genève): personalized banking solutions with preferential conditions. TPG: reduced rates on annual transport passes for active and retired staff. Aquaparc: reduced ticket prices for children and adults at this Swiss waterpark in Le Bouveret. FNAC: 5% reduction on FNAC vouchers. For more information about all these offers, please consult our web site: http://association.web.cern.ch/association/en/OtherActivities/Offers.html

Human-centered design of the human-system interfaces of medical equipment: thyroid uptake system

International Nuclear Information System (INIS)

Monteiro, Jonathan K.R.; Farias, Marcos S.; Santos, Isaac J.A. Luquetti; Monteiro, Beany G.

2013-01-01

Technology plays an important role in modern medical centers, making healthcare increasingly complex, relying on complex technical equipment. This technical complexity is particularly noticeable in the nuclear medicine. Poorly design human-system interfaces can increase the risks for human error. The human-centered approach emphasizes the development of the equipment with a deep understanding of the users activities, current work practices, needs and abilities of the users. An important concept of human-centered design is that the ease-of-use of the equipment can be ensured only if users are actively incorporated in all phases of the life cycle of design process. Representative groups of users are exposed to the equipment at various stages in development, in a variety of testing, evaluation and interviewing situations. The users feedback obtained is then used to refine the design, with the result serving as input to the next interaction of design process. The limits of the approach are that the users cannot address any particular future needs without prior experience or knowledge about the equipment operation. The aim of this paper is to present a methodological framework that contributes to the design of the human-system interfaces, through an approach related to the users and their activities. A case study is described in which the methodological framework is being applied in development of new human-system interfaces of the thyroid uptake system. (author)

Creating 21st-Century Laboratories and Classrooms for Improving Population Health: A Call to Action for Academic Medical Centers.

Science.gov (United States)

DeVoe, Jennifer E; Likumahuwa-Ackman, Sonja; Shannon, Jackilen; Steiner Hayward, Elizabeth

2017-04-01

Academic medical centers (AMCs) in the United States built world-class infrastructure to successfully combat disease in the 20th century, which is inadequate for the complexity of sustaining and improving population health. AMCs must now build first-rate 21st-century infrastructure to connect combating disease and promoting health. This infrastructure must acknowledge the bio-psycho-social-environmental factors impacting health and will need to reach far beyond the AMC walls to foster community "laboratories" that support the "science of health," complementary to those supporting the "science of medicine"; cultivate community "classrooms" to stimulate learning and discovery in the places where people live, work, and play; and strengthen bridges between academic centers and these community laboratories and classrooms to facilitate bidirectional teaching, learning, innovation, and discovery.Private and public entities made deep financial investments that contributed to the AMC disease-centered approach to clinical care, education, and research in the 20th century. Many of these same funders now recognize the need to transform U.S. health care into a system that is accountable for population health and the need for a medical workforce equipped with the skills to measure and improve health. Innovative ideas about communities as centers of learning, the importance of social factors as major determinants of health, and the need for multidisciplinary perspectives to solve complex problems are not new; many are 20th-century ideas still waiting to be fully implemented. The window of opportunity is now. The authors articulate how AMCs must take bigger and bolder steps to become leaders in population health.

[HPV vaccination: active offer in an Italian region].

Science.gov (United States)

Terracciano, Elisa; D'Alò, Gian Loreto; Aquilani, Silvia; Aversa, Anna Maria; Bartolomei, Giuseppina; Calenda, Maria Gabriella; Catapano, Raffaele; Compagno, Silvio; Della Rovere, Piera; Fraioli, Angelo; Ieraci, Roberto; Reggiani, Daniela; Sgricia, Stefano; Spadea, Antonietta; Zaratti, Laura; Franco, Elisabetta

2017-01-01

Human Papillomavirus is responsible for 4.8% of cancers, and is the main cause of cervical cancer. Cervical cancer can be reduced by mean of secondary prevention (PAP-test, HPV-DNA test), while through primary prevention (anti-HPV vaccine) the incidence of other HPV-attributable cancers can also be reduced. In Italy, anti-HPV vaccination is part of the immunization schedule in girls since 2008, and in 2017 it was extended to boys. However, vaccine coverage is decreasing nationwide. This study aims to examine anti-HPV vaccination practices in Health care services of Lazio Region, Italy. Questionnaires were sent or administered directly to those in charge of vaccinations. Data, collected from 11/12 (92%) Lazio Local Health Units and from 116 vaccination centers, show a remarkable diversity in the offer: 41% of the centers open only 1-2 days/week, 42% only in the morning, and only 7% are open on Saturday. Vaccination is available by reservation only in 62% of the centers, while vaccines are not administered to ≥18 years subjects in 33%; 93% of the centers call actively the girls in the target cohort, while 70% and 94% recall the patients who had not received the first or the second dose of vaccine, respectively. Collaboration with family physicians and/or pediatricians was declared by 80% of the centers. Vaccine coverage could probably be improved by addressing the highlighted critical issues and applying best practices widely.

The Erasmus Computing Grid - Building a Super-Computer Virtually for Free at the Erasmus Medical Center and the Hogeschool Rotterdam

NARCIS (Netherlands)

T.A. Knoch (Tobias); L.V. de Zeeuw (Luc)

2006-01-01

textabstractThe Set-Up of the 20 Teraflop Erasmus Computing Grid: To meet the enormous computational needs of live- science research as well as clinical diagnostics and treatment the Hogeschool Rotterdam and the Erasmus Medical Center are currently setting up one of the largest desktop

A Health Assessment Survey of Veteran Students: Utilizing a Community College-Veterans Affairs Medical Center Partnership.

Science.gov (United States)

Misra-Hebert, Anita D; Santurri, Laura; DeChant, Richard; Watts, Brook; Sehgal, Ashwini R; Aron, David C

2015-10-01

To assess health status among student veterans at a community college utilizing a partnership between a Veterans Affairs Medical Center and a community college. Student veterans at Cuyahoga Community College in Cleveland, Ohio, in January to April 2013. A health assessment survey was sent to 978 veteran students. Descriptive analyses to assess prevalence of clinical diagnoses and health behaviors were performed. Logistic regression analyses were performed to assess for independent predictors of functional limitations. 204 students participated in the survey (21% response rate). Self-reported depression and unhealthy behaviors were high. Physical and emotional limitations (45% and 35%, respectively), and pain interfering with work (42%) were reported. Logistic regression analyses confirmed the independent association of self-reported depression with functional limitation (odds ratio [OR] = 3.3, 95% confidence interval [CI] 1.4-7.8, p statistic 0.72) and of post-traumatic stress disorder with pain interfering with work (OR 3.9, CI 1.1-13.6, p statistic 0.75). A health assessment survey identified priority areas to inform targeted health promotion for student veterans at a community college. A partnership between a Veterans Affairs Medical Center and a community college can be utilized to help understand the health needs of veteran students. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

The Lederman Science Center: Past, Present, Future

Energy Technology Data Exchange (ETDEWEB)

Bardeen, Marjorie G.; /Fermilab

2011-11-01

For 30 years, Fermilab has offered K-12 education programs, building bridges between the Lab and the community. The Lederman Science Center is our home. We host field trips and tours, visit schools, offer classes and professional development workshops, host special events, support internships and have a strong web presence. We develop programs based on identified needs, offer programs with peer-leaders and improve programs from participant feedback. For some we create interest; for others we build understanding and develop relationships, engaging participants in scientific exploration. We explain how we created the Center, its programs, and what the future holds.

Implementing a Reliability Centered Maintenance Program at NASA's Kennedy Space Center

National Research Council Canada - National Science Library

Tuttle, Raymond

1998-01-01

.... A reliability centered maintenance (RCM) program seeks to offer equal or greater reliability at decreased cost by insuring only applicable, effective maintenance is performed and by in large part replacing time based maintenance...

Comparison of the Performance of Health Volunteers in the Health Centers of Shahid Beheshti University of Medical Sciences

Directory of Open Access Journals (Sweden)

Ahmad-Reza Farsar

2015-02-01

Full Text Available Background and Objective: Health volunteers are the women who do charity work to prevent, protect and promote the health status of the covered neighbors and hereby cooperate with the health centers. The aim of this study was to compare the health volunteer's performance in the covered health centers by Shahid Beheshti University of Medical Sciences.Materials and Methods: This descriptive- analytical study was performed by the participation of 2060 Health volunteers, who were cooperating with 90 covered health centers by Shahid Beheshti University of Medical Sciences. These include Shomal, Shargh, Shemiranat, Pakdasht, Damavand and Firoozkooh. We used census sampling method. Demographic data was gathered through interviews with the health volunteers and their performance evaluated by the supervisor of the volunteers; through the evaluation forms and these data gathered together.Results: The mean (SD of the health volunteers performance was 30.9 (16.4 in all centers. They were 35.1 (22 in Shargh, 34 (14.5 in Shomal, 32 (11.3 in Firoozkooh, 28.3 (14 in Shemiranat, 7.9 (9.2 in Damavand and 23.6 (8.5 in Pakdasht respectively. The mean (SD of the efficacy of health volunteers was 8.6 (9.9 in all centers. They were 11.7 (5.6 in Firoozkooh, 10.7 (15.7 in Shargh, 9.4 (6.8 in Shomal, 7.9 (4.9 in Damavand, 7.9 (6.1 in Shemiranat and 4.6 (4.3 in Pakdasht respectively. Older and married volunteers with more experience performed better. There was no significant relationship between the efficacy of health volunteers with their literacy level, employment status and absorber of them.              Conclusion: The health volunteers of Shomal, Shargh and Firoozkooh had the best performances respectively. The performances of those in Shemiranat, Damavand and Pakdasht were less than the overall health centers’ mean score. The efficacy score of Firoozkooh, Shomal and Shargh health centers were above the overall health centers’ mean score respectively

Epidemiological, Clinical and Paraclinical Study of Hydatid Cysts in Three Educational Medical Centers in 10 Years

Directory of Open Access Journals (Sweden)

Simindokht Shoaee

2016-01-01

Full Text Available Background: Echinococcosis or hydatidosis, caused by the larval stage of Echinococcus granulosus (E. granulosus, is an important public health problem in many areas of the world  and  Iran is a country of endemic situation for hydatidosis In the present study, we evaluated epidemiological, complications and clinical characteristics of hydatidosis at three University Medical Centers in Tehran over a 10-year period.Materials and Methods: This is a descriptive cross-sectional study performed in patients with hydatid cysts. Information about age, gender, number of cysts, organ involvement, morbidity and mortality and relapse were collected from medical records of hydatid patients. Paraclinic information such as CT Scan, MRI, ultrasound, complete blood count, pathological diagnosis and complication of disease were collected.Results: Overall, 81 patients, 35 (43.2% male and 46 (56.8% female, who were diagnosed as having hydatid cyst by clinical and radiological findings, with pathologic documentation were studied in three university medical center registries over a 10-year period (2003- 2012 in Tehran. Fourteen patients (17% of cases had complications resulting from this disease. Patients' age ranged from 5 to 86 years, and the peak prevalence of the disease was between 20 and 40 (34% of cases.Conclusion: Iran  is a country of endemic situation for hydatidosis. Prevalence rate of hydatidosis in Iran was reported to be 0.61-2 in 100000 populations. The highest  rate of infection and complications were in patients of 20-40 years age. Clinical examination revealed that abdominal pain was the most common complaint and was present in 51.7% of the cases. Other most common complain were cough, abdominal mass, dyspnea, icterus, chest pain, dyspepsia, back pain and seizure; and it was result of occupying effect of cysts in organs. This is similar with previous studies in Iran

Nursing perception of the impact of medication carts on patient safety and ergonomics in a teaching health care center.

Science.gov (United States)

Rochais, Élise; Atkinson, Suzanne; Bussières, Jean-François

2013-04-01

In our Quebec (Canada) University Hospital Center, 68 medication carts have been implemented as part of a nationally funded project on drug distribution technologies. There are limited data published about the impact of medication carts in point-of-care units. Our main objective was to assess nursing staff's perception and satisfaction of medication carts on patient safety and ergonomics. Quantitative and qualitative cross-sectional study. Data were gathered from a printed questionnaire administered to nurses and an organized focus group composed of nurses and pharmacists. A total of 195 nurses completed the questionnaire. Eighty percent of the nurses agreed that medication carts made health care staff's work easier and 64% agreed that it helped to reduce medication incidents/accidents. Only 27% and 43% agreed that carts' location reduces the risk of patients' interruptions and colleagues' interruptions, respectively. A total of 17 suggestions were extracted from the focus group (n = 7 nurses; n = 3 pharmacist) and will be implemented in the next year. This descriptive study confirms the positive perception and satisfaction of nurses exposed to medication carts. However, interruptions are a major concern and source of dissatisfaction. The focus group has revealed many issues which will be improved.

Children and adolescents with gender identity disorder referred to a pediatric medical center.

Science.gov (United States)

Spack, Norman P; Edwards-Leeper, Laura; Feldman, Henry A; Leibowitz, Scott; Mandel, Francie; Diamond, David A; Vance, Stanley R

2012-03-01

To describe the patients with gender identity disorder referred to a pediatric medical center. We identify changes in patients after creation of the multidisciplinary Gender Management Service by expanding the Disorders of Sex Development clinic to include transgender patients. Data gathered on 97 consecutive patients gender behaviors, provided letters from current mental health professional, and parental support. Main descriptive measures included gender, age, Tanner stage, history of gender identity development, and psychiatric comorbidity. Genotypic male:female ratio was 43:54 (0.8:1); there was a slight preponderance of female patients but not significant from 1:1. Age of presentation was 14.8 ± 3.4 years (mean ± SD) without sex difference (P = .11). Tanner stage at presentation was 4.1 ± 1.4 for genotypic female patients and 3.6 ± 1.5 for genotypic male patients (P = .02). Age at start of medical treatment was 15.6 ± 2.8 years. Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%). After establishment of a multidisciplinary gender clinic, the gender identity disorder population increased fourfold. Complex clinical presentations required additional mental health support as the patient population grew. Mean age and Tanner Stage were too advanced for pubertal suppressive therapy to be an affordable option for most patients. Two-thirds of patients were started on cross-sex hormone therapy. Greater awareness of the benefit of early medical intervention is needed. Psychological and physical effects of pubertal suppression and/or cross-sex hormones in our patients require further investigation.

The cost of sustaining a patient-centered medical home: experience from 2 states.

Science.gov (United States)

Magill, Michael K; Ehrenberger, David; Scammon, Debra L; Day, Julie; Allen, Tatiana; Reall, Andreu J; Sides, Rhonda W; Kim, Jaewhan

2015-09-01

As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these "advanced primary care" functions. A key required input is personnel effort. This study's objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions. Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado. Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions. © 2015 Annals of Family Medicine, Inc.

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2011-01-01

Walibi Rhône-Alpes is open until 31 October. Reduced prices for children and adults at this French attraction park in Les Avenières. For more information about all these offers, please consult our web site: http://association.web.cern.ch/association/en/OtherActivities/Offers.html

Enhanced Performance of Community Health Service Centers during Medical Reforms in Pudong New District of Shanghai, China: A Longitudinal Survey.

Directory of Open Access Journals (Sweden)

Xiaoming Sun

Full Text Available The performance of community health service centers (CHSCs has not been well monitored and analysed since China's latest community health reforms in 2009. The aim of the current investigation was to evaluate the performing trends of the CHSCs and to analyze the main factors that could affect the performance in Pudong new district of Shanghai, China.A regional performance assessment indicator system was applied to the evaluation of Pudong CHSCs' performance from 2011 to 2013. All of the data were sorted out by a panel, and analyzed using descriptive statistics and a generalized estimating equation model.We found that the overall performance increased annually, with a growing number of CHSCs achieving high scores. Significant differences were observed in institutional management, public health services, basic medical services and comprehensive satisfaction during the period of three years. However, we found no differences in the service scores of Chinese traditional medicine (CTM. The investigation also demonstrated that the key factors affecting performance were the location, information system level, family GP program and medical association program rather than the size of the center. However, the medical association participation appeared to have a significant negative effect on performance.It can be concluded from the three-year investigation that the overall performance was improved, but that it could have been further enhanced, especially in institutional management and basic medical service; therefore, it is imperative that CHSCs undertake approaches such as optimizing the resource allocation and utilization, reinforcing the establishment of the information system level, extending the family GP program to more local communities, and promoting the medical association initiative.

Simulation-based medical education in clinical skills laboratory.

Science.gov (United States)

Akaike, Masashi; Fukutomi, Miki; Nagamune, Masami; Fujimoto, Akiko; Tsuji, Akiko; Ishida, Kazuko; Iwata, Takashi

2012-01-01

Clinical skills laboratories have been established in medical institutions as facilities for simulation-based medical education (SBME). SBME is believed to be superior to the traditional style of medical education from the viewpoint of the active and adult learning theories. SBME can provide a learning cycle of debriefing and feedback for learners as well as evaluation of procedures and competency. SBME offers both learners and patients a safe environment for practice and error. In a full-environment simulation, learners can obtain not only technical skills but also non-technical skills, such as leadership, team work, communication, situation awareness, decision-making, and awareness of personal limitations. SBME is also effective for integration of clinical medicine and basic medicine. In addition, technology-enhanced simulation training is associated with beneficial effects for outcomes of knowledge, skills, behaviors, and patient-related outcomes. To perform SBME, effectively, not only simulators including high-fidelity mannequin-type simulators or virtual-reality simulators but also full-time faculties and instructors as professionals of SBME are essential in a clinical skills laboratory for SBME. Clinical skills laboratory is expected to become an integrated medical education center to achieve continuing professional development, integrated learning of basic and clinical medicine, and citizens' participation and cooperation in medical education.

Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

OpenAIRE

Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

2013-01-01

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the H...

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2011-01-01

Are you a member of the Staff Association? Did you know that as a member you can benefit from the following special offers: BCGE (Banque Cantonale de Genève): personalized banking solutions with preferential conditions. TPG: reduced rates on annual transport passes for active and retired staff. Aquaparc: reduced ticket prices for children and adults at this Swiss waterpark in Le Bouveret. Walibi: reduced prices for children and adults at this French attraction park in Les Avenières. FNAC: 5% reduction on FNAC vouchers. For more information about all these offers, please consult our web site: http://association.web.cern.ch/association/en/OtherActivities/Offers.html

Do Multiple Mini-Interview and Traditional Interview Scores Differ in Their Associations With Acceptance Offers Within and Across Five California Medical Schools?

Science.gov (United States)

Jerant, Anthony; Henderson, Mark C; Griffin, Erin; Hall, Theodore R; Kelly, Carolyn J; Peterson, Ellena M; Wofsy, David; Franks, Peter

2018-03-20

In single-school studies, multiple mini-interview (MMI) and traditional interview (TI) scores are associated with acceptance offers. Unexamined is whether scores at one school are associated with acceptance at other schools; such analyses would mitigate single-school design biases and better estimate how well interviews capture desired applicant attributes. Using data from the five California Longitudinal Evaluation of Admissions Practices (CA-LEAP) public medical schools, the authors examined associations of MMI and TI scores with acceptance offers within and across schools. The analyses included applicants who interviewed at ≥1 CA-LEAP school during the 2011-2013 admissions cycles, when three CA-LEAP schools employed TIs and two employed MMIs. Interview scores were standardized (z-scores: mean = 0, SD = 1) and associations with acceptance offers were examined within and across schools in analyses stratified by school, adjusting for applicant sociodemographics, academic metrics, year, and total number of interviews. Of 4,993 applicants interviewed, 428 (8.6%) interviewed at both MMI schools, 681 (13.6%) at ≥2 TI schools, and 1,327 (26.6%) at ≥1 MMI and ≥1 TI school. For each school, acceptance was associated with interview score at that school and also with interview scores at the other four schools. Cross-school associations of MMI versus TI scores with acceptance did not differ statistically. Interview score at a given CA-LEAP school was associated with acceptance at the other four schools, with no significant differences in associations for MMIs versus TIs. The findings suggest both MMIs and TIs captured attributes valued by admissions teams across CA-LEAP schools.

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.

Medical tourism.

Science.gov (United States)

Leggat, Peter

2015-01-01

Medical tourism is a burgeoning industry in our region. It involves patients travelling outside of their home country for medical treatment. This article provides an outline of the current research around medical tourism, especially its impact on Australians. Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad.

Intellectual Property as a Drive for Sustainable Medical Tourism – The Ana Aslan case

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Bolos Mihaela Daciana

2014-11-01

Full Text Available The present paper studies the way intellectual property rights may encourage sustainable medical tourism, meaning the advantages that a patent, traditional knowledge, a trademark, or other IP right may offer to a hospital in order to attract foreign patients. The analysis is done trough the Institute of Gerontology and Geriatrics “Ana Aslan” case study, seen not from a medical point of view but from the perspective of the intellectual property importance for the development of medical tourism. The Institute of Gerontology and Geriatrics “Ana Aslan” was founded in 1952 and become an international renowned center in the study and the diminishing of old age effects. Many celebrities (artist and state presidents came to receive treatment here, even though Romania had, at that time, a communist regime.

Medications (for IBS)

Medline Plus

Full Text Available ... Anthony J. Lembo, MD, Instructor of Medicine, Harvard Medical School; Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA. Last modified on February 23, ...

Innovative gas offers

International Nuclear Information System (INIS)

Sala, O.; Mela, P.; Chatelain, F.

2007-01-01

New energy offers are progressively made available as the opening of gas market to competition becomes broader. How are organized the combined offers: gas, electricity, renewable energies and energy services? What are the marketing strategies implemented? Three participants at this round table present their offer and answer these questions. (J.S.)

A mid year comparison study of career satisfaction and emotional states between residents and faculty at one academic medical center

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Wessel Kristen

2006-07-01

Full Text Available Abstract Background The Accreditation Council for Graduate Medical Education's (ACGME new requirements raise multiple challenges for academic medical centers. We sought to evaluate career satisfaction, emotional states, positive and negative experiences, work hours and sleep among residents and faculty simultaneously in one academic medical center after implementation of the ACGME duty hour requirements. Methods Residents and faculty (1330 in the academic health center were asked to participate in a confidential survey; 72% of the residents and 66% of the faculty completed the survey. Results Compared to residents, faculty had higher levels of satisfaction with career choice, competence, importance and usefulness; lower levels of anxiousness and depression. The most positive experiences for both groups corresponded to strong interpersonal relationships and educational value; most negative experiences to poor interpersonal relationships and issues perceived outside of the physician's control. Approximately 13% of the residents and 14% of the faculty were out of compliance with duty hour requirements. Nearly 5% of faculty reported working more than 100 hours per week. For faculty who worked 24 hour shifts, nearly 60% were out of compliance with the duty-hour requirements. Conclusion Reasons for increased satisfaction with career choice, positive emotional states and experiences for faculty compared to residents are unexplained. Earlier studies from this institution identified similar positive findings among advanced residents compared to more junior residents. Faculty are more frequently at risk for duty-hour violations. If patient safety is of prime importance, faculty, in particular, should be compliant with the duty hour requirements. Perhaps the ACGME should contain faculty work hours as part of its regulatory function.

Care coordination, the family-centered medical home, and functional disability among children with special health care needs.

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Litt, Jonathan S; McCormick, Marie C

2015-01-01

Children with special health care needs (CSHCN) are at increased risk for functional disabilities. Care coordination has been shown to decrease unmet health service use but has yet been shown to improve functional status. We hypothesize that care coordination services lower the odds of functional disability for CSHCN and that this effect is greater within the context of a family-centered medical home. A secondary objective was to test the mediating effect of unmet care needs on functional disability. Our sample included children ages 0 to 17 years participating the 2009-2010 National Survey of Children with Special Health Care Needs. Care coordination, unmet needs, and disability were measured by parent report. We used logistic regression models with covariate adjustment for confounding and a mediation analysis approach for binary outcomes to assess the effect of unmet needs. There were 34,459 children in our sample. Care coordination was associated with lower odds of having a functional disability (adjusted odds ratio 0.82, 95% confidence interval 0.77, 0.88). This effect was greater for care coordination in the context of a medical home (adjusted odds ratio 0.71, 95% confidence interval 0.66, 0.76). The relationship between care coordination and functional disability was mediated by reducing unmet services. Care coordination is associated with lower odds of functional disability among CSHCN, especially when delivered in the setting of a family-centered medical home. Reducing unmet service needs mediates this effect. Our findings support a central role for coordination services in improving outcomes for vulnerable children. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Rationale and design of a patient-centered medical home intervention for patients with end-stage renal disease on hemodialysis.

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Porter, Anna C; Fitzgibbon, Marian L; Fischer, Michael J; Gallardo, Rani; Berbaum, Michael L; Lash, James P; Castillo, Sheila; Schiffer, Linda; Sharp, Lisa K; Tulley, John; Arruda, Jose A; Hynes, Denise M

2015-05-01

In the U.S., more than 400,000 individuals with end-stage renal disease (ESRD) require hemodialysis (HD) for renal replacement therapy. ESRD patients experience a high burden of morbidity, mortality, resource utilization, and poor quality of life (QOL). Under current care models, ESRD patients receive fragmented care from multiple providers at multiple locations. The Patient-Centered Medical Home (PCMH) is a team approach, providing coordinated care across the healthcare continuum. While this model has shown some early benefits for complex chronic diseases such as diabetes, it has not been applied to HD patients. This study is a non-randomized quasi-experimental intervention trial implementing a Patient-Centered Medical Home for Kidney Disease (PCMH-KD). The PCMH-KD extends the existing dialysis care team (comprised of a nephrologist, dialysis nurse, dialysis technician, social worker, and dietitian) by adding a general internist, pharmacist, nurse coordinator, and a community health worker, all of whom will see the patients together, and separately, as needed. The primary goal is to implement a comprehensive, multidisciplinary care team to improve care coordination, quality of life, and healthcare use for HD patients. Approximately 240 patients will be recruited from two sites; a non-profit university-affiliated dialysis center and an independent for-profit dialysis center. Outcomes include (i) patient-reported outcomes, including QOL and satisfaction; (ii) clinical outcomes, including blood pressure and diet; (iii) healthcare use, including emergency room visits and hospitalizations; and (iv) staff perceptions. Given the significant burden that patients with ESRD on HD experience, enhanced care coordination provides an opportunity to reduce this burden and improve QOL. Copyright © 2015 Elsevier Inc. All rights reserved.

Improving communication skill training in patient centered medical practice for enhancing rational use of laboratory tests: The core of bioinformation for leveraging stakeholder engagement in regulatory science.

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Moura, Josemar de Almeida; Costa, Bruna Carvalho; de Faria, Rosa Malena Delbone; Soares, Taciana Figueiredo; Moura, Eliane Perlatto; Chiappelli, Francesco

2013-01-01

Requests for laboratory tests are among the most relevant additional tools used by physicians as part of patient's health problemsolving. However, the overestimation of complementary investigation may be linked to less reflective medical practice as a consequence of a poor physician-patient communication, and may impair patient-centered care. This scenario is likely to result from reduced consultation time, and a clinical model focused on the disease. We propose a new medical intervention program that specifically targets improving the patient-centered communication of laboratory tests results, the core of bioinformation in health care. Expectations are that medical students training in communication skills significantly improve physicians-patient relationship, reduce inappropriate use of laboratorial tests, and raise stakeholder engagement.

Barriers and facilitators to providing primary care-based weight management services in a patient centered medical home for Veterans: a qualitative study.

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Jay, Melanie; Chintapalli, Sumana; Squires, Allison; Mateo, Katrina F; Sherman, Scott E; Kalet, Adina L

2015-11-14

Obesity is highly prevalent among Veterans. In the United States, the Veterans Health Administration (VHA) offers a comprehensive weight management program called MOVE!. Yet, fewer than 10 % of eligible patients ever attend one MOVE! visit. The VHA has a patient-centered medical home (PCMH) model of primary care (PC) called Patient-Aligned Care Teams (PACT) at all Veterans Affairs (VA) Medical Centers. PACT teamlets conduct obesity screening, weight management counseling, and refer to MOVE!. As part of a needs assessment to improve delivery of weight management services, the purpose of this study was to assess PACT teamlet and MOVE! staff: 1) current attitudes and perceptions regarding obesity care; 2) obesity-related counseling practices 3) experiences with the MOVE! program; and 4) targets for interventions to improve implementation of obesity care in the PC setting. We recruited 25 PACT teamlet members from a single VA study site-11 PC physicians, 5 registered nurses, 5 licensed practical nurses, 1 clerical assistant, and 3 MOVE! staff (2 dietitians, 1 psychologist)-for individual interviews using a combination of convenience and snowball sampling. Audio recorded interviews were professionally transcribed and iteratively coded by two independent reviewers. The analytic process was guided by discourse analysis in order to discover how the participants perceived and provided weight management care and what specific attitudes affected their practices, all as bounded within the organization. Emerging themes included: 1) role perceptions, 2) anticipated outcomes of weight management counseling and programs, and 3) communication and information dissemination. Perceived role among PCPs was influenced by training, whereas personal experience with their own weight management impacted role perception among LPNs/RNs. Attitudes about whether or not they could impact patients' weight outcomes via counseling or referral to MOVE! varied. System-level communication about VHA

Offer

CERN Multimedia

Staff Association

2016-01-01

CERN was selected and participated in the ranking "Best Employers" organized by the magazine Bilan. To thank CERN for its collaboration, the magazine offers a reduction to the subscription fee for all employed members of personnel. 25% off the annual subscription: CHF 149.25 instead of CHF 199 .— The subscription includes the magazine delivered to your home for a year, every other Wednesday, as well as special editions and access to the e-paper. To benefit from this offer, simply fill out the form provided for this purpose. To get the form, please contact the secretariat of the Staff Association (Staff.Association@cern.ch).

[Merkel cell carcinoma experience in a reference medical center.

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Roesch-Dietlen, Federico; Devezé-Bocardi, Raúl; Ruiz-Juárez, Isabel; Grube-Pagola, Peter; Romero-Sierra, Graciela; Remes-Troche, José María; Silva-Cañetas, Carmen Sofía; Lozoya-López Escalera, Hilda

2013-01-01

Background: Merkel cell carcinoma is a rare tumor that occurs on areas exposed to ultraviolet light. It is usually asymptomatic and it is diagnosed late often. The treatment is surgical, associated with adjuvant radiotherapy. The objective was to present the experience in the management of Merkel cell carcinoma in a reference medical center. Methods: all patients with Merkel cell carcinoma treated at the Instituto de Investigaciones Médico-Biológicas of the Universidad Veracruzana during the period 2008 to 2011 were studied. Sex, age, evolution time, tumor localization, size, metastases and treatment were analyzed. Results: of 3217 patients treated, three cases were Merkel cell carcinoma (0.09 %), their age was 52.1 ± 14.17, male predominance of 66.67 %; the evolution time was of 29.66 ± 35.36 months; the tumour localization was on inguinal region, anterior chest and left arm; the noodle size was of 6.0 ± 5.19 cm; two patients had lymph node metastases. In two cases, resection and lymphadenectomy were performed. They all received radiation therapy and chemotherapy in one case. Histologically the medium variant predominated; immunohistochemistry was positive in the three cases. One patient died ten months after the study was done. Conclusions: our experience is similar with others authors, Merkel cell carcinoma is a rare tumor, usually diagnosed late, and it has poor survival.

A systematic strategic planning process focused on improved community engagement by an academic health center: the University of Kansas Medical Center's story.

Science.gov (United States)

Cook, David C; Nelson, Eve-Lynn; Ast, Cori; Lillis, Teresa

2013-05-01

A growing number of academic health centers (AHCs) are considering approaches to expand collaboration with their communities in order to address complex and multisystem health concerns. In 2010, internal leaders at the University of Kansas Medical Center undertook a strategic planning process to enhance both community engagement activities and the scholarship resulting from these engagement activities. The authors describe the strategic planning process, recommendations, and actions associated with elevating community engagement within the AHC's mission and priorities. The strategic planning process included conducting an inventory of community engagement activities within the AHC; analyzing strengths, weaknesses, opportunities, and threats for community engagement work; and identifying goals and strategies to improve future community engagement activities and scholarship. The resulting road map for enhancing community engagement at their institution through 2015 consists of four main strategies: emphasize scholarship in community engagement, revise organizational structures to better facilitate community engagement, prioritize current engagement activities to ensure appropriate use of resources, and enhance communication of engagement initiatives to further develop stakeholder relationships.The authors also discuss implementation of the plan to date and highlight lessons learned that may inform other AHCs as they enhance and expand similar endeavors.

MANAGEMENT OF MEDICAL SERVICES

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BARBU MARIA-MAGDALENA

2009-05-01

Full Text Available The offer of medical services depends on medical personnel and more than this, on the management in the medical field since any resource not managed well or not managed at all is only a lost one, regardless its value. Management is therefore the key, the

Molecular epidemiology of carbapenem non-susceptible Acinetobacter nosocomialis in a medical center in Taiwan.

Science.gov (United States)

Yang, Ya-Sung; Lee, Yi-Tzu; Wang, Yung-Chih; Chiu, Chun-Hsiang; Kuo, Shu-Chen; Sun, Jun-Ren; Yin, Ti; Chen, Te-Li; Lin, Jung-Chung; Fung, Chang-Phone; Chang, Feng-Yee

2015-04-01

The mechanism by which carbapenem non-susceptible Acinetobacter nosocomialis (CNSAN) is disseminated is rarely described in the literature. In this study, we delineated the molecular epidemiology of CNSAN isolated from patients in a medical center in Taiwan. Fifty-four non-duplicate bloodstream isolates of CNSAN were collected at the Taipei Veterans General Hospital between 2001 and 2007. Pulsed-field gel electrophoresis (PFGE) was performed to determine their clonal relationship. Carbapenem-resistance genes and associated genetic structures were detected by polymerase chain reaction (PCR) mapping. Southern hybridization was performed to determine the plasmid location of carbapenem-resistance genes. Transmissibility of these genes to Acinetobacterbaumannii was demonstrated by conjugation tests. The overall carbapenem non-susceptibility rate among A. nosocomialis isolates during the study period was 21.6% (54/250). PFGE revealed three major pulsotypes: H (n=23), I (n=10), and K (n=8). The most common carbapenem-resistance gene was blaOXA-58 (43/54, 79.6%), containing an upstream insertion sequence IS1006 and a truncated ISAba3 (IS1006-ΔISAba3-like-blaOXA-58). All isolates belonging to the pulsotypes H, I, and K carried plasmid located IS1006-ΔISAba3-like-blaOXA-58. A common plasmid carrying ISAba1-blaOXA-82 was found in six isolates, which belonged to five pulsotypes. A type 1 integron that carried blaIMP-1 was detected in different plasmids of seven isolates, which belonged to five pulsotypes. Plasmids carrying these carbapenem-resistant determinants were transmissible from A. nosocomialis to A. baumannii via conjugation. In this medical center, CNSAN mainly emerged through clonal dissemination; propagation of plasmids and integrons carrying carbapenem-resistant determinants played a minor role. This study showed that plasmids carrying carbapenem-resistant determinants are transmissible from A. nosocomialis to A. baumannii. Copyright © 2015 Elsevier B.V. All

Strong leadership and teamwork drive culture and performance change: Ohio State University Medical Center 2000-2006.

Science.gov (United States)

Sanfilippo, Fred; Bendapudi, Neeli; Rucci, Anthony; Schlesinger, Leonard

2008-09-01

Several characteristics of academic health centers have the potential to create high levels of internal conflict and misalignment that can pose significant leadership challenges. In September 2000, the positions of Ohio State University (OSU) senior vice president for health sciences, dean of the medical school, and the newly created position of chief executive officer of the OSU Medical Center (OSUMC) were combined under a single leader to oversee the OSUMC. This mandate from the president and trustees was modeled after top institutions with similar structures. The leader who assumed the role was tasked with improving OSUMC's academic, clinical, and financial performance. To achieve this goal, the senior vice president and his team employed the service value chain model of improving performance, based on the premise that leadership behavior/culture drives employee engagement/satisfaction, leading to customer satisfaction and improved organizational performance. Implementing this approach was a seven-step process: (1) selecting the right leadership team, (2) assessing the challenges and opportunities, (3) setting expectations for performance and leadership behavior, (4) aligning structures and functions, (5) engaging constituents, (6) developing leadership skills, and (7) defining strategies and tracking goals. The OSUMC setting during this period provides an observational case study to examine how these stepwise changes, instituted by strong leadership and teamwork, were able to make and implement sound decisions that drove substantial and measurable improvements in the engagement and satisfaction of faculty and staff; the satisfaction of students and patients; and academic, clinical, and financial performance.